LAPAROSCOPIC SURGERY IN PATIENTS WITH HYPOVOLEMIC SHOCK DUE TO ECTOPIC PREGNANCY

Objective To evaluate the feasibility and safety of operative laparoscopy for ectopic pregnancy with hypovolemic shock. Methods Two hundred and fifteen women with ectopic pregnancy underwent operative laparoscopy. These patients were divided into two groups. The study group included 21 patients with shock and intraperitoneal hemorrhage more than 1000 mL, and control group included 194 patients, hemodynamically stable, with blood loss less than 1000 mL. Clinical data of perio-perative periods in two groups were retrospectively analyzed. Results All patients were tubal pregnancies. The occurrence rate of tubal rupture was higher in study group than in control group (80.95% vs. 15.98%, P < 0.001). Intraabdominal blood loss was significantly higher in study group than in control group (1900 mL vs. 300 mL, P < 0.001), and autologous blood transfusions were given to 95.24% and 9.3% of patients in study and control group, respectively (P < 0.001). Laparoscopic salpingectomy was performed on 85.7 % and 50.5% of patients in study and control group (P < 0.001). The operative time was somewhat longer in study group than that in control group (60 minutes vs. 45 minutes), but with no significant difference. All patients had no perioperative complications. Conclusion Operative laparoscopy in patients with hopovolemic shock can be safely and effectively performed by experi-enced laparoscopists with the aid of optimal anesthesia, advanced cardiovascular monitoring, and autologous blood transfusion.

Recurrent ovarian endometrioma after conservative surgery:A retrospective study

Objective:To study the prevalence and associated factors of recurrent ovarian endometrioma after ovarian cystectomy.Methods:This retrospective study analyzed 303 patients who underwent cystectomy for ovarian endometrioma and had at least a 2-year follow-up at Srinagarind Hospital from January 2013 to December 2018.The patients were divided into the recurrent and nonrecurrent groups according to the findings from postoperative transvaginal ultrasonography 6 months after undergoing surgery.Nineteen factors were collected for risk evaluation.The prevalence of recurrent ovarian endometrioma and its 95%confident interval(CI)were calculated.Univariate and multivariable logistic regression analyses were performed to determine the association between factors and recurrence.Results:Recurrent ovarian endometrioma occurred in 33%(95%CI 27.7%-38.3%)patients.The median duration of followup was 36 months.during the median follow-up period of 36 months.Preoperative history of parity,preoperative infertility history,endometriosis surgery,moderate to severe dysmenorrhea,dyspareunia,intraoperative stage 4 according to revised American Society for Reproductive Medicine classification,presence of adenomyosis,and postoperative pain relief were associated factors based on univariate analysis.In contrast,infertility[odds ratio(OR)2.22,95%CI 1.14-4.33],moderate to severe dysmenorrhea(OR 2.13,95%CI 1.09-4.15),and postoperative pelvic pain relief(OR 0.22,95%CI 0.12-0.42)were independently associated factors based on multivariable logistic regression analysis.Conclusions:In our setting,preoperative infertility history and moderate to severe dysmenorrhea were associated with a higher recurrent ovarian endometrioma risk.In contrast,postoperative pain relief was significantly associated with lower recurrence risk.

Nearly-complete labial adhesions diagnosed with repetitive cystitis in postmenopausal women:A case report

BACKGROUND Nearly-complete labial adhesions diagnosed with repetitive cystitis in postmenopausal women:A case report CASE SUMMARY The case of an 83-year-old woman who presented with dysuria,urination disorders,recurrent cystitis,and bacteriuria and was admitted to a private hospital after 1 mo of antibiotic treatment without improvement of her symptoms.Upon examination,labial adhesions were observed with nearly-complete labial fusion with a pinpoint opening.Bacteriuria was detected in urine analysis,and the urine culture test was positive for Escherichia coli.Therefore,a parenteral antibiotic(Fosfomycin)and topical estrogen cream were administered.However,since the adhesion did not separate after 2 wk of treatment,surgical correction was performed.First,adhesiolysis was conducted with a blunt instrument.Then,hysteroscopy and cystoscopy were performed.Hysteroscopic findings showed no abnormalities of the endometrium and endocervix,and the cystoscopic results were also normal.Finally,labiaplasty was completed to prevent adhesion recurrence.One month after the surgery,the discomfort while urinating was eliminated and the adhesion did not recur.CONCLUSION Labial adhesions in postmenopausal women cannot be successfully treated with estrogen creams,and surgical treatment should be considered.

Extensive Vulvar Hematoma as a Complication of Labiaplasty: A Case Report

Vulvar hematoma is an extremely rare complication outside obstetric practice. Owing to the vulvar structure and its rich blood supply, hematoma can reach an enormous size over a short period. Although direct trauma is the anesthetic 31-year-old nullipara admitted for acute massive vulvar swelling as a complication of labiaplasty. She scored 10 on the pain scale. Upon admission to the emergency department, she had normal vital signs and was immediately started on intravenous acetaminophen and prophylactic antibiotics. The patient was subsequently transferred to the operating theater for examination and drainage of the hematoma under anesthesia. Reconstruction of the labia was performed. The patient had a smooth postoperative course and was discharged on the 3rd postoperative day. We concluded that Anesthetic gynecological procedures, although categorized as minor, can result in grave sequelae, and must therefore be performed in a hospital set-up.

Evaluating the feasibility and safety of vaginal myomectomy in China

Background Classically, myomectomy has been performed via laparotomy, but laparoscopic myomectomy has now become a valuable treatment option. Vaginal myomectomy as a minimal invasive procedure has also been evaluated; however, its feasibility and safety are controversial with few clinical trials published. This study was designed to evaluate the feasibility of vaginal myomectomy in China and to document any associated complications. Methods From January 2005 to December 2010, 43 patients with symptomatic myomas were admitted for vaginal myomectomy in Peking Union Medical College Hospital （PUMCH）. The indications, operative performance, postoperative complications and outcome of these patients were analyzed retrospectively. Results Myomectomy was performed vaginally in all patients. The mean operating time was （66.4±22.6） minutes and the mean operative blood loss and hospital stay were （78.3±64.4） ml and （4.9±3.3） days, respectively. Five （12%） patients developed febrile morbidity and experienced a high postoperative temperature （mean 38.4℃）. Postoperative fever was associated with greater operative trauma, longer operative time and greater weight of the tumor （all P 〈0.01）. The cost of surgery was RMB （820.6±339.1） Yuan （（124.3±51.4） US dollars） and the total medical cost was RMB （4880.4±1088.4） Yuan （（739.5±164.9） US dollars）. Three patients later conceived spontaneously and had uneventful vaginal deliveries. Only one patient had a tumor recurrence during the following-up period. Conclusion Vaginal myomectomy is a feasible and safe surgical procedure with low recurrence and complication rates.