Daily practice management of septate uterus: reproductive outcome after septoplasty.

peer reviewed("[en] BACKGROUND: Septate uterus is the most common uterine malformation found in women presenting poor reproductive history. Hysteroscopic septoplasty (HS) restores the uterine anatomy in a safe procedure. OBJECTIVES: The goal of our study is to determine the reproductive outcomes after HS of symptomatic septate uterus. MATERIALS AND METHODS: In a retrospective observational single centre study the reproductive outcomes and complications after HS were evaluated in 31 women with symptomatic septate uterus. The patients were separated into two groups according to the symptoms - infertility or recurrent pregnancy loss (RPL). MAIN OUTCOME MEASURES: were the pregnancy and live birth rate and secondarily the complication rate. Furthermore, the results were analysed depending on the need of assisted reproductive techniques (ART). RESULTS: The treatment has resulted in an overall pregnancy rate of 71% for both groups. The spontaneous pregnancy rate is 45% and 8 pregnancies resulted from ART (26%). The overall first live birth rate is 51.6%. A decrease has been noticed in the miscarriage rate from 95.24% to 24% (p<0.001) in the overall population. CONCLUSIONS: In patients with a symptomatic septate uterus hysteroscopic septoplasty is a safe and effective procedure. The favourable results pointing out the benefits of surgery on the reproductive outcomes as well as the relatively simple and safe technique of HS make the intervention attractive.","[en] ",""

Incidental primary peritoneal serous borderline tumor miming endometriosis during laparoscopy for chronic pelvic pain

peer reviewe

Impact of Surgical Management of Endometrioma on AMH Levels and Pregnancy Rates: A Review of Recent Literature.

Ovarian endometrioma are found in up to 40% of women with endometriosis and 50% of infertile women. The best surgical approach for endometrioma and its impact on pregnancy rates is still controversial. Therefore, we conducted a literature review on surgical management of ovarian endometrioma and its impact on pregnancy rates and ovarian reserve, assessed by anti-Müllerian hormone (AMH) serum levels. Ovarian cystectomy is the preferred technique, as it is associated with lower recurrence and higher spontaneous pregnancy rate. However, ablative approaches and combined techniques are becoming more popular as ovarian reserve is less affected and there are slightly higher pregnancy rates. Preoperative AMH level might be useful to predict the occurrence of pregnancy. In conclusion, AMH should be included in the preoperative evaluation of reproductive aged women with endometriosis. The surgical options for ovarian endometrioma should be individualized. The endometrioma ablation procedure seems to be the most promising treatment

Laparoscopic Isthmocele Repair: Efficacy and Benefits before and after Subsequent Cesarean Section.

OBJECTIVE: To evaluate the effect of laparoscopic isthmocele repair on isthmocele-related symptoms and/or fertility-related problems. The residual myometrial thickness before and after subsequent cesarean section was also evaluated. DESIGN: Retrospective, case series. SETTING: Public university hospital. POPULATION: Women with isthmocele (residual myometrium < 5 mm) complaining of abnormal uterine bleeding, chronic pelvic pain or secondary infertility not otherwise specified. METHODS: Women's complaints and the residual myometrium were assessed pre-operatively and at three to six months post-operatively. In patients who conceived after surgery, the latter was measured at least six months after delivery by cesarean section. MAIN OUTCOME MEASURES: Resolution of the main symptom three to six months after surgery and persistence of laparoscopic repair benefits after subsequent cesarean section were considered as primary outcome measures. RESULTS: Overall, 31 women underwent laparoscopic isthmocele repair. The success rates of the surgery as improvement of abnormal uterine bleeding, chronic pelvic pain and secondary infertility were 71.4% (10 of 14), 83.3% (10 of 12) and 83.3% (10 of 12), respectively. Mean residual myometrial thickness increased significantly from 1.77 mm pre-operatively to 6.67 mm, three to six months post-operatively. Mean myometrial thickness in patients who underwent subsequent cesarean section (N = 7) was 4.49 mm. In this sub-group, there was no significant difference between the mean myometrial thickness measured after the laparoscopic isthmocele repair and that measured after the subsequent cesarean section. None of these patients reported recurrence of their symptoms after delivery. CONCLUSION: Our findings suggest that the laparoscopic isthmocele excision and repair is an appropriate approach for the treatment of isthmocele-related symptoms when done by skilled laparoscopic surgeons. The benefit of this new surgical approach seems to persist even after a subsequent cesarean section. Further investigations and prospective studies are required to confirm this finding

L'endométriose de l'adolescente

L’endométriose est une pathologie chronique généralement diagnostiquée à l’âge adulte, alors que les symptômes débutent à l’adolescence. L’anamnèse est une aide précieuse au diagnostic et devrait permettre de sélectionner les patientes qui pourront bénéficier d’un traitement médical ou chirurgical. Le critère essentiel est la description d’une dysménorrhée sévère justifiant la prescription d’une contraception orale très tôt après la ménarche. Le diagnostic précoce est un enjeu majeur dans l’évolution de l’affection dont les répercussions physiques, psycho-sociales et sexuelles sont majeures.Endometriosis is a chronic disease usually diagnosed at adult age, even the symptoms begin at adolescence. The medical history could help for the diagnosis and could select the patients for medical or surgical treatment. The main criterion is the description of severe dysmenorrhea necessitating the prescription of oral contraceptive pill early after the menarcha. The early diagnosis is a major issue in the evolution of the disease which is caracterized by physical, psyco-social and sexual repercussions

Choosing the right technique for deep endometriosis

The surgical management of bowel endometriosis is a real challenge. In addition to the fact that only symptomatic patients should undergo surgery, no consensus has been approved in the literature. Among the surgical techniques, the surgeon has to choose between rectal shaving, disc excision, or segmental colorectal resection. All those procedures are associated with complications, but the risk of rectovaginal fistula is higher if a disc excision or segmental colorectal resection is performed. It is therefore of utmost importance to evaluate preoperatively the bowel infiltration by several imaging techniques to estimate the feasibility of a deep rectal shaving with possible incomplete removal of the endometriotic lesions or to discuss with the patient about the indication of a segmental bowel resection. Because of the risk of major preoperative and postoperative complications, proper patient counseling is mandatory. © 201

La prise en charge multidisciplinaire des douleurs pelviennes chroniques

La douleur pelvienne chronique (DPC) est définie par la présence d’une douleur située dans le pelvis, sous l’ombilic, depuis plus de 6 mois, suffisamment sévère pour entraîner une incapacité ou nécessiter un traitement médical et/ou chirurgical. Elle concerne entre 2 et 24 % des femmes selon les études et son incidence est comparable à celle de l’asthme ou des lombalgies. Différents organes peuvent être touchés par de multiples pathologies, parfois en association, ce qui rend la prise en charge complexe. Les différentes étiologies possibles, la nature chronique de la DPC et l’influence de facteurs biologiques, sociaux et comportementaux encouragent à une prise en charge multidisciplinaire incluant médecins, kinésithérapeutes et psychologiques