Clinical Application of Sex Hormone in Different Physiological Periods in the Diagnosis of Infertility Patients

Background: Infertility is characterized by the inability to conceive after a year of regular unprotected intercourse. Aims: This study aimed to investigate the diagnostic value of sex hormone levels during different physiological periods in the diagnosis of infertility patients. Methods: From December 2019 to May 2021, a total of 93 infertility patients were admitted and selected as the observation group. Among them, 31 cases were in the follicular stage, 31 cases in the ovulation stage, and 31 cases in the luteal stage. Ninety-three healthy women for fertility evaluation due to male infertility were selected as the control group. The control group included 31 women in the follicular phase, 31 women in the ovulatory phase, and 31 women in the luteal phase. The levels of sex hormones (prolactin (PRL), luteinizing hormone (LH), follicle-stimulating hormone (FSH), estradiol (E2), testosterone (T), and progesterone (P)) during different physiological phases were compared between the observation and control groups. Results: The follicular phase showed no significant difference in LH levels between the observation group and the control group. The observation group showed higher levels of PRL and P compared to the control group, while the levels of FSH, E2, and T were lower in the observation group compared to the control group. The ovulation phase showed no significant difference in PRL levels between the two groups. The observation group showed lower levels of LH, FSH, E2, T, and P compared to the control group. The luteal phase showed no statistical difference in E2 levels between the two groups. The observation group showed higher levels of PRL, LH, and FSH compared to the control group, while the levels of T and P were lower in the observation group compared to the control group. Conclusion: Infertile women show variations in hormone levels compared to the normal levels during the follicular phase, ovulatory phase, and luteal phase.

Laparoscopy in the Diagnosis and the Treatment of Infertility（Analysis of 340 consecutive cases）

Three hundred and jorty patients suffering from primary and secondary infertility were investigated by laparoscopy with the following results. 1. The substantial and most common causes of infertility were related to chronic pelvic inflammatory disease and pelvic endometriosis. 2. Comparison of the result of chromopertubation under direct vision during loparoscy with the preoperative results with hysterosalpingography and phenolphthaline tubal instillation test showed significant difference (P<0.01). In the tubal patent group the compatibility of the results was 90.2% and 79% respectively whereas in the obstructed tubal group the discrepancy between the results was 50.5% and 59% respectively. 3. With the aid of laparoscopic investigation, the underlying cause of infertility could be verified in 97.6% of the patients. In 53.2% of the cases 14 different kinds of operations were performed directly under the laparoscope, while 12.9% of the cases required loparotomy. In 58.5% of the patients laparoscopy was performed in combination with hysteroscopy and 26 operations,consisting of uterine septum resection and intrauterine adhesiolysis were completed undder the monitoring of the loparoscope.

Diagnosis and management of choledocholithiasis in the golden age of imaging, endoscopy and laparoscopy

Biliary lithiasis is an endemic condition in both Western and Eastern countries, in some studies affecting 20% of the general population. In up to 20% of cases, gallbladder stones are associated with common bile duct stones (CBDS), which are asymptomatic in up to one half of cases. Despite the wide variety of examinations and techniques available nowadays, two main open issues remain without a clear answer: how to cost-effectively diagnose CBDS and, when they are finally found, how to deal with them. CBDS diagnosis and management has radically changed over the last 30 years, following the dramatic diffusion of imaging, including endoscopic ultrasound (EUS) and magnetic resonance cholangiography (MRC), endoscopy and laparoscopy. Since accuracy, invasiveness, potential therapeutic use and cost-effectiveness of imaging techniques used to identify CBDS increase together in a parallel way, the concept of &#x0201c;risk of carrying CBDS&#x0201d; has become pivotal to identifying the most appropriate management of a specific patient in order to avoid the risk of &#x0201c;under-studying&#x0201d; by poor diagnostic work up or &#x0201c;over-studying&#x0201d; by excessively invasive examinations. The risk of carrying CBDS is deduced by symptoms, liver/pancreas serology and ultrasound. &#x0201c;Low risk&#x0201d; patients do not require further examination before laparoscopic cholecystectomy. Two main &#x0201c;philosophical approaches&#x0201d; face each other for patients with an &#x0201c;intermediate to high risk&#x0201d; of carrying CBDS: on one hand, the &#x0201c;laparoscopy-first&#x0201d; approach, which mainly relies on intraoperative cholangiography for diagnosis and laparoscopic common bile duct exploration for treatment, and, on the other hand, the &#x0201c;endoscopy-first&#x0201d; attitude, variously referring to MRC, EUS and/or endoscopic retrograde cholangiography for diagnosis and endoscopic sphincterotomy for management. Concerning CBDS diagnosis, intraoperative cholangiography, EUS and MRC are reported to have similar results. Regarding management, the recent literature seems to show better short and long term outcome of surgery in terms of retained stones and need for further procedures. Nevertheless, open surgery is invasive, whereas the laparoscopic common bile duct clearance is time consuming, technically demanding and involves dedicated instruments. Thus, although no consensus has been achieved and CBDS management seems more conditioned by the availability of instrumentation, personnel and skills than cost-effectiveness, endoscopic treatment is largely preferred worldwide.

Experience with Diagnostic Laparoscopy in the Evaluation of Tubal Factor Infertility

Context and Objectives: Tubal factor infertility accounts for a large portion of female factor infertility. Tubal disease is responsible for 25% - 35% of female infertility. The most prevalent cause of tubal factor infertility is pelvic inflammatory disease and acute salpingitis. The incidence of tubal damage after one episode of pelvic infection is approximately 12%, 23% after two episodes and 54% after three episodes. Various modalities for investigating tubal factor infertility exist including: saline Infusion sonography (SIS), Hystero-contrast sonography (HyCoSy), hysterosalpingography (HSG) and laparoscopy with chromopertubation, the latter being the gold standard. The aim of this study was to determine the role of diagnostic laparoscopy in the evaluation of tubal factor in infertile women. Settings and Design: A retrospective descriptive study on all diagnostic laparoscopic procedures carried out to evaluate tubal factor infertility in the endoscopic gynecology unit of a tertiary-level hospital from 2010 to 2019. Methods: A retrospective descriptive study was conducted in the Department of Obstetrics and Gynaecology of a tertiary-level hospital in Ghana. A total of three hundred and ninety-one (391) records of all diagnostic laparoscopy procedures performed because of infertility in the endoscopic gynecology unit of a tertiary-level hospital between 2010 and 2019 were analyzed. Clients who underwent diagnostic laparoscopy to assess tubal factor infertility in the Obstetrics and Gynaecology Directorate of Komfo Anokye Teaching Hospital (KATH), Kumasi, from 2010 to 2019 were included in the study. Tubal patency was tested by laparoscopy and chromopertubation using methylene blue dye. The clinical characteristics of these women (age, parity, type of infertility), the intra-operative findings and complications were evaluated. Data on age, parity, type of infertility and intra operative findings were extracted using a proforma. Cases in which the bio-data or other clinical and laparoscopic findings were missing were excluded from the study. Ethical approval for the study was obtained from the Institutional Review Board (IRB) for Research and Development (R & D). A simple percentage method was used for statistical analysis. Results: A total of 391 women underwent diagnostic laparoscopy for investigation of tubal factor infertility between 2010 and 2019. The women’s mean age was 33.16 years. The youngest patient was 20 years and the oldest was 46 years. 232 (59.3%) patients were in primary infertility group while 159 (40.7%) patients were in secondary infertility group. 265 (66.8%) of the women were in the age group 20 - 35 years. The main laparoscopic findings for tubal factor were: 57.28% with bilateral tubal occlusion, 16.39% with unilateral tubal occlusion and 7.92% with hydrosalpinx. 18.41% had bilateral tubal patency. Other findings were identified during the laparoscopic procedure. For peritoneal abnormalities, 200 (51.15%) had normal findings, 184 (47.06%) had adhesions and 7 (1.79%) had peritoneal endometriosis. For uterine factor, 185 (47.31%) had normal uterus with no fibroids or adenomyosis, 202 (51.67%) had uterine fibroids, 2 (0.51%) had uterine anomaly and 2 (0.51%) had adenomyosis. For ovarian pathology, 13 (3.32%) had simple cyst, 2 (0.51%) had endometrioma, 184 (47.07%) had the ovaries involved in adhesions. 192 (49.10%) of patients had normal looking ovaries. There was no mortality or conversion to open laparotomy in this series. Conclusions: Unilateral and bilateral tubal blockade was detected in 73.67% of cases of infertile women. Diagnostic laparoscopy is a safe procedure.

Is Laparoscopy Still Necessary in the Management of Tubal Infertility?

Objectives: To compare between hysterosalpingography (HSG) and laparoscopic findings in patients tested for infertility and thereby to determine the significance of the latter examination. Methods: This was a descriptive study performed in two Gynecology departments in the Dakar (Senegal). Included were 84 patients with suspicious tubal-infertility who underwent HSG followed by laparoscopy. The Kappa (K) statistics was used to clarify the concordance between HSG vs. laparoscopy findings. Results: Kappa concordance between HSG and laparoscopy showed the followings: 0.08 for proximal tubal obstructions (poor agreement), 0.40 for distal tubal obstructions (moderate agreement), and -0.08 for peritoneal adhesions (no agreement). Laparoscopy revealed pelvic adhesions in 84% of cases, pelvic endometriosis in 12% of cases, and apparently normal tubes in 12%. According to the distal tubal operability score, 16.6% of the lesions were classified as stage 4 and 23.8% at stage 1. Conclusion: HSG and laparoscopy findings did not agree in patients with tubal infertility, and thus, laparoscopy should be employed, especially when HSG showed abnormal findings. HSG has a low diagnostic value in adhesions.

Diagnostic Accuracy of Sonosalpingography for Assessing Tubal Pathology in Women with Secondary Infertility Taking Laparoscopy as Gold Standard

Context: Secondary infertility is a major public health issue with growing urbanisation and increasing age of marriage among women. Disease limited to low socioeconomic strata is commonly seen in general population. Judicious and accurate assessment of underlying pathology targeting tubes should be undertaken. Aims: The aim of this observational study was to assess the diagnostic accuracy of sonosalpingography taking laparoscopy as gold standard in patients of secondary infertility. Main aim was to assess tubal factors as an underlying cause and to assess feasibility of a radiation free protocol in patients of reproductive age group. Settings and Design: The study was carried out in a hospital setting. A total of 123 patients were selected. Patients of primary infertility were excluded. Sonosalpingography was performed by a single experienced radiologist. This was confirmed by laparoscopy conducted by an experienced gynaecologist. Methods and Material: A detailed clinical and physical examination including internal examination was done. This was followed by sonosalpingography using high frequency TVS probe (Philips IU 22). All patients were subjected to laparoscopic evaluation on the same day. Statistical analysis: Sensitivity, specificity, diagnostic accuracy and predictive values. Results: Sonosalpingography was 72.91% sensitive, 81.33% specific with diagnostic accuracy of 78.05% and positive predictive value of 71.42% for tubal pathologies. Conclusions: Sonosalpingography is a very useful complementary diagnostic modality in assessment of tubal pathology. This should precede direct laparoscopic evaluation. Patients of secondary infertility can be assessed with a combination of sonosalpingography and laparoscopy. This saves the patient of radiation exposure as well as pain of contrast

Diagnosis and treatment of tubal endometriosis in women undergoing laparoscopy:A case series from a single hospital

BACKGROUND Tubal endometriosis(TEM)is a category of pelvic endometriosis(EM)that is characterized by ectopic endometrial glands and/or stroma within any part of the fallopian tube.The fallopian tubes may be a partial source of ovarian endometriosis(OEM).TEM is difficult to diagnose during surgery and is usually detected by pathology after surgery.AIM To provide a clinical basis for the diagnosis and treatment of TEM.METHODS In this study,the data of 30 patients who underwent laparoscopic salpingectomy due to various gynecological diseases and had pathological confirmation of TEM at our hospital were retrospectively analyzed,and the clinical basis for the diagnosis and treatment of TEM was evaluated.RESULTS Among 1982 surgical patients,30 met the study criteria.Among those,6 patients had a history of infertility,12 patients had a history of artificial abortion,13 patients had a history of cesarean section,1 patient had a history of tubal ligation,4 patients had an intrauterine device,and 22 patients had hydrosalpinx.Sixteen patients(53.33%)conceived naturally and gave birth to healthy babies.Pathology showed that only 2 patients had TEM without any other gynecological diseases,while the others all had simultaneous diseases,including 26 patients with EM at other pelvic sites.CONCLUSION The final diagnosis of TEM depends on pathological examination since there are no specific clinical characteristics.The rate of TEM combined with EM(especially OEM)was higher than that of other gynecological diseases,which indicates that TEM is related to OEM.

Contribution of Laparoscopy in the Management of Female Infertility in Low Resource Countries: A Review of 208 Cases at the YaoundéGeneral Hospital, Cameroon

Background: Infertility is a global problem, but the highest prevalence is in low resource countries, particularly in sub-Saharan Africa where tubal damage following pelvic infection is the commonest cause. Objectives: This study aimed to assess contribution of laparoscopy as a diagnostic and therapeutic tool in infertile women in our setting. Methods: A descriptive review of complete medical records of 208 women who underwent laparoscopy at the Gynaecology Unit of Yaoundé General Hospital from December 2007 to December 2012. Results: Two hundred and eight women were enrolled in this study. Mean age was 32.6 ± 11.25 years. Infertility was secondary in 71.6% of cases;125 (60.1%) women were married and 116 (55.8%) had a positive serology of Chlamydia trachomatis infection. The most frequent findings during diagnostic laparoscopy were: pelvic adhesions (83.7%), hydrosalpinx (21.6%), pyosalpinx (4.8%), perihepatic adhesions (25.5%), uterine fibromas (22.6%), pelvic endometriosis (13%) and ovarian abnormalities (10.1%). The surgical procedures during laparoscopy were: adhesiolysis (79.7%), tuboplasty (35.0%), salpingectomy (8.2%), ovarian cystectomy (5.8%) and myomectomy (1.9%). Three (1.4%) cases of uterine perforation and 1 (0.5%) case of laparoscopy conversion to laparotomy were observed. Conclusion: Diagnostic laparoscopy revealed that tubal lesions and pelvic adhesions were still the major causes of female infertility in developing countries. Adhesiolysis and tuboplasty were the most frequently performed surgical procedures during laparoscopy. Therefore, training in endoscopic surgery should be regarded as an important issue in developing countries.

Laparoscopy and the Era of ART in Unexplained Primary Infertility: Randomized Clinical Trial

OBJECTIVES: To compare the outcomes (effectiveness and safety) of laparoscopic surgery as a treatment option of unexplained primary infertil-ity with ART. DESIGN: Randomized prospective clinical trial. PATIENTS AND METHODS: 536 patients with primary unexplained infertility diag-nosed by normal hormonal profile and ovulatory at ovulation testing, nor-mal HSG, and normal semen analysis were randomized according to com-puter based system into: group I, 267 patients were managed with laparos-copy with aim of diagnosis and treatment. While in group II, 269 patients were treated by controlled ovarian stimulation and IUI up to 3 trials, if failed ICSI was performed. We calculated cumulative pregnancy outcome after two years for each group. RESULTS: In group I, Laparoscopic find-ings were as follow: minimal to mild endometriosis was found in 83 cases (31.1%), moderate to severe endometriosis 44 cases (16.5%) managed by adhesiolysis and ablation-excision of endometriotic implants. The preg-nancy rate after two years was 55.4% (46 cases), 38.6% (17 cases) in both respectively, significant periadnexal and pelvic adhesions 41 cases (15.3%) managed by adhesiolysis with pregnancy occurred in 22 cases (53.7%), while laparoscopy revealed hypo plastic tubes 33 cases (12.4%), and 66 cases (24.6%) remained unexplained. With the expectant manage-ment, pregnancy rate was 21.2% (7 cases), and 15.2% (10 cases) respec-tively. The overall pregnancy rate in group I is 102 cases (38.2%). In group II, 114 cases (42.3) got pregnant as 27 cases (8.78%) by IUI, and 87 cases (33.52%) by ICSI. OHSS occurred in 3 cases, multiple pregnancy occurred in 13 cases, abortion and miscarriage 6 cases in group II, while 2 cases of ectopic pregnancy in group I, and the patients of both groups did not suffer any significant operative complications. CONCLUSION: Laparoscopy is safe and effective as a treatment option in unexplained infertility and its performance provides diagnostic findings which are valuable in manage-ment of the unidentified causes, enabling good number of patients to have pregnancy spontaneously which is comparable to ART while avoiding economic, psychological and physical burdens of ART, like OHSS, multi-ple pregnancy and abortion which are higher in cases treated with ART. In the future if ART is needed, the success rate is increased by closure of (undiagnosed) hydrosalpinx and reposition of the ovary to facilitate oocyte retrieval.

Combined laparoscopy and hysteroscopy in the treatment of tubal infertility

From July 1991 to June 1996 169 cases of tubal infertility were treated by surgery combined laparoscopy and hysteroscopy. The Procedure include: Adhesiolysis of perisalpingoovaritis , dilation of fallopian tube, salpingostomy, endometriosis cantery, enucleation and puncture of endometrioma, excision of Morgani cyst. Meanwhile hysteroscopic catheterization and hydrotubaation monitoring by laparoscopy.Result:135 cases were followed up. The mean follow-up time was 18.4 month.70 cases became pregnant (pregnant rate 51.8%). 67 of them had intrauterine Pregnancy and three cases were ectopic pregnancies. The surgery combined laparoscopy and hysteroscopy to treat tubal infertility is simple, effective, less-harmful and the patients had rapid recovery.

The Endometrium Biopsy and Hystero-Laparoscopy in Evaluation of Women’s Infertility. A Prospective Study in Algeria

Female infertility is considered as a real obstacle to the development of a couple who cannot conceive in a natural way. The aim of this study is to evaluate female infertility using two complementary methods of exploration: hystero-laparoscopy and endometrial biopsy, to compare histopathological data with those of hystero-laparoscopy findings in the same patients, and finally assess the interest to couple both methods to detect a greater number of pathologies. Our prospective study included 64 patients aged 20 - 43 years with primary or secondary infertility for a period of 3 years ranging from 2012 to 2015 at obstetrics and gynecology department in which all patients were admitted to a hysteroscopy followed by laparoscopy. Endometrial biopsy curettage was performed and sent to the Pathological Anatomy Department for a histopathological study. On 64 infertile women explored, no pathologies were findings in 20 patients (31.3%) to the biopsy and 27 patients (42.2%) by hysteroscopy-laparoscopy. Histopathological study was in favor of dysfunctional endometrium (50%) followed by hyperplasia (10.9%). The lesions findings in the hystero-laparoscopy were in the first place uterine (18.8%) followed by equally between tubal and endometrial pathologies (10.9%). Associated diseases affecting the same organs or more were recorded with a percentage of 7.8%. The two methods have been shown effective and the most of common pathologies findings were uterine and endometrial. We concluded that the endometrial biopsy was more decisive in the exploration of endometrium pathologies while hystero-laparoscopy is more sensitive for the exploration of uterine, tubal and ovarian pathologies. Each method taken individually was revealed incomplete. It is more interesting to systematically couple the histology with endoscopic examination in order to detect a greater number of pathologies.

Reproductive outcomes after operative laparoscopy of patients with tubal infertility with or without hydrosalpinx

Infertility is defined as the inability for a couple to have children without any contraceptive methods within 1 year.Tubal factors are responsible for 25％ to 35％ of female reasons,and these have been proven to be a major cause of female infertility.Hydrosalpinx is a special type of tubal occlusion in which fluid accumulates inside the hymen of the tube.This adversely affects fallopian function,and hydrosalpinx fluids have a toxic effect on the quality of the embryos and endometrial receptivity.Currently,reconstructive surgery still plays a role in female infertility for tubal factors and has not been totally replaced by assisted reproductive technology in developing countries and districts.Keywords：infertility; hydrosalpinx; laparoscopy; pregnancy; ectopic pregnancy rate

Chromosomal disorders and male infertility

Infertility in humans is surprisingly common occurring in approximately 15% of the population wishing to start a family. Despite this, the molecular and genetic factors underlying the cause of infertility remain largely undiscovered. Nevertheless, more and more genetic factors associated with infertility are being identified. This review will focus on our current understanding of the chromosomal basis of male infertility specifically： chromosomal aneuploidy, structural and numerical karyotype abnormalities and Y chromosomal microdeletions. Chromosomal aneuploidy is the leading cause of pregnancy loss and developmental disabilities in humans. Aneuploidy is predominantly maternal in origin, but concerns have been raised regarding the safety of intracytoplasmic sperm injection as infertile men have significantly higher levels of sperm aneuploidy compared to their fertile counterparts. Males with numerical or structural karyotype abnormalities are also at an increased risk of producing aneuploid sperm. Our current understanding of how sperm aneuploidy translates to embryo aneuploidy will be reviewed, as well as the application of preimplantation genetic diagnosis （PGD） in such cases. Clinical recommendations where possible will be made, as well as discussion of the use of emerging array technology in PGD and its potential applications in male infertility.

Choledocholithiasis: Evolving standards for diagnosis and management

Cholelithiasis, one of the most common medical conditions leading to surgical intervention, affects approximately 10 % of the adult population in the United States. Choledocholithiasis develops in about 10%-20% of patients with gallbladder stones and the literature suggests that at least 3%-10% of patients undergoing cholecystectomy will have common bile duct （CBD） stones. CBD stones may be discovered preoperatively, intraoperatively or postoperatively Multiple modalities are available for assessing patients for choledocholithiasis including laboratory tests, ultrasound, computed tomography scans （CT）, and magnetic resonance cholangiopancreatography （MRCP）. Intraoperative cholangiography during cholecystectomy can be used routinely or selectively to diagnose CBD stones. The most common intervention for CBD stones is ERCP. Other commonly used interventions include intraoperative bile duct exploration, either laparoscopic or open. Percutaneous, transhepatic stone removal other novel techniques of biliary clearance have been devised. The availability, of equipment and skilled practitioners who are facile with these techniques varies among institutions. The timing of the intervention is olden dictated by the clinical situation.

Role of laparoscopy in the diagnosis and treatment of adnexal masses

Background Laparoscopy has been accepted for years as a management of benign ovarian tumors. The aim of this study was to estimate the feasibility and safety of laparoscopy in diagnosis and management of adnexal masses. Methods A total of 2083 patients with benign adnexal mass were treated by laparoscopy at Peking Union Medical College Hospital from January 2000 to December 2003. Their clinical data were reviewed retrospectively. All the adnexal masses suspicious of malignancy at the time of laparoscopy were sent for frozen section evaluation intraoperatively. The rates of unexpected intracystic vegetation and low malignant potential （LMP） tumor or malignancy were investigated. The sensitivity, specificity, positive predictive value, and negative predictive value of laparoscopic diagnosis for LMP or ovarian malignancies were calculated. The ratios were compared by Chi-square test and the continuous variables were tested using two-tailed t test. Results Of the 2083 patients, 16 had LMP or invasive tumors （0.77%）, among which 14 were diagnosed histologically intraoperatively and 2 postoperatively. Fifty-five （2.6%） of the 2083 patients had unexpected intracystic vegetations. Their frozen sections showed benign tumors in 41 （74.5%）, LMP tumors in 8 （14.5%）, and focal invasive ovarian cancers （stage Ic） in 6 （10.9%）. The final pathological diagnosis were benign tumors in 41 （74.5%）, LMP tumors 7 （12.7%）, and focal invasive ovarian cancers （stage Ic） in 7 （12.7%）. Laparoscopy achieved a sensitivity of 87.5%, specificity of 98%, positive predictive value of 25.5%, and negative predictive value of 99.9% in the diagnosis of ovarian malignancies. 2067 cases with benign adnexal masses underwent laparoscopy successfully. No conversion to laparotomy, or intra- and postoperative complications in this series. Of the 16 patients with LMP or invasive ovarian cancer, seven underwent laparoscopic surgery including immediate staging laparoscopy in 3. The mean follow-up was 17.3 months for the 16 patients. Among them, 1 developed a recurrent LMP tumor in the contralateral ovary 36 months after laparoscopic salpingo-oophorectomy, and received subsequent laparoscopic cystectomy and pelvic lymph node sampling; the others had no evidence of recurrent tumor during the follow-up.Contusion Laparoscopy is feasible for diagnosis of adnexal masses, and the surgery is safe for patients with benign ovarian tumors.

Diagnostic Value of Mini-laparoscopy in Patients with Abdominal Neoplasm

Objective：Blood biochemistry,ascites tests,and imaging examinations have low sensitivities in abdominal neoplasm diagnoses.In addition,exploratory laparotomy is not suitable for final stage patients.Mini-laparoscopy has recently emerged as a new diagnostic technology for abdominal disease.The aim of this research was to evaluate the value of mini-laparoscopy in diagnosing abdominal neoplasms.Methods：Clinical and operational data were retrospectively analyzed in 20 cases with pathologically confirmed abdominal malignancies.Of these,10 cases were each diagnosed by mini-laparoscopy and exploratory laparotomy.The surgical and anesthesia expenses,perioperative nursing,monitoring and treating charges,postoperative hospital stay and complications were compared between groups.Results：The surgical and anesthesia costs were statistically lower in patients who received a mini-laparoscopy （P0.01）.Perioperative drug expenses and nursing and monitoring charges were also significantly decreased （P0.05 and P0.01,respectively）.Further,the gastrointestinal function recovery time and postoperative hospital stay were significantly reduced in the mini-laparoscopy group.There was no significant difference between the two groups regarding the preoperative hospital stay and postoperative complications.Conclusion：Mini-laparoscopy effectively reduces surgical injury and treatment costs,and is capable of safely diagnosing abdominal tumors.Moreover,the procedure is also easy to perform.

Gonadotropin releasing hormone agonists and laparoscopy in the treatment of adenomyosis with infertility

To study the role and value of gonadotropin releasing hormone agonists (GnRH a) and laparoscopy for the treatment of adenomyosis with infertility Methods Four cases were seen with adenomyosis and infertility, 3 of these cases also presented local adenomyomata in the posterior uterine wall GnRH a Triptorelin (decapeptyl) or Goserelin (Zoladex) therapy was instituted for six months before laqaroscopic surgery for coexisting pelvic pathologic infertility factors in one case and after laparoscopic surgery in three cases Results All cases remained amenorrheic during GnRH a therapy After the GnRH a therapy, all enlarged uterus (7-10 weeks gestation size) all decreased to normal or near normal size; menstruation returned in 80-90 days and three cases conceived within four menstrual periods after cessation of treatment In the 4 cases one pregnancy resulted in the birth of a healthy 3150?g male newborn at 38 weeks gestation by cesarean section; one pregnancy was terminated after adenomyomectomy by emergency cesarean section at 30 weeks gestation because of threatened rupture of uterus; one case was then normal at 28 weeks pregnancy; the last case had 2 resumptive menstrual periods and was still being followed up Conclusions GnRH a is markedly efficient in reducing adenomyotic uterine size, facilitates uterine or endometrial receptivity for embryos and enhances uterine ability to maintain pregnancy For adenomyomata associated with infertility, GnRH a instead of surgical removal of lesions, which are deep in the myometrium, may avoid uterine rupture when pregnancy occurs For infertility, GnRH a treatment before laparoscopic surgery greatly decreases surgical difficulties and blood loss in certain cases

Is laparoscopy equal to laparotomy in detecting and treating small bowel injuries in a porcine model?

AIM: To evaluate the safety and effectiveness of laparoscopy compared with laparotomy for diagnosing and treating small bowel injuries (SBIs) in a porcine model. METHODS: Twenty-eight female pigs were anesthetized and laid in the left recumbent position. The SBI model was established by shooting at the right lower quadrant of the abdomen. The pigs were then randomized into either the laparotomy group or the laparoscopy group. All pigs underwent routine exploratory laparotomy or laparoscopy to evaluate the abdominal injuries, particularly the types, sites, and numbers of SBIs. Traditional open surgery or therapeutic laparoscopy was then performed. All pigs were kept alive within the observational period (postoperative 72 h). The postoperative recovery of each pig was carefully observed. RESULTS: The vital signs of all pigs were stable within 1-2 h after shooting and none of the pigs died from gunshot wounds or SBIs immediately. The SBI model was successfully established in all pigs and definitively diagnosed with single or multiple SBIs either by exploratory laparotomy or laparoscopy. Compared with exploratory laparotomy, laparoscopy took a significantly longer time for diagnosis (41.27 ± 12.04 min vs 27.64 ± 13.32 min, P = 0.02), but the time for therapeutic laparoscopy was similar to that of open surgery. The length of incision was significantly reduced in the laparoscopy group compared with the laparotomy group (5.27 ± 1.86 cm vs 15.73 ± 1.06 cm, P < 0.01). In the final post-mortem examination 72 h after surgery, both laparotomy and laparoscopy offered a definitive diagnosis with no missed injuries. Postoperative complications occurred in four cases (three following laparotomy and one following laparoscopy, P = 0.326). The average recovery period for bowel function, vital appearance, and food re-intake after laparoscopy was 10.36 ± 4.72 h, 14.91 ± 3.14 h, and 15.00 ± 7.11 h, respectively. All of these were significantly shorter than after laparotomy (21.27 ± 10.17 h, P = 0.004; 27.82 ± 9.61 h, P < 0.001; and 24.55 ± 9.72 h, respectively, P = 0.016). CONCLUSION: Compared with laparotomy, laparoscopy offers equivalent efficacy for diagnosing and treating SBIs, and reduces postoperative complications as well as recovery period.

Clinical Analysis of 32 Cases on Treatment of Infertility with Laparoscopic Hysteropexy

The diagnosis and treatment for 32 patients suffering from infertility, were established with the aid of laparoscopy. Among them, 14 cases were found to be of chronic pelvic inflammatory disease, 13 cases endometriosis and 2 cases simple habitual abortion. After performing conservative operative procedures for the treatment of the primary diseases, all of the 32 patients underwent the laparoscopic hysteropexy. This operative technique is simple and is easily mastered by experienced laparoscopists who are familiar with the pelvic anatomy and ready to deal with intra-or post-operative complications. Follow-up study of these 32 cases for 2 to 6 years showed an overall pregnancy rate of 56.3% (18/32), a live birth rate of 53.1% (17/32) and an abortion rate of 3.1% (1/32). The pregnancy rate alter operation in the patients suffering from endometriosis was 85% (11/13), which was much higher than that of the patients with chronic inflammatory disease who had a pregnacy rate of 42.8% (6/14). The difference was highly significant (P< 0.01).These results indicate that in patients suffering from infertility due to various etiological causes, after treatment of the primary diseases, ventrohysteropexy, in selected cases, can be mphed as a fertility-promoting measure.

A comparative analysis of spontaneous fertility after myomectomy by laparotomy associated or not with a“second look”laparoscopy

Objective:The importance of a“second look”laparoscopy for adhesion formation after myomectomy by laparotomy in improving fertility is not clearly defined in our context.The aim of this study was to compare spontaneous fertility after myomectomy by laparotomy between women who underwent a“second look”laparoscopy and those who did not.Methods:We conducted an analytical cross-sectional study with retrospective data collection from January 1,2008 to December 31,2015,comparing spontaneous fertility between patients who underwent“second-look”laparoscopy after myomectomy by laparotomy to those who did not.Firstly,data was collected from the records of patients included in the study.Secondly,through phone calls,informed consent for each participant was obtained after which inquiries were made regarding their fertility status.Results:After a period of 24 months,23 patients(47.9%)with“second look”laparoscopy conceived,compared to 37 patients(35.2%)without“second look”laparoscopy(p=0.136);and 24 patients(50.0%)with“second look”had term pregnancies compared to 39 patients(37.1%)without“second look”laparoscopy(p=0.134).Conclusion:Spontaneous fertility rates seemed to be improved after a“second look”laparoscopy,however,there was no statistically significant difference between spontaneous fertility rates obtained after myomectomy by laparotomy,irrespective of the fact that the patient had undergone a“second look”laparoscopy or not at Yaounde Gyneco-Obstetric and Pediatric Hospital.