Trocar-site hernia after gynecological laparoscopic surgery: a 20-year, single-center experience

Background:Trocar-site hernia(TSH)is a serious complication after laparoscopic procedures.Although it is a rare entity,it have life-threatening consequences.This study aimed to retrospectively analyze the potential associated factors for TSH following gynecologic laparoscopy and summarize prevention strategies based on our experience.Methods:We searched for gynecological laparoscopic surgeries in the medical records system of Peking Union Medical College Hospital(PUMCH)from August 1998 to July 2018 and further sifted through the results for cases involving TSH.All included patients were divided into different groups according to patient characteristics,and the rate of TSH was compared among groups.Moreover,the detailed information of all patients with TSH was recorded and analyzed.Statistical analyses were performed with GraphPad Prism 6.Results:The approximate total rate of post-operative TSH among gynecologic laparoscopy procedures performed at PUMCH in the last 20 years was 0.016%(9/55,244).The rate of TSH was significant higher in elder patients(>60 years old;3/2686,0.112%)than in younger patients(<60 years old,6/52,558;0.011%,P=0.008).Moreover,the approximate rate of TSH was significantly higher after single-incision laparoscopic surgery(SILS,2/534,0.357%)than conventional laparoscopic surgery(7/54,710,0.013%,P=0.003).The average age of patients with TSH was 53.4 years(range,35.0-79.0 years).Two of the nine patients had late-onset TSH following SILS;the other seven had early-onset TSH following conventional laparoscopy.Five TSH cases occurred at right lateral port sites,and the remaining three occurred at the umbilical port site.All patients underwent repair surgery,and one required small bowel resection.Conclusion:Older age and SILS are potential associated factors for TSH development,while reducing excessive manipulation and improving suturing skills,especially at the umbilical trocar site following SILS and the right lateral trocar site,can avoid herniation.

MicroRNA Dysregulation and Steroid Hormone Receptor Expression in Uterine Tissues of Rats with Endometriosis during the Implantation Window

Background： Estrogen receptor （ER） and progesterone receptor （PR） are involved in endometriosis, but the involvement of microRNAs （miRNAs） is unknown. The aim of the study was to explore the correlation between miRNA and EPUPR in uterine tissues of rats with endometriosis during the implantation window. Methods： Twenty female Sprague-Dawley rats were randomized in three groups： endometriosis （n = 7）, fat tissue control （n = 6）, and normal （n = 7） groups. The female rats were mated and sacrificed on day 5 （implantation）. Uterine tissues were obtained for hematoxylin-eosin staining, immunohistochemistry, and miRNA expression. Reverse transcription polymerase chain reaction （RT-PCR） was used to validate the expression of rno-miR-29c-3p, rno-miR-34c-5p, rno-miR-14 l-5p, mo-miR-24-1-5p, and rno-miR-490-5p. Results： The 475 miRNAs were found to differentially express between the endometriosis and normal control groups, with 127 being upregulated and 348 being downregulated. Expression of five miRNAs （rno-miR-29c-3p, rno-miR-34c-5p, rno-miR-141-5p, rno-miR-24-1-5p, and rno-miR-490-5p） were validated by RT-PCR and found to be differentially expressed among the three groups. Expression of ER and PR proteins （immunohistochemistry） in the glandular epithelium and endometrial stroma was significantly different among the three groups （all P 〈 0.05）. Five miRNAs were involved in pathways probably taking part in implantation and fertility. Conclusions： The results suggested that miRNAs, ER, and PR could play important roles in the embryo implantation period of rats with endometriosis. These miRNAs might play a role in endometrial receptivity in endometriosis.

Clinical Characteristic and Management of Acquired Uterine Arteriovenous Malformation

To the Editor： Arteriovenous malformations （AVM）, also referred to as cirsoid aneurysm, arteriovenous aneurysm, arteriovenous fistula, and cavernous hemangioma, can occur in any organ in the body. Uterine AVM is a rare entity that is classified as either congenital or acquired. Congenital uterine AVM is thought to develop from a defect during embryologic differentiation leading to abnormal vascular connections, whereas acquired uterine AVM has been reported to occur due to a previous uterine trauma, such as curettage or cesarean delivery, or to be associated with neoplastic disorders, including gestational trophoblastic disease （GTD） and endometrial adenocarcinoma.