Morbid obesity is associated with postoperative complications in laparoscopic hysterectomy

Background: The prevalence of obesity in American women is 38.3%. Hysterectomy is the second most common surgery in reproductive age women; most of these procedures are performed laparoscopically. From 2011 to 2015, 3.2% of women age 15-44 years underwent hysterectomy; 89.6% of these procedures were performed for management of medical conditions including uterine fibroids, menstrual disorders, uterine prolapse, and endometriosis. The high rates of obesity and hysterectomy in women demand better understanding of the relationship between obesity and postoperative complications following laparoscopic hysterectomy. Methods: We conducted a retrospective cohort study using the American College of Surgeons National Quality Improvement Database (ACS-NSQIP) by identifying all patients who underwent laparoscopic total hysterectomy, laparoscopic assisted vaginal hysterectomy, or laparoscopic supracervical hysterectomy from 2007 to 2013 using Current Procedural Terminology (CPT) codes. These patients were stratified by BMI (40); univariate and multivariate analyses were then performed to evaluate the incidence of postoperative complications in these groups. Results: Patients with BMI \u3e 30 were more likely to experience postoperative complications including superficial surgical site wound infection, deep surgical site infection, failure to wean from the ventilator \u3e 48 hours, unplanned reintubation, deep vein thrombosis, pulmonary embolism, urinary tract infection, renal insufficiency, renal failure, and extended hospital length of stay \u3e 2 days. Multivariate analysis suggests that BMI \u3e 30 is an independent risk factor for superficial surgical site infection, deep vein thrombosis, and pulmonary embolism. Conclusion: Patients with obesity and morbid obesity were more likely to present with risk factors and comorbidities than nonobese patients. While complication rates following laparoscopic hysterectomy are low across BMI groups, patients with BMI \u3e 30 were more likely to suffer from at least one postoperative complication. Data indicate that obesity may contribute to a significantly increased risk of deep vein thrombosis and pulmonary embolism in the postoperative period, suggesting the need for additional venous thromboembolism prophylaxis. Obesity should be considered when planning for and performing laparoscopic hysterectomy

Impact of lifestyle and diet on endometriosis: a fresh look to a busy corner

Endometriosis is a chronic inflammatory disorder with a prevalence of six to ten percent in women of childbearing age. As long as the aetiology of endometriosis is not fully understood and the disease has no definitive treatment, an examination of the environmental factors or interventions that could modify or cure endometriosis would greatly benefit women suffering from this chronic condition. This literature review utilized the electronic databases PubMed, EMBASE, and MEDLINE until February 2021. Studies indicate that fish oil may have a positive effect on reducing endometriosis-related pain due to the effects of pro-inflammatory prostaglandins derived from omega-3 fatty acids. The same effect was seen with the introduction of antioxidant vitamins C, D, and E. There is clinical viability of a low fermentable oligo-, di-, and monosaccharides and polyols diet to successfully reduce the symptoms of patients who suffer from both endometriosis and irritable bowel syndrome. Despite the low level of evidence, there are frequent associations between endometriosis and gastrointestinal conditions in addition to the influence of various nutritional factors on the disease. The management of endometriosis requires a holistic approach focused on reducing overall inflammation, increasing detoxification, and attenuating troublesome symptoms. A dietician may provide great benefit in the management of these patients, especially at younger ages and in early stages. High-level evidence and welldesigned randomized studies are lacking when it comes to studying the effect of lifestyle and dietary intake on endometriosis. Inarguably, further research with a more extensive focus is needed

A 29-year-old woman with secondary amenorrhea after a septic abortion

© Cambridge University Press 2015. History of present illness: A 29-year-old gravida 3, para 1-0-2-1 woman presents to your office reporting no menses since her second spontaneous abortion, which she experienced 6 months prior. She has a history of regular menstrual cycles preceding her two recent spontaneous abortions, and one uneventful normal spontaneous vaginal delivery four years ago. Her first spontaneous abortion was diagnosed at 11 weeks\u27 gestation, and was treated with dilation and curettage. The most recent spontaneous abortion was diagnosed at nine weeks\u27 gestation, when she presented to the emergency department with five days of heavy bleeding per vagina. A dilation and sharp curettage was performed; however, the patient returned 3 days later with a fever to 39.4°C, a tender uterus, leucocytosis, and retained products of conception identified on ultrasound. Another dilation and sharp curettage was performed and the patient received postoperative antibiotics as an outpatient for seven days. The remainder of her postoperative course was unremarkable thereafter but she continues to report cyclic pelvic pain since that event. Her medical history is otherwise unremarkable. She is sexually active with one partner, with whom she desires another pregnancy. She has not been using any contraception. She smokes socially and works as a sales associate. Physical examination General appearance: Well-developed, well-nourished young woman Vital signs: Temperature: 37.1°C Pulse: 80 beats/min Blood pressure: 110/70 mmHg Respiratory rate: 16 breaths/min BMI: 24 kg/m2Breasts: No masses, adenopathy, or nipple discharge Abdomen: Soft, nontender, no masses External genitalia: Normal Vagina: Normal mucosa, no lesions, scant discharge Cervix: Parous, no lesions Uterus: Normal size, minimally tender, retroflexed, mobile Adnexa: Nontender, no masses Laboratory studies: Urine pregnancy test: Negative

A Case of Recurrent Rudimentary Horn Ectopic Pregnancies Managed by Methotrexate Therapy and Laparoscopic Excision of the Rudimentary Horn

This report presents a case of a 31-year-old woman successfully treated medically for a noncommunicating rudimentary horn ectopic pregnancy who presented with a second, successive rudimentary horn pregnancy. Patient underwent laparoscopic excision of right rudimentary horn and right salpingectomy after failed methotrexate therapy. Given the potential for rupture and recurrence, serious efforts should be made to excise a uterine rudimentary horn

Robotic surgery for deep-infiltrating endometriosis: is it time to take a step forward?

Endometriosis is a chronic debilitating disease that affects nearly 10% of women of the reproductive age. Although the treatment modalities of endometriosis are numerous, surgical excision of the endometriotic implants and nodules remains the sole cytoreductive approach. Laparoscopic excision of endometriosis was proven to be beneficial in improving the postoperative pain and fertility. Moreover, it was also proved to be safe and efficient in treating the visceral localization of deep endometriosis, such as urinary and colorectal endometriosis. More recently, robotic-assisted surgery gained attention in the field of endometriosis surgery. Although the robotic technology provides a 3D vision of the surgical field and 7-degree of freedom motion, the safety, efficacy, and cost-effectiveness of this approach are yet to be determined. With this paper, we aim to review the available evidence regarding the role of robotic surgery in the management of endometriosis along with the current practices in the field