Modified segmental bowel resection technique in deep infiltrated endometriosis. Is it a suitable method to reduce the risk of bowel leakage after an extensive complex surgery?

Objectives: To evaluate the novel modified laparoscopic technique of the bowel resection for deep infiltrated endometriosis (DIE) of the bowel versus the classical technique of bowel segmental resection in terms of anastomosis leakage. Material and methods: Patients (n = 138) treated with segmental bowel resections due to DIE were included; 30 patients had the classic, while 108 patients had the modified laparoscopic bowel segmental resection with indocyanine green vascular visualization and fibrin sealant use. Results: The modified technique was used more often in complex operations (65.7% vs 46.6%). More anastomotic leakages occurred in patients undergoing the classic technique than the modified technique (10% vs 2.8%; p = 0.117). No leakage in modified versus 12% in classic technique was observed in simple segmental bowel resections (p = 0.05); 2.5% of cases with leakage in modified versus 7.1% in classic technique were observed in bowel resections with hysterectomy. In complex cases operated with the modified technique, the frequency of anastomotic leakage was 4.2%, which were even less than leakage in simple cases in classic technique group (10%). Although the low location of the lesions increases the risk of leakage, the modified technique was associated with a small percentage of leakages (25% vs 6.3%). The laparotomy conversion rate was similar in both groups (3.4% for classic and 2.7% for modified). Conclusions: In DIE, the modified technique of segmental bowel resection showed superiority over the classic technique in terms of the risk of anastomotic leakage. This risk was lower regardless of the complexity of the surgery and lesion location

Sonoelastografia szyjki macicy jako nowa metoda diagnostyczna w ocenie stanu szyjki u kobiet ciężarnych – doniesienie wstępne

Objectives: The study aimed at determining whether there exists a correlation between the cervical cohesion parameters assessed in the elastography and the length of the cervix. Material and methods: Assessment of cervical cohesion parameters with the use of real-time sonoelastography was performed on 59 patients between 28 and 39 weeks of gestation. Results: The analysis showed that there exists a statistically significant (p=0.033) correlation between the cervical length and the elasticity of the front cervical labium (strain ratio A). Correlation coefficient (r) stood at (-) 0.28. Conclusions: 1. There exists a negative correlation between the condition on the front cervical labium in elastographic imaging and the length of the cervical canal in USG imaging. 2. Elastography of the uterine cervix may be helpful in assessing the risk of premature labour or cervical insufficiency. 3. There is a need to perform a study on a larger group of patients in order to determine whether elastography may find its place among routine obstetric diagnostic methods.Cel pracy: Celem pracy było zbadanie czy istnieje korelacja między spoistością szyjki macicy ocenianej metodą elastografii a długością szyjki macicy. Materiał i metody: Badaniu poddano 59 ciężarnych kobiet pomiędzy 28. i 39. tygodniem ciąży, u których oceniono parametry konsystencji szyjki macicy przy użyciu sonoelastografii w czasie rzeczywistym (real-time sonoelastography) . Wyniki: Analiza wykazała, iż istnieje istotna statystycznie (p=0.033) korelacja między długością szyjki macicy a konsystencją przedniej wargi szyjki macicy (strain ratio A). Współczynnik korelacji (r) wyniósł (-) 0.28. Wnioski: 1. Istnieje ujemna korelacja pomiędzy stanem przedniej wargi szyjki macicy ciężarnej ocenianej w badaniu elastograficznym z długością kanału szyjki macicy w obrazie USG. 2. Badanie elastograficzne szyjki macicy może być pomocne w prognozowaniu ryzyka porodu przedwczesnego oraz niewydolności szyjki macicy. 3. Potrzebne są badania na większej grupie pacjentek aby stwierdzić czy elastografia znajdzie miejsce wśród rutynowych położniczych metod diagnostycznych

Laparoscopic trans teres vault suspension, a new laparoscopic method of treatment of female genital prolapse – a preliminary report

Introduction : Pelvic organ prolapse (POP) is treated with a great variety of procedures and none is fully satisfactory. The aim of the study was to introduce and evaluate the effectives of laparoscopic trans teres vault suspension (LTTVS) technique as a new method for POP treatment. Material and methods: In the years 2013-2014, eight symptomatic women with grades II-IV POP underwent LTTVS procedure. The mean age of patients was 65.25 years (range from 52 to 76 years). The surgery encompassed total hysterectomy, suturing the vagina and fixation of uterosacral ligaments to the vaginal stump, fixation of stumps of round ligaments to the vaginal stump, and fixation of the vaginal stump to the anterior rectus fascia. Mean follow-up was 17.75 months (range from 6 to 27 months). Results : Eight patients were successfully operated. The symptoms of POP resolved after surgery and subjective quality of life increased. In one case a complication such as common fibular nerve injury appeared; however, it resolved after one month of physiotherapy. The other patient reported radiating pain down the leg after three months. No recurrence of vaginal stump prolapse was observed during the follow-up. Conclusions : LTTVS is a promising method for POP treatment. Due to repair with the use of native tissues, physiological placement of vaginal stump, and high efficacy it can be considered as an alternative to other POP surgeries. The method requires additional research on larger groups of patients