Tubal reanastomosis results of our clinic: A tertiary center experience

Objective: In our study, it was aimed to determine the clinical results of 42 patients who underwent tubal reanastomosis for various reasons. Materials and Methods: Our study included 42 patients at fertile age who presented to our clinic for tubal reanastomosis between 2017 and 2019. Demographic information and surgery notes of the patients were accessed through the hospital files and hospital archive system. For retrospective screening, patients were contacted by phone and their pregnancy status was learned. Results: Of the patients, 47.6% (n=20) were operated on due to a wish for fertility, 53.4% (n=22) because of other reasons. The mean age of the patients was 36.2 and the mean number of children of the patients was 4.85. Laparotomy was performed in 23.8% (n=10) of the patients, and laparoscopic surgery in 76.2% (n=32). Our intrauterine pregnancy rate after tubal reanastomosis was calculated as 9.5%. Conclusion: Tubal reanastomosis can be performed by both laparoscopic and mini-laparotomy methods. We recommend performing bilateral reanastomosis if possible. We think that it would be appropriate to prioritize laparoscopic surgery because it is minimally invasive and provides high pregnancy success.

Minilaparotomy in the treatment of choledochal malformations in children

Introduction. The article presents the analysis of surgical treatment of children with choledochal malformations (CM) with mini-laparotomy and laparoscopy techniques.Purpose. The aim of the study is to improve outcomes of surgical treatment of choledochal malformations in children.Material and methods. For the last ten years (January 2010 - May 2020), 84 children with choledochal malformations (CM) (n = 84) were operated on with different surgical techniques in our hospitals. Group 1 - patients who had Roux-en-Y hepaticojejunoanastomosis (RYHJ, n = 68, 81%); Group 2 - patients who had hepaticoduodenoanastomosis (HD, n = 16, 19%). The authors compared outcomes because Roux-en-Y hepaticojejunostomosis and hepaticoduodenanastomosis were formed under mini-laparotomic (ML) and laparoscopic (LS) accesses. Surgical time, short-term and long-term postoperative outcomes were assessed.Results. The groups were comparable in gender, age, clinical manifestations, CM complications before surgery, comorbidities (p > 0.05). A statistically significant (p = 0.0000001, Mann–Whitney U-test) decrease in the surgical time was revealed when using mini-laparotomy access. Independent defecation appeared 3 times faster in the subgroup with mini-laparotomy and Roux-en-Y hepaticojejunostomy (ML RYHJ) than in the subgroup of laparoscopic Roux-en-Y hepaticojejunostomy (LS RYHJ) (p = 0.033, Mann–Whitney U-test), mainly due to early enteral loading in the first subgroup (on 0-1 postoperative day). Long-term postoperative outcomes in laparoscopic subgroups revealed a statistically insignificant (p> 0.05) prevalence of 4 anastomotic stenosis requiring repeated surgical interventions. Good outcomes were seen in 90% of patients after ML RYHJ (p = 0.002, Pearson’s Chi-square with Yates’ correction) versus 52.6% after LS RYHJ.Conclusion. Currently, laparoscopy is not a method of choice in children with CM due to the development of short-term and long-term postoperative complications. Minilaparotomy gives promising results in pediatric CM and can be “a gold standard” in the treatment of children with this pathology.