Laparoscopic partial sacrocolpopexy mesh resection due to mesh infection.

PURPOSE: Sacrocolpopexy is considered the gold-standard procedure for apical compartment prolapse and has become a widely used intervention strategy. The mesh material used in the surgical treatment of pelvic organ prolapse is associated with significant complications in some cases, frequently managed conservatively but sometimes necessitating mesh excision for symptom relief. METHODS: In this video we present the case of a 49-year-old woman who after sacrocolpopexy reported foul-smelling discharge as the only symptom. The patient was treated with vaginocervical seroma debridement and removal of large parts of the mesh and paravaginal tissue. A methodical procedure including retroperitoneal dissection along with identification of the anatomical landmarks is critical in cases of suspected mesh infection and facilitates the procedure. RESULTS: The operation does not include a complete mesh excision in order to avoid major surgery and to reduce the risk of recurrent prolapse. In the follow-up visits at 1 and 6 months postoperatively the patient was asymptomatic. CONCLUSION: Synthetic mesh activates an inflammatory process that leads to surrounding tissue fibrosis and scar tissue formation that can distort the pelvic anatomy (Chamsy and Lee in J Minim Invasive Gynecol. 21(6):986, 2014), thereby making dissection more difficult. This surgical procedure requires a comprehensive knowledge of the pelvic anatomy and a methodical surgical strategy.

Microinvasive squamous carcinoma of neovagina created with peritoneal flap (Davidov): Case report and literature review.

Carcinoma of the vagina is a rare disease, and it is even more rare when it appears in a neovagina, having its incidence and optimum treatment constantly discussed. The aim of this article was to review the cases described in the currently available literature and describe the second documented case of carcinoma in a neovagina created with peritoneal flaps, and also list the possible pathways and risk factors for its development. The case we present is a 49-year-old female who after undergoing a laparoscopic colpectomy of the upper two-thirds of the vagina, with an immediate reconstruction with peritoneal flaps by laparoscopy, at a 4 months follow up presented a focal microinvasive squamous carcinoma in the vault of the neovagina. After reviewing the literature, we conclude that excisional treatment is the preferable option to avoid the progression to an invasive carcinoma. However, this case demonstrates the importance of the necessity to do regular cito-vulvovaginoscopic examinations after the complete surgical treatment because of the chance of persistent or recurrent lesions on the transplanted tissue.

Feasibility of Essure placement in intrauterine device users.

We present a review of 28 cases of intrauterine device (IUD) users who asked for permanent contraception with Essure procedure and accepted concomitant use of IUD and Essure. We ultimately achieved correct bilateral placement in 26 women (92.8%). In 8 cases (28.6%), it was necessary to remove the IUD to try and place the device. Our results suggest hysteroscopic tubal sterilization with Essure microinserts in IUD users is feasible, safe, and reliable. Moreover, there is no need to instruct the patients to use another form of birth control until 3 months postprocedure. We think this application could be a good alternative approach for a high percentage of IUD users who request a permanent hysteroscopic sterilization.

Gestación en una paciente con ventrículo único / Pregnancy in woman with a single ventricle

La enfermedad cardíaca durante el embarazo se relaciona con el 15% de la mortalidad materna, y es la causa no obstétrica más habitual de muerte materna. Las complicaciones neonatales y cardiovasculares maternas son más frecuentes entre las gestantes cardiópatas, por lo que es importante conocer los factores de riesgo de la embarazada para que reciba un consejo preconcepcional y un seguimiento obstétrico adecuados. Presentamos un caso de embarazo y parto por cesárea en una gestante con cardiopatía congénita no cianótica tipo ventrículo único, con estenosis pulmonar grave y transposición de grandes vasos, tratada a los 4 años de edad mediante corrección quirúrgica con técnica de Fontan

Cardiac disease in pregnancy is the most common non-obstetric cause of maternal death, accounting for 15% of pregnancy-related maternal mortality. Pregnancy in women with heart disease is associated with significant cardiac and neonatal complications. Consequently, risk factors should be identified in pregnant women so that they receive appropriate preconceptional counseling and obstetric care. We report the case of a pregnant woman with a single ventricle, severe pulmonary stenosis and transposition of the great arteries treated surgically at the age of 4 years with Fontan operation. The route of delivery was a cesarean section