scholarly journals Recurrent vaginal cuff dehiscence after surgery for endometriosis: a technique for laparoscopic repair with an omental flap

2021 ◽  
Vol 14 (3) ◽  
pp. e239540
Author(s):  
Gerard-Peter Frank ◽  
Johann Rhemrev ◽  
Marinke Westerterp ◽  
Jim English
Keyword(s):  
Laparoscopic Approach ◽  
Omental Flap ◽  
Sexually Active ◽  
Management Options ◽  
Vaginal Cuff ◽  
Vaginal Evisceration ◽  
Tissue Healing ◽  
Laparoscopic Excision ◽  
Vaginal Cuff Dehiscence

Vaginal evisceration is a rare but severe complication after hysterectomy or colpotomy and is generally successfully repaired by reapproximating healthy tissue edges of the vagina. Recurrent vaginal cuff dehiscence is problematic especially in sexually active women. We describe two cases of recurrent vaginal cuff dehiscence. The first patient had a hysterectomy for endometriosis. The second patient underwent laparoscopic excision of an endometriotic nodule at the vaginal vault. The vaginal cuff dehiscence was repaired by a laparoscopic approach employing an omental flap to enhance tissue healing. This closure technique turned out to be successful at follow-up in both cases. In case of recurrent vaginal cuff dehiscence, management options are limited. Our case report offers a laparoscopic treatment option by using an omental flap. This procedure can be used when conventional repair fails.

scholarly journals Intestinal Loop Evisceration after Vaginal Cuff Dehiscence: A Case Report and Review

2021 ◽  
Vol 04 (01) ◽  
pp. 01-06
Author(s):  
Sonia Manso
Keyword(s):  
Intestinal Resection ◽  
Genital Prolapse ◽  
Medical Emergency ◽  
Intestinal Loop ◽  
Vaginal Cuff ◽  
Vaginal Evisceration ◽  
Vaginal Repair ◽  
Vaginal Cuff Dehiscence ◽  
Omentum Flap

Background: Intestinal loop evisceration complicates 35-67% of vaginal cuff dehiscence, constituting a medical emergency. In most cases, it is associated with genital prolapse in postmenopausal women with previous hysterectomy. Complications associated with the use of a pessary are rare. They are usually due to loss of patient follow-up or negligent use of the device. Clinical presentation: We present the case of a 94-year-old patient who debuted with vaginal evisceration after vaginal cuff dehiscence, associated with prolonged use of pessary as a treatment for vaginal cuff prolapse and enterocele, after laparotomic hysterectomy. Vaginal repair was performed abdominally, due to the size and condition of the eviscerated loops, requiring intestinal resection. An omentum flap was attached to the vaginal cuff to improve healing and to try to occlude the Douglas space. Conclusions: EV requires vaginal, abdominal, or mixed repair, generally deferring definitive prolapse treatment to a second stage and we recommend being very careful with the closure of the vaginal vault after any type of hysterectomy

scholarly journals Evisceration after vaginal cuff dehiscence: A case report and review

2021 ◽  
Vol 2 (2) ◽  
Author(s):  
Sonia De-Miguel-Manso ◽  
◽  
Dakota Viruega-Cuaresma ◽  
Elena García-García ◽  
Carmen E Badillo-Bercebal ◽  
...  
Keyword(s):  
Intestinal Resection ◽  
Genital Prolapse ◽  
Medical Emergency ◽  
Definitive Treatment ◽  
Barbed Suture ◽  
Intestinal Loop ◽  
Vaginal Cuff ◽  
Vaginal Evisceration ◽  
Vaginal Repair ◽  
Vaginal Cuff Dehiscence

Introduction: Intestinal loop Evisceration (VE) complicates the 35- 67% Of Vaginal Cuff Dehiscence (VCD), constituting a medical emergency. In most cases, it is associated with genital prolapse in postmenopausal women with previous hysterectomy. Clinical case: 94-year-old patient with VE after VCD, associated with prolonged use of pessary as a treatment for vaginal cuff prolapse and enterocele, after laparotomic hysterectomy. Results: Vaginal repair was performed abdominally, due to the size and condition of the eviscerated loops, requiring intestinal resection. An omentum flap was attached to the vaginal cuff to improve healing and to try to occlude the Douglas space. Conclusions: VE requires vaginal, abdominal or mixed repair, generally deferring the definitive treatment of the prolapse to a second stage. We recommend being very careful with vaginal vault closure after any type of hysterectomy, avoiding electrosurgery, infection and bleeding, performing the colporrhaphy with bidirectional barbed suture or two layers with braided suture and facing enough tissue at the suture. Keywords: Vaginal evisceration; Vaginal cuff dehiscence; Complications after hysterectomy; Long-standing pessary.

scholarly journals Symptomatic cystic seminal vesicle: a laparoscopic approach for effective treatment

2013 ◽  
Vol 3 (6) ◽  
pp. 81 ◽  
Author(s):  
Anmar Nassir
Keyword(s):  
Renal Agenesis ◽  
Iliac Fossa ◽  
Preoperative Evaluation ◽  
Laparoscopic Approach ◽  
Rare Condition ◽  
Uneventful Recovery ◽  
The Third ◽  
Laparoscopic Excision ◽  
Right Iliac Fossa Pain

This case report highlights a symptomatic cystic seminal vesiclelesion, treated laparoscopically. A young adult male known tohave congenital right renal agenesis presented with a history ofrecurrent right iliac fossa pain, as well as deep pelvic discomfort.The preoperative evaluation revealed a 7 x 4.5 x 4 cm cystic seminalvesicle mass. After discovery of the mass, the patient underwenta transperitoneal laparoscopic excision of the lesion. Thepatient was discharged on the third postoperative day and hadan uneventful recovery. There were no complications noted duringa routine follow-up. The laparoscopic approach was shownto be effective in the management of this rare condition.

scholarly journals Incidence of and risk factors for vaginal cuff dehiscence following total laparoscopic hysterectomy: a monocentric hospital analysis

2021 ◽  
Author(s):  
Julia Caroline Radosa ◽  
Marc Philipp Radosa ◽  
Julia Sarah Maria Zimmermann ◽  
Eva-Marie Braun ◽  
Sebastian Findeklee ◽  
...  
Keyword(s):  
Risk Factors ◽  
Odds Ratio ◽  
Laparoscopic Hysterectomy ◽  
Incidence Rates ◽  
Total Laparoscopic Hysterectomy ◽  
University Hospital ◽  
Vaginal Cuff ◽  
Gynecology And Obstetrics ◽  
Vaginal Cuff Dehiscence

Abstract Purpose Vaginal cuff dehiscence (VCD) is one of the major surgical complications following hysterectomy with data on incidence rates varying largely and studies assessing risk factors being sparse with contradictive results. The aim of this study was to assess the incidence rate of and risk factors for VCD in a homogenous cohort of women treated for benign uterine pathologies via total laparoscopic hysterectomy (TLH) with standardized follow-up. Methods All patients undergoing TLH at the Department of Gynecology and Obstetrics, Saarland University Hospital between November 2010 and February 2019 were retrospectively identified from a prospectively maintained service database. Results VCD occurred in 18 (2.9%) of 617 patients included. In univariate and multivariate analyses, a lower level of surgeon laparoscopic expertise (odds ratio 3.19, 95% confidence interval (CI) 1.0–9.38; p = 0.03) and lower weight of removed uterus (odds ratio 0.99, 95% CI 0.98–0.99; p = 0.02) were associated positively with the risk of VCD. Conclusion In this homogenous cohort undergoing TLH, laparoscopic expertise and uterine weight influenced the risk of postoperative VCD. These findings might help to further reduce the rate of this complication.

Ultrasonic Percutaneous Tenotomy for Recalcitrant Lateral Elbow Tendinopathy: Clinical and Sonographic Results at 90 Months

2021 ◽  
pp. 036354652110101
Author(s):  
Benjamin F.H. Ang ◽  
P. Chandra Mohan ◽  
Meng Ai Png ◽  
John Carson Allen ◽  
Tet Sen Howe ◽  
...  
Keyword(s):  
Pain Relief ◽  
Extensor Tendon ◽  
Tissue Healing ◽  
Lateral Elbow ◽  
Percutaneous Tenotomy ◽  
Vas Scores ◽  
The Common ◽  
Lateral Elbow Tendinopathy

Background: In a study from our institution, ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon for recalcitrant lateral elbow tendinopathy showed excellent safety profiles, high tolerability, efficiency, sustained pain relief, functional improvement, and sonographic evidence of tissue healing in 20 patients at 3 years’ follow-up. Purpose: To explore the long-term clinical and sonographic results of ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon. Study Design: Case series; Level of evidence, 4. Methods: The same cohort of 20 patients was recalled after 7 years, and visual analog scale (VAS) for pain and Disabilities of the Arm, Shoulder and Hand (DASH) scores, need for secondary intervention, and overall satisfaction were assessed. They were also reassessed using ultrasound imaging of the brevis and the common extensor tendon to evaluate tendon hypervascularity, tendon thickness, and the progress or the recurrence of the hypoechoic scar tissue. Results: We successfully scored 19 patients and performed ultrasound on 16 patients with a median follow-up of 90 months (range, 86-102 months). There were no adverse outcomes and satisfaction remained at 100% (6 patients, satisfied; 13 patients, very satisfied). No patient developed a recurrence of symptoms and signs of lateral elbow tendinopathy, and therefore no secondary intervention was required. The improvement from baseline and early term scores was sustained ( P < .001 for all). At 90 months, there was a significant improvement in VAS scores and DASH–Compulsory scores compared with preprocedure scores and all follow-up times until 3 months. There was no difference in VAS scores and DASH–Compulsory scores at 90 months compared with 6 and 36 months. For DASH–Work scores, there was a significant improvement at 90 months compared with preprocedure scores, but there was no difference between DASH–Work scores at 90 months and scores at all other points of follow-up. At 90 months, hypervascularity remained resolved in 79% of patients, while all patients had reduced tendon swelling and sustained resolution or reduction of the hypoechoic lesion. Conclusion: At the long-term follow-up of 90 months, ultrasonic percutaneous tenotomy of the brevis and the common extensor tendon, previously shown to enhance recovery of lateral elbow tendinopathy, demonstrated good durability of pain relief and functional recovery that was previously achieved. This was accompanied by sustained sonographic tissue healing with no significant deterioration.

scholarly journals Impact of a Revised Cuff Closure Technique on the Rate of Vaginal Cuff Dehiscence with Endoscopic Hysterectomy

2020 ◽  
Vol 27 (7) ◽  
pp. S105
Author(s):  
S. Behbehani ◽  
E. Suarez-Salvador ◽  
H. Kosiorek ◽  
J. Yi ◽  
J.F. Magrina
Keyword(s):  
Vaginal Cuff ◽  
Closure Technique ◽  
Vaginal Cuff Dehiscence

scholarly journals Laparoscopic treatment of congenital choledochal cyst and hepaticojejunostomy with extracorporeal Roux-en-Y anastomosis: technical aspects and early experience with three cases

2016 ◽  
Vol 38 (2) ◽  
Author(s):  
Mario Lima ◽  
Tommaso Gargano ◽  
Giovanni Ruggeri ◽  
Francesca Destro ◽  
Michela Maffi
Keyword(s):  
Choledochal Cyst ◽  
Laparoscopic Approach ◽  
Rare Condition ◽  
Early Experience ◽  
Cyst Excision ◽  
Intrahepatic Bile Ducts ◽  
First Case ◽  
Laparoscopic Excision ◽  
Extracorporeal Anastomosis ◽  
Laparoscopic Removal

Choledochal cyst (CDC) is a congenital dilatation of the extra and/or intrahepatic bile ducts and it is a rare condition in western countries. Classical treatment consists of cyst excision and hepaticojejunostomy. The first case of a laparoscopic CDC excision was described in 1995 and since that time an increasing number of institutions have adopted this technique, with good success. We describe our early experience of 3 cases of CDC treated with laparoscopic approach. We used a 10 mm umbilical port for the camera, and four 3-5 mm operative ports. We performed the laparoscopic removal of the cyst and gallbladder, videoassisted preparation of the Roux-en-Y loop and laparoscopic hepaticjejunostomy. No post-operative complications occurred. Laparoscopic excision of CDCs has been supposed to give better observation, a better cosmetic result, potentially less postoperative pain, and a shorter recovery. The main argument for performing an extracorporeal anastomosis is that it decreases the operative time. We recommend caution to prevent injury to the pancreatic duct and biliary structures during dissection and anastomosis. Lifelong surveillance is mandatory, even after resection of the choledochal cyst.

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