Bowel injury following gynecological laparoscopic surgery

Background: Bowel injury remains a serious complication of gynecological laparoscopic surgery. We aimed to review the literature on this topic, combined with personal experiences, so as to give recommendations on how to avoid and manage this complication.Methods: We performed a narrative review on bowel injury following gynecological laparoscopic surgery using PubMed covering prevention, diagnosis, and management. Search terms used were laparoscopy, gynaecology, injury, bowel, prevention, treatment.Results: Important principles of prevention include proper pre-operative evaluation and increased laparoscopic surgical skills and knowledge. High clinical suspicion is crucial for early diagnosis. Diagnostic workup of suspected cases includes serial abdominal examination, measuring inflammatory markers, and performing imaging studies including abdominal ultrasound and CT scan. When bowel injury is recognized during the first laparoscopic procedure then laparoscopic primary suturing could be tried although laparotomy may be needed. When diagnosis is delayed, then laparotomy is the treatment of choice. The role of robotic surgery and three-dimensional laparoscopic gynecological surgery on bowel injury needs to be further assessed.Conclusion: Early recognition of bowel injury is crucial for a favorable clinical outcome. A combined collaboration between gynecologists and general surgeons is important for timely and proper decisions to be made.Keywords: Laparoscopy, gynaecology, injury, bowel, prevention, treatmen

Prevalence of pelvic floor disorders in the Eastern Mediterranean region

Objectives: High prevalence of risk factors for pelvic floor disorders (PFD) in the Eastern Mediterranean may result in higher rates of prevalence of PFD in comparison to other regions. Despite individual studies, there are no clear statistics on the cumulative prevalence of PFDs in the East Mediterranean region. The aim of this study was to investigate the prevalence of PFDs in the Eastern Mediterranean region.Methods: A literature search without language restriction was conducted in PubMed, Cochrane database and Web of Science from 2016 to 01 June 2022. Cross-sectional and cohort studies that reported prevalence of urinary incontinence (UI), constipation, fecal incontinence (FI) and pelvic organ prolapse (POP) among women in the Eastern Mediterranean region were included. Study quality was assessed according to the Joanna Briggs Institute critical appraisal tool. Data were pooled and meta-analysed using a random effects model. PROSPERO: CRD42021283127Results: The search yielded 390 articles, from which 12 studies containing 9905 patients were included. Five studies were high quality and seven were low quality. The prevalence of POP (12 studies, 9905 participants), UI (5 studies, 2340 participants), constipation (4 studies, 2045 participants) and FI (1 study, 166 participants) was 39% (95% CI 21-57; I2 99.8%), 48% (95% CI 16-80; I2 99.7%), 39% (CI 17-60; I2 99.1%) and 14% (95% CI 9-20) respectively.Conclusion: In meta-analysis pooling studies of mixed quality, a high prevalence of PFDs was seen in the Eastern Mediterranean region.PROSPERO No.: CRD4202128312

The degree of bother and healthcare seeking behaviour in women with symptoms of pelvic organ prolapse from a developing gulf country

Abstract Background The healthcare-seeking behaviour of women with pelvic organ prolapse (POP) is affected by several factors including the cultural background. There is limited number of studies which addressed the healthcare-seeking behaviour in women with POP. The aim of this study was to determine the degree of bother, social impact and healthcare seeking behaviour of symptoms of POP in one of the Gulf countries and compare the results to published data from other areas. Methods All women who attended the three family development centres in our city between January 2010 and January 2011 and who had symptoms suggestive of POP were included in the study. The data was collected by well-trained interviewers. Results One hundred twenty-seven women reported symptoms of POP (mean age: 38.2 years; range: 18–71). Out of these, 111 (87.4%) had at least one activity (physical, social or prayers) or sexual relationship affected by POP symptoms. In 49 women (38%), the effect on at least one of these activities or relationships has been described as moderate and in 18 women (14%), the effect was severe. Sixty-nine women (54%) did not seek medical advice due to: embarrassment to see medical doctors (51%), the belief that POP is normal among women (51%), hope for spontaneous resolution (48%), embarrassment to see male doctors (33%) and unawareness of the existence of medical treatment (30%). On univariate analysis, the need to insert the finger in the vagina to empty the bladder or bowel and the interference of symptoms with physical activities, had significantly determined healthcare seeking attitude (P < 0.05 for all). However, on multivariate analysis interference with physical activities was the only significant determinant (P = 0.04). Conclusions Although POP had affected the quality of life in the majority of the affected women, unlike some other societies, more than half failed to seek healthcare advice mainly due to shyness and embarrassment and lack of proper knowledge about the condition. Interference of symptoms with physical activities was the main significant determinants of healthcare-seeking behaviour. Additional teaching campaigns designed according to cultural backgrounds in each society are required to address these sensitive issues

Transplacental transfer of 2-naphthol in human placenta

Objective: To determine the transfer of 2-naphthol (2-NPH) in fullterm human placental tissues. Methods: Six placentas were studied. The ex-vivo dual closed-loop human placental cotyledon perfusion model was used. 2-NPH was added to the perfusate in the maternal compartment. Samples were obtained from the maternal and fetal up to 360 min measuring. Results: The mean fetal weight was 2880 ± 304.2 g. Mean perfused cotyledon weight was 26.3 (±5.5) g. All unperfused placental tissue samples contained NPH with a mean level of 7.98 (±1.73) μg\g compared to a mean of 15.58 (±4.53) μg\g after 360 min perfusion. A rapid drop in maternal 2-NPH concentration was observed; from 5.54 μg\g in the first 15 min and 13.8 μg\g in 360 min. The fetal side increased from 0.65 μg\g in the initial 15 min to 1.5 μg\g in 360 min. The transfer rate of NPH was much lower than that of antipyrine. Conclusion: 2-NPH has the ability to rapidly across the placenta from the maternal to the fetal compartment within 15 min. The placenta seems to play a role in limiting the passage of 2-NPH in the fetal compartment

Caesarean scar pregnancy: time to explore indications of the caesarean sections?

A retrospective study was conducted in women with history of a caesarean scar pregnancy (CSP) to explore the possible causative mechanisms. Over a period of 40 months, a total of 16,926 deliveries and 3554 caesarean sections (CS) occurred in our hospital. Nine cases of CSP were identified at an incidence of 1:1880 births and 0.25% of all CS. Analysis of the indications of the previous CS revealed that 88.8% of women with known indication had undergone CS without labour. Out of them, 75% underwent CS at preterm gestation and 25% had term elective procedure for breech presentation. Of the patients, 77.7% had multiple CS. Conservation of the uterus was possible in 77.7% of patients utilising non-radical forms of treatment. As most of the women underwent CS with a non-contractile uterus without labour, we believe that the risk of CSP may be related to the indications of the previous CS as the number of CS alone could not explain the occurrence of CSP. It is time to explore this area so that screening strategies can be developed to detect CSP at the earliest possible gestation and to prevent life-threatening complications such as uterine rupture and severe hemorrhage.Impact statement What is already known on this subject? A caesarean scar pregnancy (CSP) is a life-threatening condition that can result in uterine rupture and in severe haemorrhage. Although the diagnostic criteria for the CSP have been established, the risk factors that favour the condition are not well understood. We know that the incomplete healing of the lower uterine segment (LUS) from poor vascularisation can create a microscopic dehiscent tract through which the blastocyst enters the myometrium. Some have postulated that the healing processes following the elective procedures, such as for breech deliveries performed in a non-developed LUS, might facilitate this process. What do the results of this study add? In this study, analysis of the indications of the previous CS revealed that majority of women with a known indication had undergone CS without labour, either at preterm gestation or term elective procedure for breech presentation. We have postulated the possible causative mechanisms in relation to the physiology of LUS development. To the best of our knowledge, this is the first study that has looked specifically at the relationship between the indications of previous CS and CSP. What are the implications of these findings for clinical practice and/or further research? Further studies exploring the indications of the previous CS are recommended so that early first-trimester screening strategies can be generated towards this subgroup of patients to detect CSP at the earliest possible gestation