Double circular stapler technique for bowel resection in rectosigmoid endometriosis.

To reduce bladder function impairment and avert the serious complications of anastomotic leakage after segmental rectosigmoidectomy and to minimize the persistence of endometriotic lesions associated with discoid resection, we used the double circular stapling (DCS) technique. This technique enables excision of bowel endometriosis nodules larger than those that can be removed with the single-load technique of the circular stapler. Of 120 patients who underwent surgery to treat bowel endometriosis, intestinal shaving was performed in 24, discoid resection with single circular stapling in 40, and rectosigmoidectomy in 55. Eleven patients (9.2%) underwent the DCS technique. In the DCS group, the size of the rectosigmoid lesion ranged from 2.2 cm to 4.2 cm. Median operative time for the DCS technique was 100 minutes, compared with 150 minutes for rectosigmoidectomy (p = .04). Only 1 of 11 patients (9%) had urinary retention, compared with postoperative urinary retention in 14 of 55 patients (25%) who had undergone rectosigmoidectomy (difference not significant). Only 1 patient, with a 4.2-cm nodule, had a positive margin in the specimen obtained at the second stapling. DCS is a promising technique and may avert rectosigmoidectomy in selected patients.

Diagnostic hysteroscopy using liquid distention medium: comparison of pain with warmed saline solution vs room-temperature saline solution.

STUDY OBJECTIVE: To compare pain intensity and degree of satisfaction reported by patients undergoing hysteroscopic examinations using saline solution kept at room temperature (control group) or saline solution heated to 37.5°C (test group). DESIGN: Randomized, controlled, prospective study (Canadian Task Force Classification I). PATIENTS: Sixty-four women underwent diagnostic hysteroscopy during the second half of 2008. INTERVENTION: In both the test and control groups, examinations were performed using the vaginoscopy technique without use of a speculum or Pozzi tenaculum forceps. Pain was assessed using a visual analog scale immediately after the examination and at 1 and 15 minutes after the procedure. MEASUREMENTS AND MAIN RESULTS: Immediately after the examination, mean (SD; 95% confidence interval) pain intensity in the warmed saline solution group was 3.84 (2.71; 2.89-4.79), and in the room-temperature saline solution group was 4.31 (3.02; 3.18-5.44) (p = .51). At 1 and 15 minutes after the procedure, pain intensity in the 2 groups was, respectively, 2.41 (2.00; 1.66-3.16) and 2.43 (2.49; 1.57-3.30) (p = .96), and 1.83 (2.30; 1.02-2.64) and 1.85 (2.06; 1.08-2.62) (p = .96). Differences were not significant. Time to complete the examination was 3.80 (1.32; 3.34-4.26) minutes in the test group, and 3.75 (1.10; 3.34-4.15) minutes in the control group (p = .82). The satisfaction rate with the warmed distention medium was 84% (95% confidence interval, 72%-96%), and with the room-temperature saline solution was 85% (73%-97%) with saline at room temperature (p = .48). CONCLUSION: There was no statistically significant difference between the 2 groups insofar as pain, duration of the examination, and degree of patient satisfaction.