This study was undertaken to determine the complication rates of abdominal sacral suspensions (ASC) using polypropylene mesh and to compare the erosion rates in women who underwent ASC at the time of supracervical hys...This study was undertaken to determine the complication rates of abdominal sacral suspensions (ASC) using polypropylene mesh and to compare the erosion rates in women who underwent ASC at the time of supracervical hysterectomy (SCH) versus total abdominal hysterectomy (TAH) versus ASC in women who had previously undergone TAH. Study design: A retrospective analysis of patients from the urogynecology practice at North Shore University Hospital, who underwent ASC with polypropylene mesh between March 1997 and July 2004. Office and hospital charts were reviewed for patient demographics, preoperative history and physical examinations, intraoperative and postoperative findings, and complications. Women were stratified into 3 groups: group I: SCH with ASC; group Ⅱ : TAH with ASC; and group Ⅲ : ASC alone in women with a history of prior TAH. Results: A total of 121 patients were analyzed and comprised group I, 30.6% (n = 37); group Ⅱ , 40.5% (n = 49); and group Ⅲ , 28.9% (n = 35). Four patients (3.3% ) had mesh erosions develop. There were no significant differences in age, weight, parity, menopause status, estrogen therapy, previous surgery, or degree of preoperative prolapse between the patients with and without erosions. All the erosions occurred in group Ⅱ (8.2% , 95% CI 2.3% - 19.6% , P = .0389). The intraoperative complication rate was 2.5% and included a cystotomy (n = 2) and a small bowel laceration (n = 1). Immediate postoperative complications included partial SBO/Ileus (3.5% ), febrile morbidity (9.6% ), and autologous blood transfusions (1.7% ). Long term complications included persistent vaginal discharge (4.7% ), vaginal bleeding (1.6% ), dysparuenia (6.3% ), and recurrent prolapse (2.5% ). There were no significant differences in short or long term complications among the 3 groups (P > .05). Conclusion: ASC with polypropylene mesh is a safe surgical procedure for vaginal vault prolapse with low complication rates. Mesh erosion occurred in 8.2% of patients who underwent TAH with concurrent ASC. Patients having ASC at the time of TAH had a 7- fold increased risk for mesh erosion compared with patients who underwent SCH with ASC.展开更多
Background:Endometriosis is a chronic inflammatory condition involving endometrial-like tissue outside of the uterus.There are no medical management options available to improve fertility in patients with known endome...Background:Endometriosis is a chronic inflammatory condition involving endometrial-like tissue outside of the uterus.There are no medical management options available to improve fertility in patients with known endometriosis prior to conception.Specifically,the fertility sparing surgical techniques used to manage endometriomas and colorectal endometriosis are controversial prior to natural conception and implementing assisted reproductive technology.Methods:A literature search,including PubMed and the Cochrane Library,was performed from November 2020 to February 2021 and articles in English that addressed endometriosis associated infertility and surgical treatments were included.Our review provides a comprehensive evidence-based evaluation of fertility sparing endometriosis surgery.Results:The pathogenesis of endometriosis and its role in infertility is poorly understood and complex.The management of patients with painful endometriomas continues to be excision,whereas small asymptomatic endometriomas require an individualized approach.Colorectal endometriosis excision improves pregnancy rates in retrospective and prospective cohort studies.However,randomized control trials are still needed to confirm these findings and their functional risks must be carefully discussed with the patient.Conclusions:Surgical excision of endometriosis improves fertility in patients with symptomatic disease.Further research with randomized controlled trials is needed to determine if surgery is mandatory prior to implementing assisted reproductive technologies in those patients with asymptomatic endometriosis and infertility.展开更多
文摘This study was undertaken to determine the complication rates of abdominal sacral suspensions (ASC) using polypropylene mesh and to compare the erosion rates in women who underwent ASC at the time of supracervical hysterectomy (SCH) versus total abdominal hysterectomy (TAH) versus ASC in women who had previously undergone TAH. Study design: A retrospective analysis of patients from the urogynecology practice at North Shore University Hospital, who underwent ASC with polypropylene mesh between March 1997 and July 2004. Office and hospital charts were reviewed for patient demographics, preoperative history and physical examinations, intraoperative and postoperative findings, and complications. Women were stratified into 3 groups: group I: SCH with ASC; group Ⅱ : TAH with ASC; and group Ⅲ : ASC alone in women with a history of prior TAH. Results: A total of 121 patients were analyzed and comprised group I, 30.6% (n = 37); group Ⅱ , 40.5% (n = 49); and group Ⅲ , 28.9% (n = 35). Four patients (3.3% ) had mesh erosions develop. There were no significant differences in age, weight, parity, menopause status, estrogen therapy, previous surgery, or degree of preoperative prolapse between the patients with and without erosions. All the erosions occurred in group Ⅱ (8.2% , 95% CI 2.3% - 19.6% , P = .0389). The intraoperative complication rate was 2.5% and included a cystotomy (n = 2) and a small bowel laceration (n = 1). Immediate postoperative complications included partial SBO/Ileus (3.5% ), febrile morbidity (9.6% ), and autologous blood transfusions (1.7% ). Long term complications included persistent vaginal discharge (4.7% ), vaginal bleeding (1.6% ), dysparuenia (6.3% ), and recurrent prolapse (2.5% ). There were no significant differences in short or long term complications among the 3 groups (P > .05). Conclusion: ASC with polypropylene mesh is a safe surgical procedure for vaginal vault prolapse with low complication rates. Mesh erosion occurred in 8.2% of patients who underwent TAH with concurrent ASC. Patients having ASC at the time of TAH had a 7- fold increased risk for mesh erosion compared with patients who underwent SCH with ASC.
文摘Background:Endometriosis is a chronic inflammatory condition involving endometrial-like tissue outside of the uterus.There are no medical management options available to improve fertility in patients with known endometriosis prior to conception.Specifically,the fertility sparing surgical techniques used to manage endometriomas and colorectal endometriosis are controversial prior to natural conception and implementing assisted reproductive technology.Methods:A literature search,including PubMed and the Cochrane Library,was performed from November 2020 to February 2021 and articles in English that addressed endometriosis associated infertility and surgical treatments were included.Our review provides a comprehensive evidence-based evaluation of fertility sparing endometriosis surgery.Results:The pathogenesis of endometriosis and its role in infertility is poorly understood and complex.The management of patients with painful endometriomas continues to be excision,whereas small asymptomatic endometriomas require an individualized approach.Colorectal endometriosis excision improves pregnancy rates in retrospective and prospective cohort studies.However,randomized control trials are still needed to confirm these findings and their functional risks must be carefully discussed with the patient.Conclusions:Surgical excision of endometriosis improves fertility in patients with symptomatic disease.Further research with randomized controlled trials is needed to determine if surgery is mandatory prior to implementing assisted reproductive technologies in those patients with asymptomatic endometriosis and infertility.
