A simplified, practical, cost-effective surgical approach to sacrospinous colpopexy

Sacrospinous ligament fixation (SSLF) or colpopexy or colpohysteropexy (when the uterus is conserved) for the treatment of pelvic organ prolapse as a procedure is more than 200 years old. Consequently, umpteen modifications vis-à-vis techniques, instrumentations, lighting options have been described. Most of these make a simple procedure needlessly complex, cumbersome and expensive. We have performed this procedure using a simplified, practical approach with readily available surgical instruments, suture methods and endoscopic lightening apparatus. The main aim of this paper is to highlight the surgical steps of sacrospinous colpopexy performed with simple and easily available routine surgical instruments

A prospective study on the role of Hysterolaparoscopy in the evaluation of infertility

Background: Infertility affects about 10-15% of couples of reproductive age groups. The current evidence indicates a 9% prevalence of infertility with 56% of couples seeking medical care. Hysterolaparoscopy provides a comprehensive investigative procedure in which various factors causing female infertility can be assessed at one sitting.Methods: A total 100 infertile women between 20-40 years of age including primary and secondary infertility were evaluated. Patients would be investigated thoroughly for infertility and in preparation for anaesthesia. Tests include follicular study, Ultrasound pelvis. Hysterolaparoscopy was performed in the pre ovulatory period between days 6-10 of the cycle for infertility evaluation.Results: In the present study out of 100 cases for infertility evaluated, primary infertility were 57(57%) and secondary infertility were 43(43%). In our study out of 100 patients, Hysterolaparoscopy showed tuberculosis in 24 (24%) patients, remaining were endometriosis, polycystic ovarian syndrome, congestion, intra-pelvic adhesions, hydro-salpinx.Conclusions: It is concluded that while treating the causes of female infertility combined simultaneous diagnostic laparoscopy and hysteroscopy should be performed in all infertile patients as” seeing is believing” and if any pathologies found to be operable the gynaecologist can perform operative hystero-laparoscopy at that time, hence anticipating the pathologies after pre-operative work up is very important

An original research paper on incidence and risk factors for surgical site infections following major abdominal surgeries in obstetrics and gynaecology

Background: Surgical site infections associated with substantial morbidity and mortality, increase in hospital stay and enhanced cost of health care. Objective of present study is to analyse the incidence of surgical site infections after major abdominal obstetrics and gynaecologic surgeries and risk factors for development SSIs.Methods: It is observational study carried out at Department of Obstetrics and Gynaecology, ESI-PGIMSR at a teaching public hospital Mumbai, Maharashtra, India. It is a tertiary care centre and a teaching hospital. Women who had undergone abdominal surgery for various Obstetrics and Gynaecology indications.Results: 7.3% of operated subjects had SSI. And significant risk factors are anemia, obesity hypoprotenemia, prolonged pre-operative hospital stay, Diabetes mellitus.Conclusions: Post-operative abdominal wound infection represents a substantial burden of disease both for the patients and the healthcare services in terms of the morbidity, mortality and economic costs

Isolated twisted hematosalphinx misleading with ovarian cyst torsion

Normal or chronically inflamed fallopian tube can undergo torsion and present as acute abdomen, simulating clinically as ectopic gestation. Torsion of the fallopian tube is less frequent but significant cause of lower abdominal pain in reproductive age women that is difficult to recognize preoperatively. Authors present a rare case of hematosalpinx with torsion at its pedicle with hemoperitonium who presented as 28 years old female with acute abdomen that was successfully treated. In cases presenting with hemoperitoneum diagnosis of ruptured ectopic pregnancy should be made unless proved otherwise during reproductive age. Rarely ruptured ovarian cyst may also be a cause. Unfortunately, hematosalpinx sometimes can undergo torsion due to circulatory imbalance and can present as hemoperitoneum and circulatory collapse due to rupture. There have been no specific symptoms, clinical findings, imaging or laboratory characteristics identified for this condition. Imaging findings are non-specific in the preoperative diagnosis of torsed fallopian tubes. Therefore, most of cases with isolated fallopian tubal torsion had a delayed diagnosis and a subsequent delay of timely intervention that may result in failure to save tubal function. Torsion of tube can lead to hematosalpinx, hemoperitonium and necrosis of tube which necessitates urgent surgical management. This case report describes a twisted hematosalpinx presentation without any predisposing high-risk factors. A tubal torsion should be suspected in females with acute pelvic pain, of any age group. An early diagnosis and treatment are required to prevent complications. This rare case may highlight a new insight into pathogenesis of tubal torsion associated with hematosalpinx

Pre-operative diagnosis of ovarian ectopic pregnancy: a challenge to practicing clinician

The first case of primary ovarian ectopic pregnancy was reported by St. Maurice in 1689. Primary ovarian ectopic pregnancy is rare entity, with incidence of around 3% of all ectopic pregnancies. The aim of present case report is to study the role of different modalities like clinical findings, biochemistry, sonography, surgery and histopathology in diagnosis of primary ovarian ectopic pregnancy. Authors present a case of a 24 years old female with history of 2 months amenorrhoea, per vaginal spotting and mild intermittent abdominal pain in RIF. Examination was unremarkable and serum βHCG was 2007.5IU/ml. An ultrasound scan showed an ectopic mass in the right adnexa suggestive of a tubal ectopic pregnancy and she underwent surgical management at our institute.  At laparoscopy, both fallopian tubes were noted to be normal with an ectopic mass attached to the right ovary with a pedicle. With these unusual laparoscopic findings, possibilities of tubal miscarriage, ovarian pregnancy, or abdominal pregnancy were suspected. Ectopic mass was coagulated and cut through the pedicle with bipolar cautery and specimen was sent for HPE. Our patient made an uneventful recovery and no further medical management was indicated. The diagnosis of right ovarian ectopic pregnancy was finally confirmed by histopathological evidence of the presence of chorionic villi in a background of ovarian stromal tissue, in consideration with Spigelberg’s criteria. Present case highlights the importance of considering non-tubal ectopic pregnancies when making a diagnosis based on ultrasound scan. Pre-operative diagnosis of ovarian ectopic pregnancy still remains a challenge in spite of current medical advances. Despite the benefits and reliability of ultrasound scanning, there will still be situations where the definitive diagnosis can only be made at surgery. However, histopathological examination is confirmatory and always mandatory

Total laparoscopic hysterectomy: why surgeon teachers must learn and train residents

Background: The purpose of the present study is to demonstrate the feasibility of laparoscopic surgery for hysterectomy and elaborate our experience.Methods: Between September 2017 and April 2018, 15 patients who were counselled for and opted for total laparoscopic hysterectomy our hospital enrolled in this study. Surgeons used a four-port system with, one 10mm and three 5-mm trocars. All surgical procedures were performed with 30°, 10-mm laparoscope and conventional laparoscopic instruments including monopolar and bipolar cautery system and the LigaSure system.  Patient’s history, clinical findings and surgical outcomes were prospectively tabulated, evaluated and analyzed.Results: Out of 15 patients under the study with age range of 40-55years, only 2 patients had hypertension and diabetes mellitus and 2 had anaemia. All 15 patients underwent conventional laparoscopic surgery. Operative time was in a range of 6O–240 min.  There were no intra operative complications in 6 patients (40%) and no post op complications in 11 women (73%).Conclusions: The results from our 15 women show that, in experienced hands, laparoscopic hysterectomy is not associated with any increase in major complication rates

Genital tuberculosis and infertility

Background: An analytical study to diagnose genital tuberculosis, using various modalities, it`s treatment options and fertility outcomes in infertile labour class women.Methods: A prospective study, where 120 women, presented to hospital due to infertility were subjected to hystero-laparoscopy over 36 months. Endometrium sent for TB-PCR and HPR. Those diagnosed with GTB were given Anti-Tubercular Drugs as per standard regimes and their fertility outcome was studied.Results: Out of 120 women, 32(27%) were diagnosed with GTB using accepted clinical criteria, TB-PCR and endometrial HPR. 30 of these 32 were diagnosed by HLscopic picture (94%) alone, 18 by positive endometrial TB-PCR (58%) and another 3 by HPR (10%). Among 32 women treated, 9(28%) conceived after treatment.Conclusions: High incidence of GTB amongst the labour class warrants strong suspicion and early diagnosis using hystero-laparoscopy and prompt treatment to minimize the short and long-term effects of GTB on fertility

PRES in pregnancy: MRI and it's role in decision making

Posterior reversible encephalopathy syndrome (PRES) is an alarming clinic-neuro-radiological syndrome accompanying various clinical conditions, presenting with headache, encephalopathy, seizures, cortical visual disturbances or blindness. The lesions in PRES are thought to be due to vasogenic oedema, predominantly in the water-shed regions of the posterior cerebral hemisphere, fortunately, completely reversible with management of the primary condition. We report a case of primigravida with 26 weeks pregnancy, who presented with acute, severe, in-tractable, throbbing headache, tingling sensation in the posterior neck and upper shoulder region, photophobia, nausea and mild pre-eclampsia. Standard therapy did not relieve the headache, BP remained fluctuant, so migraine/some intra-cranial pathology was suspected. MRI is the gold-standard diagnostic modality. It revealed the classical acute PRES picture. PRES implies breaching of the blood brain barrier, resultant cerebral edema and potential for further intra-cranial events of serious proportions. Notably, PRES may be seen with normotension. Pregnancy was terminated un-eventfully, recovery was prompt and complete. Two weeks later, the patients showed marked improvement clinically and neuro-imaging features of PRES had dis-appeared

Rare case of deep pelvic retroperitoneal mature cystic teratoma

Mature cystic retroperitoneal teratomas are typically rare childhood tumours. Less than 20% of these occur in adults more than 30 yrs of age. Our adult patient presented with such a tumour, which had grown to a disproportionately large extent. It was deeply embedded in the true pelvis extending laterally to the pelvic wall and inferiorly till the ischiorectal fossa and was adherent to the surrounding structures displacing all. A provisional diagnosis was made after MRI scan and patient was posted for exploratory laparotomy. After extensive blunt and sharp dissection, the cyst wall could be separated from the surrounding structures and successfully excised. Histopathology confirmed the diagnosis. Being such a rare tumour, it is essential to have a high degree of suspicion in such cases that can be supported by advanced imaging modality. Early diagnosis and complete surgical removal are the mainstay of management that provide an excellent prognosis for such patients.