Single vs. Multiple Laparoscopies: Pain Status One Year Post-Hysterectomy for Chronic Pelvic Pain

Despite the prevalence of chronic pelvic pain (CPP)— affecting one in seven women in the U.S.— its cause is often unknown. As such, an evaluation of our current approaches to the work-up of CPP is warranted. Laparoscopy is considered a gold standard tool in the evaluation of CPP with 40% of all laparoscopies in the U.S. performed for this condition [1]. However, limited data exists portraying the clinical importance and outcomes for repeat diagnostic laparoscopies. This is a retrospective case-control study to determine the incidence of multiple laparoscopies for CPP over the past 10 years, and to compare outcomes between patients who underwent single (SL) vs multiple (ML) laparoscopies. We propose that patients who undergo multiple laparoscopies warrant discussion of hysterectomy as our results indicate that resolution of pain in patients who undergo multiple laparoscopies for the indication of CPP is similar to patients undergoing hysterectomy after single laparoscopy

E-Z Point: A New Safe and Reproducible Laparoscopic Entry in the Left Upper Quadrant Using a Veress Needle

BACKGROUND: Over half of all fatal complications occur during primary laparoscopic entry. In our practice, we developed a novel modification of closed LUQ entry at Palmer\u27s point and designated it E-Z entry. AIMS: To evaluate the risks and safety of left subcostal entry, a technique we have designated \u27E-Z\u27 entry at our institution. SETTINGS AND DESIGN: A retrospective chart review was conducted at a tertiary care medical centre of patients who underwent laparoscopic procedures by a single surgeon known to perform left subcostal entry for the last 10 years, using the E-Z entry technique. MATERIALS AND METHODS: Retrospective chart review and description of surgical technique. STATISTICAL ANALYSIS USED: Simple descriptive statistics and univariate two-group comparisons. RESULTS: One hundred ninety-eight laparoscopic cases were identified as performed by a single surgeon in the last 10 years: 149 underwent umbilical entry and 49 underwent E-Z entry. The average number of previous abdominal surgeries was higher in the E-Z entry group compared to the umbilical group, 1.3 versus 0.5, respectively (P = 0.003). The umbilical entry group had no complications. One complication was noted with the E‑Z entry technique, in which the Veress needle was noted to perforate the liver capsule but was managed expectantly. CONCLUSION: We propose the E-Z entry technique for Veress needle entry as an ergonomic and easily reproducible entry technique in the left upper quadrant in the setting of suspected intraperitoneal adhesions

Radiated Immediate Prepectoral Direct to Implant Reconstruction: A Retrospective Cohort Study

Purpose: Increasing use of prepectoral plane in post mastectomy implant-based reconstruction has made immediate direct to implant (DTI) reconstruction more achievable. There has been increased incidence of post mastectomy radiation therapy (PMRT) making it important to understand the complication profile of immediate DTI reconstruction in patients who may require adjuvant radiation therapy. Methods: A retrospective cohort study of consecutive patients undergoing prepectoral DTI reconstruction with and without PMRT was performed. Patient and treatment level factors, operative, and post-operative outcomes were extracted on both the patient and breast level for the prepectoral radiated and nonradiated patients. The presence of at least one minor complication (superficial or full-thickness necrosis, cellulitis requiring oral antibiotics, hematoma, or seroma) or major complication (cellulitis requiring intravenous antibiotics, hospital readmission, explanation, or unplanned return to the operating room) was compared. We also evaluated how radiation affects outcomes of prepectoral DTI vs subpectoral DTI. Univariate analysis was performed to evaluate differences in outcomes between groups. Results: 242 patients underwent DTI reconstruction.148 patients underwent prepectoral DTI reconstruction. 54 patients underwent subpectoral DTI reconstruction. Patients who underwent PMRT had higher rates of neoadjuvant chemotherapy and axillary lymph node dissection. Univariate analysis did not demonstrate any significant differences in minor or major complications between the radiated and non-radiated prepectoral DTI breasts. Radiated prepectoral patients had a higher rate of capsular contracture and explant for capsular contracture. Conclusion: Immediate prepectoral DTI reconstruction in patients who will have PMRT has an improved complication profile compared to subpectoral placement