Ovariopexy—Before and after Endometriosis Surgery

Endometriosis surgery is often very challenging. Key to complete resection of endometriosis is access to the retroperitoneum. Endometriosis can involve the ureter and uterine vessels, and ovary on the lateral pelvic wall makes retroperitoneal access difficult. Primary and post-surgical adhesions prevalence in endometriosis is very high. Ovariopexy, transposition of ovaries temporarily, is done for better surgical access and to reduce postoperative adhesions. We concluded that although limited evidence, ovariopexy is an excellent tool to aid endometriosis surgery and prevent postoperative adhesions. It is cost effective, simple and complication rate almost nil. More robust trials are required to substantiate evidence for its impact on preventing postoperative adhesions and its effect on fertility. In this review, we describe our technique of ovariopexy supplemented with a video, with the aim to put light on this useful and important technique, which is beneficial both for surgeons and patients.

Ectopic pregnancy in a case of congenital mullerian anomaly: a diagnostic dilemma

Ectopic or extrauterine pregnancy occurring in a case with mullerian defect is very rare and poses diagnostic challenges. Undescended and non-communicating fallopian tubes are extremely rare mullerian anomalies. Here authors present a case of ectopic pregnancy occurring in an undescended non-communicating fallopian tube in a patient with unicornuate uterus with absent horn, which was managed laparoscopically. A 32-year-old lady, diagnosed case of left unicornuate uterus with absent right horn, was referred to us with the suspicion of ruptured ectopic pregnancy. The abdominopelvic ultrasound showed a soft tissue lesion of size 32×24 mm, towards the right lateral pelvic wall near the iliac vessels, with increased vascularity on colour flow doppler. The patient underwent laparoscopy which showed left sided unicornuate uterus with normal left tube and ovary. The right uterine horn was absent. An undescended right ovary and tube were found attached to the peritoneum at the level of pelvic brim along the right lateral pelvic wall. Right sided tubal ectopic pregnancy with rupture was present along with 300-350 cc of hemoperitoneum. The patient was treated with laparoscopic right sided total salpingectomy. In patients with unicornuate uterus and atypical presentation, ectopic pregnancy should be ruled out in an undescended non-communicating fallopian tube. Salpingectomy of incidentally diagnosed non-communicating fallopian tubes is recommended to prevent future ectopic pregnancy.

Vaginoplasty with Uterovaginal Anastomosis for partial Vaginal and Complete Cervical Agenesis: A Rare Müllerian Anomaly

ABSTRACT Congenital absence of cervix is a rare condition that occurs in 1 in 80,000 to 100,000 births. Here, we report a case of a 20-year-old, married woman who presented to the gynecology outpatient department with primary amenorrhea and complaints of cyclical left-sided lower abdominal pain and difficult coitus for 2 years. Magnetic resonance imaging report suggested unicornuate uterus with hematometra and cervical agenesis. On laparotomy, unicornuate globular uterine horn with absent cervix was present on the left side and separate solid rudimentary horn was found on right lateral pelvic wall. Left adnexa was normal, whereas right ovary was enlarged with minimal hydrosalpinx. Vaginoplasty with uterovaginal anastomosis was performed after draining the hematometra and successful restoration of cyclical menses was achieved on follow-up. How to cite this article Mishra VV, Nawal R, Aggarwal R, Nanda S, Bandwal P, Gandhi K. Vaginoplasty with Uterovaginal Anastomosis for partial Vaginal and Complete Cervical Agenesis: A Rare Müllerian Anomaly. J South Asian Feder Obst Gynae 2017;9(3):274-276.