Office Hysteroscopic Treatment of Uterine Fibroids

Advances in endoscopic and therapeutic hysteroscopic technology have made the removal of submucosal fibroids possible in the outpatient setting. Removal of submucosal fibroids can be particularly challenging in the outpatients due to intramural components of some submucosal fibroids and the hard consistency of fibroids which makes specimen retrieval rather difficult through the endocervical canal. Fibroids which are <2 cm and completely intracavitary are easier to remove in the outpatients. Specimen retrieval can be addressed either by slicing the fibroid using bipolar electrodes, by using a hysteroscopic morcellator or leaving the fibroid in the uterine cavity after enucleation to be expelled with uterine contractions. Patient acceptability appears to be high in a small number of retrospective case series published in the literature. Further reports and data from prospective trials would be beneficial in improving our understanding of this procedure which appears to be performed by a relatively small number of centres

Population‐based cohort study of outcomes following cholecystectomy for benign gallbladder diseases

Background The aim was to describe the management of benign gallbladder disease and identify characteristics associated with all‐cause 30‐day readmissions and complications in a prospective population‐based cohort. Methods Data were collected on consecutive patients undergoing cholecystectomy in acute UK and Irish hospitals between 1 March and 1 May 2014. Potential explanatory variables influencing all‐cause 30‐day readmissions and complications were analysed by means of multilevel, multivariable logistic regression modelling using a two‐level hierarchical structure with patients (level 1) nested within hospitals (level 2). Results Data were collected on 8909 patients undergoing cholecystectomy from 167 hospitals. Some 1451 cholecystectomies (16·3 per cent) were performed as an emergency, 4165 (46·8 per cent) as elective operations, and 3293 patients (37·0 per cent) had had at least one previous emergency admission, but had surgery on a delayed basis. The readmission and complication rates at 30 days were 7·1 per cent (633 of 8909) and 10·8 per cent (962 of 8909) respectively. Both readmissions and complications were independently associated with increasing ASA fitness grade, duration of surgery, and increasing numbers of emergency admissions with gallbladder disease before cholecystectomy. No identifiable hospital characteristics were linked to readmissions and complications. Conclusion Readmissions and complications following cholecystectomy are common and associated with patient and disease characteristics