The document discusses the laparoscopic sacropexy procedure for treating pelvic prolapse, outlining the preoperative evaluation and preparation, operating strategy including dissection and mesh fixation techniques, reported results including anatomical correction rates and complications, and concluding that laparoscopy has advantages over laparotomy and vaginal approaches for treating pelvic prolapse.
Chirurgia protesica e compartimento posteriore: un connubio possibile?GLUP2010
This document summarizes evidence on surgical treatments for posterior compartment prolapse. It finds that posterior fascial duplication has better objective outcomes than site-specific repair. There is no evidence of benefit from using mesh or biological grafts. While symptoms improve in most patients, elevatormuscle suturing can increase dyspareunia. The transvaginal approach is superior to the transanal approach. Overall, the literature provides no evidence that mesh or biological patches provide any added benefit over traditional non-mesh surgery for posterior compartment prolapse repair.
PROLASSO E CHIRURGIA FASCIALE - Compartimento posterioreGLUP2010
The document discusses surgical techniques for repairing posterior compartment prolapse, including traditional posterior colporrhaphy, site-specific defect repair, and transanal vs transvaginal approaches. It reviews studies comparing success rates, anatomical outcomes, and rates of dyspareunia, constipation, and other functional outcomes between techniques. Key points emphasized are the importance of levatorplasty for advanced prolapse and aggressive reattachment of the posterior vaginal wall to the uterosacral ligaments for high rectoceles or those with an enterocele.
Laparoscopic ventral hernia repair involves placing mesh over the hernia defect using laparoscopic techniques. It has advantages over open repair such as lower wound complications, recurrence rates, hospital stay and pain. While more technically challenging, it is effective for primary and recurrent hernias. Outcomes are better in non-obese patients, with obese patients having higher recurrence rates and longer operating times.
This document discusses pelvic reconstructive surgery and highlights related to surgical mesh. It notes that over 1,000 complications have been reported with transvaginal mesh including erosion, infection, pain and other issues. Mesh may not improve outcomes over traditional non-mesh repairs for pelvic organ prolapse. The FDA recommends registries to track outcomes, standardized training, improved informed consent processes and clarifying mesh indications. Specific mesh properties like pore size, weight, material and surgical techniques can impact complications. Alternative native tissue repairs and hybrid meshes are also discussed.
Incisional hernias develop through weaknesses in the abdominal wall that result from prior abdominal surgeries. Risk factors include surgical techniques like midline incisions and poor suture methods, as well as patient characteristics such as age, obesity, and smoking. Treatment involves either open suture repair for small hernias or open/laparoscopic mesh repair for larger hernias, with mesh repair having a lower recurrence rate but higher risk of infection. Proper surgical technique and modification of patient risk factors can help reduce hernia development and recurrence.
Gossypiboma, textiloma or more broadly Retained Foreign Object (RFO) is the technical term for a surgical complications resulting from foreign materials, such as a surgical sponge, accidentally left inside a patient's body
The document discusses laparoscopy procedures for various gynecological conditions. It begins by outlining conditions that can be diagnosed or treated via laparoscopy, including infertility, ectopic pregnancy, adhesions, endometriosis, ovarian masses, hysterectomy, uterine fibroids, and gynecological oncology issues. It then discusses different laparoscopy access techniques such as direct trocar insertion, open laparoscopy, and Verres needle insertion. It provides data on complication rates for different access methods. The document also discusses techniques for avoiding major vascular injuries during access. In summary, the document provides an overview of laparoscopy procedures and techniques for gynecological conditions.
Disfunzioni uretro-vescicali dopo sling: quale approccio?GLUP2010
The document discusses voiding dysfunctions after sling surgery for stress urinary incontinence. It notes that voiding dysfunctions occur in 2-20% of patients after various sling procedures. The causes can include excessive tension on the sling, displacement of the sling, or external compression of the urethra. Diagnosis involves evaluating the patient history and symptoms, as well as urodynamics testing and imaging exams. Treatment options include conservative measures like clean intermittent catheterization, or surgical interventions like sling loosening or incision if conservative options fail. Early sling loosening or incision within 2 weeks of surgery appears to effectively resolve voiding dysfunction in many patients without compromising continence.
Chirurgia protesica e compartimento posteriore: un connubio possibile?GLUP2010
This document summarizes evidence on surgical treatments for posterior compartment prolapse. It finds that posterior fascial duplication has better objective outcomes than site-specific repair. There is no evidence of benefit from using mesh or biological grafts. While symptoms improve in most patients, elevatormuscle suturing can increase dyspareunia. The transvaginal approach is superior to the transanal approach. Overall, the literature provides no evidence that mesh or biological patches provide any added benefit over traditional non-mesh surgery for posterior compartment prolapse repair.
PROLASSO E CHIRURGIA FASCIALE - Compartimento posterioreGLUP2010
The document discusses surgical techniques for repairing posterior compartment prolapse, including traditional posterior colporrhaphy, site-specific defect repair, and transanal vs transvaginal approaches. It reviews studies comparing success rates, anatomical outcomes, and rates of dyspareunia, constipation, and other functional outcomes between techniques. Key points emphasized are the importance of levatorplasty for advanced prolapse and aggressive reattachment of the posterior vaginal wall to the uterosacral ligaments for high rectoceles or those with an enterocele.
Laparoscopic ventral hernia repair involves placing mesh over the hernia defect using laparoscopic techniques. It has advantages over open repair such as lower wound complications, recurrence rates, hospital stay and pain. While more technically challenging, it is effective for primary and recurrent hernias. Outcomes are better in non-obese patients, with obese patients having higher recurrence rates and longer operating times.
This document discusses pelvic reconstructive surgery and highlights related to surgical mesh. It notes that over 1,000 complications have been reported with transvaginal mesh including erosion, infection, pain and other issues. Mesh may not improve outcomes over traditional non-mesh repairs for pelvic organ prolapse. The FDA recommends registries to track outcomes, standardized training, improved informed consent processes and clarifying mesh indications. Specific mesh properties like pore size, weight, material and surgical techniques can impact complications. Alternative native tissue repairs and hybrid meshes are also discussed.
Incisional hernias develop through weaknesses in the abdominal wall that result from prior abdominal surgeries. Risk factors include surgical techniques like midline incisions and poor suture methods, as well as patient characteristics such as age, obesity, and smoking. Treatment involves either open suture repair for small hernias or open/laparoscopic mesh repair for larger hernias, with mesh repair having a lower recurrence rate but higher risk of infection. Proper surgical technique and modification of patient risk factors can help reduce hernia development and recurrence.
Gossypiboma, textiloma or more broadly Retained Foreign Object (RFO) is the technical term for a surgical complications resulting from foreign materials, such as a surgical sponge, accidentally left inside a patient's body
The document discusses laparoscopy procedures for various gynecological conditions. It begins by outlining conditions that can be diagnosed or treated via laparoscopy, including infertility, ectopic pregnancy, adhesions, endometriosis, ovarian masses, hysterectomy, uterine fibroids, and gynecological oncology issues. It then discusses different laparoscopy access techniques such as direct trocar insertion, open laparoscopy, and Verres needle insertion. It provides data on complication rates for different access methods. The document also discusses techniques for avoiding major vascular injuries during access. In summary, the document provides an overview of laparoscopy procedures and techniques for gynecological conditions.
Disfunzioni uretro-vescicali dopo sling: quale approccio?GLUP2010
The document discusses voiding dysfunctions after sling surgery for stress urinary incontinence. It notes that voiding dysfunctions occur in 2-20% of patients after various sling procedures. The causes can include excessive tension on the sling, displacement of the sling, or external compression of the urethra. Diagnosis involves evaluating the patient history and symptoms, as well as urodynamics testing and imaging exams. Treatment options include conservative measures like clean intermittent catheterization, or surgical interventions like sling loosening or incision if conservative options fail. Early sling loosening or incision within 2 weeks of surgery appears to effectively resolve voiding dysfunction in many patients without compromising continence.
Prolasso e chirurgia fasciale: steps ed evidenze - COMPARTIMENTO ANTERIOREGLUP2010
This document discusses the anatomy of pelvic floor support structures and techniques for fascial colporrhaphy surgery to repair anterior vaginal prolapse. It notes that traditional vaginal surgery often had high recurrence rates of 20-40%. The key anatomical structures of pelvic floor support are identified as the pubocervical and rectovaginal fascia. Successful colporrhaphy requires identifying and repairing individual fascial defects at specific sites. The objective of anterior colporrhaphy is to reattach the pubocervical fascia over the bladder to reduce protrusion. Modifications to the standard technique include more lateral dissection and fixation of the pubocervical fascia to other pelvic ligaments
This document announces a one day endoscopy workshop and continuing medical education event taking place on September 1, 2013 at Lotus Hospital in Erode. It will be hosted by the IMA Tamil Nadu State Branch AMS Wing, IMA Erode Branch, and ASI Erode City Chapter. The event will include live endoscopy workshops, lectures, panel discussions, and case scenarios focused on diagnostic and therapeutic endoscopy techniques. Delegates and postgraduates can register for Rs. 1000 and Rs. 500 respectively. The workshop and CME will run from 8am to 6pm and cover topics such as variceal banding, stricture dilation, endoscopic guidelines, and management of corrosive strictures
Chirurgia ricostruttiva pelvica fasciale: Il compartimento centraleGLUP2010
This document discusses surgical techniques for reconstructive pelvic surgery involving the central compartment. It compares surgery for primary pelvic organ prolapse (POP) grade 2 or higher to surgery for apical prolapse. Different techniques are described for vaginal vault repair involving the uterus versus repair after hysterectomy. Variations of sacrospinous hysteropexy and iliococcygeus fixation are outlined. Studies comparing outcomes of abdominal sacral colpopexy to vaginal repairs are summarized. The document advocates following principles of regenerative surgery using native tissues to repair defects and avoid excessive tension.
TAPP and TEP in the Complicated Hernia: Scrotal, Strangulated, and RecurrentGeorge S. Ferzli
This document reviews the literature on the use of TAPP and TEP procedures for complicated hernias such as scrotal, incarcerated, recurrent, and femoral hernias. It provides recommendations on the use of laparoscopic techniques in different clinical scenarios and complication settings. The recommendations are based on evidence levels ranging from I to IV, with level I evidence existing for use of TAPP and TEP in recurrent hernias compared to open repair. Surgeon experience is emphasized as an important factor for many of the more complex cases.
The document discusses retained textile foreign bodies (RTFBs), also known as gossypibomas, which are surgical sponges or towels accidentally left in a patient's body after a procedure, outlining their diagnosis using imaging tests, treatment requiring removal, potential complications, and importance of prevention through accurate counting of sponges before and after surgery. RTFBs can lead to serious issues like infection, fistula formation or bowel obstruction if not addressed, and prevention is critical given incidents continue to occur despite various counting guidelines and technologies introduced over the years.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
Incisional Hernia, risk factors, management and relation to Surgical Abdomina...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses the role of vaginal mesh in current practice for pelvic organ prolapse (POP) surgeries. It notes that while mesh has been successful in hernia repairs and is the gold standard for stress urinary incontinence surgeries, there is a lack of high-quality evidence supporting its routine use for POP. The document outlines various mesh types, surgical techniques, and complications reported with mesh including erosion, infection, pain, and new onset of issues like urinary or fecal incontinence. It recommends that mesh be used selectively and with informed patient consent given the risks, and that more research is needed to better define its role and safety in POP surgeries.
A 23-year-old female presented with abdominal pain 11 days after an exploratory laparotomy for a suspected ruptured ectopic pregnancy. Imaging revealed a 10cm heterogeneous mass in her right lower abdomen consistent with a gossypiboma (retained surgical sponge). During a mini-laparotomy, a surgical sponge was discovered and removed from her abdomen. Gossypibomas are a known complication of surgery where a sponge or laparotomy pad is accidentally left in the patient's body during a procedure and gets walled off. They should be considered when a patient has postoperative pain, infection, or mass to avoid any delays in diagnosis.
Imaging of gossybioma (retained missed towel surgical spongs) Dr Ahmed EsawyAHMED ESAWY
Imaging of gossybioma dr ahmed esawy (retained missed towel surgical spongs)
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray images
ultrasound
post operative missed towel
post operative missed spongs
post operative missed cotton
Gossypiboma: A Diagnostic Challenge but a Surgeon's Nightmare.KETAN VAGHOLKAR
This document discusses gossypiboma, which is a retained surgical sponge or foreign body left inside the body after surgery. It can occur due to various risk factors like emergency surgery or unexpected changes during the procedure. Retained foreign bodies can elicit an inflammatory response and cause complications like infection, obstruction, or fistula formation. Diagnosis is usually made using imaging like x-rays, ultrasound, or CT scan. Treatment requires surgical removal of the foreign body. Prevention relies on accurate counting of sponges and instruments before, during, and after surgery. Failure to prevent gossypiboma can result in legal liability for surgeons under negligence laws.
Combined Tissue and Mesh repair for Midline Incisional HerniaKETAN VAGHOLKAR
Repair of incisional hernia continues to pose a challenge to the general surgeon. A combination technique best suited for mid line incisional hernias with loss of domain is presented.
Treatment of small bowel fistulae in the open abdomenFerstman Duran
This article describes the successful use of topical negative pressure (TNP) therapy to treat small-bowel fistulae in patients with an open abdomen. TNP therapy was applied using the VAC device for 9 patients with a total of 17 fistulae. Three fistulae closed spontaneously with TNP therapy alone. For the remaining fistulae, TNP therapy controlled drainage and protected the wound until definitive surgery could be performed a median of 51 days later to resect the bowel and close the abdomen. No additional fistulae developed during TNP therapy. TNP therapy is an effective option for managing enteroatmospheric fistulae in an open abdomen.
Short term endpoints of conventional versus laparoscopic assisted surgerymanjil malla
This randomized controlled trial compared short-term outcomes of laparoscopic versus open surgery for colorectal cancer. It found that laparoscopic surgery was as safe as open surgery based on similar tumor and node status, short-term outcomes, and quality of life. However, laparoscopic rectal resection had higher positive margin rates and more complications, so it cannot yet be routinely recommended for rectal cancer. Overall, the laparoscopic approach provided equivalent cancer resection as open surgery for colon cancer.
Results of incisional hernia repair are poor. Centralized hernia surgery is a prerequisite for improvement of clinical outcomes. Center for a hernia and abdominal wall reconstruction should be an essential component of a university hospital. A hernia and abdominal wall reconstructive surgery is a practical and academic sub-specialization.
Post Operative status in patients undergoing Total Laparoscopic HysterectomyIndraneel Jadhav
To determine the indications and complications of Total Laparoscopic Hysterectomy
Post procedure Hemoglobin fall, pain scoring and total hospital stay
Time interval for regain to work and associated delayed complications
The document discusses surgical meshes and methods of fixation for hernia repair. It covers biologic and synthetic meshes and factors that influence hernia occurrence. Direct closure of hernias has a high recurrence rate of around 50%, which is reduced to around 5-18% when meshes are used. Long stitch lengths during closure are associated with higher rates of surgical site infection and hernia recurrence compared to short stitch lengths. Polypropylene meshes allow for tissue ingrowth but can cause complications like chronic infection, fistulas and erosion over time. Other synthetic mesh options discussed include ePTFE meshes.
The document discusses laparoscopy procedures for various gynecological conditions such as infertility, chronic pelvic pain, ectopic pregnancy, and oncological issues. It notes that laparoscopy can be used for both diagnostic and operative purposes. It then discusses different techniques for laparoscopic access such as direct trocar insertion versus Verres needle insertion. It reviews studies comparing complication rates between different access techniques. The document emphasizes the importance of evidence-based medicine and following guidelines from organizations like NICE when determining appropriate diagnostic tests and treatments for conditions like infertility.
Incisional hernia repair is commonly performed, and minimally invasive approaches using larger mesh that covers the entire previous incision can significantly reduce complications like recurrence. The document discusses a study of 40 patients who underwent laparoscopic incisional hernia repair with intraperitoneal onlay mesh covering the whole previous incision site. Post-operatively, most patients experienced moderate pain that was managed with oral medications. No recurrences were observed during follow-up. The conclusions are that technical modifications like defect closure, larger mesh coverage, and fixation methods can reduce morbidity when performed minimally invasively.
1) The reported recurrence rate of endometriosis was high, estimated at 21.5% at 2 years and 40-50% at 5 years based on a 23 year follow up study.
2) Risk factors for recurrence include disease stage at initial surgery, incomplete excision, and impaired ovarian reserve from extensive surgery.
3) Recurrent endometriosis can impair quality of life due to pain and cause infertility. Treatment options discussed include repeat surgery, medical suppression, and assisted reproductive technology.
Prolasso e chirurgia fasciale: steps ed evidenze - COMPARTIMENTO ANTERIOREGLUP2010
This document discusses the anatomy of pelvic floor support structures and techniques for fascial colporrhaphy surgery to repair anterior vaginal prolapse. It notes that traditional vaginal surgery often had high recurrence rates of 20-40%. The key anatomical structures of pelvic floor support are identified as the pubocervical and rectovaginal fascia. Successful colporrhaphy requires identifying and repairing individual fascial defects at specific sites. The objective of anterior colporrhaphy is to reattach the pubocervical fascia over the bladder to reduce protrusion. Modifications to the standard technique include more lateral dissection and fixation of the pubocervical fascia to other pelvic ligaments
This document announces a one day endoscopy workshop and continuing medical education event taking place on September 1, 2013 at Lotus Hospital in Erode. It will be hosted by the IMA Tamil Nadu State Branch AMS Wing, IMA Erode Branch, and ASI Erode City Chapter. The event will include live endoscopy workshops, lectures, panel discussions, and case scenarios focused on diagnostic and therapeutic endoscopy techniques. Delegates and postgraduates can register for Rs. 1000 and Rs. 500 respectively. The workshop and CME will run from 8am to 6pm and cover topics such as variceal banding, stricture dilation, endoscopic guidelines, and management of corrosive strictures
Chirurgia ricostruttiva pelvica fasciale: Il compartimento centraleGLUP2010
This document discusses surgical techniques for reconstructive pelvic surgery involving the central compartment. It compares surgery for primary pelvic organ prolapse (POP) grade 2 or higher to surgery for apical prolapse. Different techniques are described for vaginal vault repair involving the uterus versus repair after hysterectomy. Variations of sacrospinous hysteropexy and iliococcygeus fixation are outlined. Studies comparing outcomes of abdominal sacral colpopexy to vaginal repairs are summarized. The document advocates following principles of regenerative surgery using native tissues to repair defects and avoid excessive tension.
TAPP and TEP in the Complicated Hernia: Scrotal, Strangulated, and RecurrentGeorge S. Ferzli
This document reviews the literature on the use of TAPP and TEP procedures for complicated hernias such as scrotal, incarcerated, recurrent, and femoral hernias. It provides recommendations on the use of laparoscopic techniques in different clinical scenarios and complication settings. The recommendations are based on evidence levels ranging from I to IV, with level I evidence existing for use of TAPP and TEP in recurrent hernias compared to open repair. Surgeon experience is emphasized as an important factor for many of the more complex cases.
The document discusses retained textile foreign bodies (RTFBs), also known as gossypibomas, which are surgical sponges or towels accidentally left in a patient's body after a procedure, outlining their diagnosis using imaging tests, treatment requiring removal, potential complications, and importance of prevention through accurate counting of sponges before and after surgery. RTFBs can lead to serious issues like infection, fistula formation or bowel obstruction if not addressed, and prevention is critical given incidents continue to occur despite various counting guidelines and technologies introduced over the years.
Component seperation technique for the repair of very large ventral hernias nikhilameerchetty
Includes all the ventral hernia repairs with the loss of domain and the various methods of component separation technique with their success rate for their repair ,few videos showing the methods of repair in addition to the latest techniques of repair .
Incisional Hernia, risk factors, management and relation to Surgical Abdomina...iosrjce
IOSR Journal of Dental and Medical Sciences is one of the speciality Journal in Dental Science and Medical Science published by International Organization of Scientific Research (IOSR). The Journal publishes papers of the highest scientific merit and widest possible scope work in all areas related to medical and dental science. The Journal welcome review articles, leading medical and clinical research articles, technical notes, case reports and others.
This document discusses the role of vaginal mesh in current practice for pelvic organ prolapse (POP) surgeries. It notes that while mesh has been successful in hernia repairs and is the gold standard for stress urinary incontinence surgeries, there is a lack of high-quality evidence supporting its routine use for POP. The document outlines various mesh types, surgical techniques, and complications reported with mesh including erosion, infection, pain, and new onset of issues like urinary or fecal incontinence. It recommends that mesh be used selectively and with informed patient consent given the risks, and that more research is needed to better define its role and safety in POP surgeries.
A 23-year-old female presented with abdominal pain 11 days after an exploratory laparotomy for a suspected ruptured ectopic pregnancy. Imaging revealed a 10cm heterogeneous mass in her right lower abdomen consistent with a gossypiboma (retained surgical sponge). During a mini-laparotomy, a surgical sponge was discovered and removed from her abdomen. Gossypibomas are a known complication of surgery where a sponge or laparotomy pad is accidentally left in the patient's body during a procedure and gets walled off. They should be considered when a patient has postoperative pain, infection, or mass to avoid any delays in diagnosis.
Imaging of gossybioma (retained missed towel surgical spongs) Dr Ahmed EsawyAHMED ESAWY
Imaging of gossybioma dr ahmed esawy (retained missed towel surgical spongs)
include different cases for oral radiodiagnosis examination all over the world
CT /MRI Plain X ray images
ultrasound
post operative missed towel
post operative missed spongs
post operative missed cotton
Gossypiboma: A Diagnostic Challenge but a Surgeon's Nightmare.KETAN VAGHOLKAR
This document discusses gossypiboma, which is a retained surgical sponge or foreign body left inside the body after surgery. It can occur due to various risk factors like emergency surgery or unexpected changes during the procedure. Retained foreign bodies can elicit an inflammatory response and cause complications like infection, obstruction, or fistula formation. Diagnosis is usually made using imaging like x-rays, ultrasound, or CT scan. Treatment requires surgical removal of the foreign body. Prevention relies on accurate counting of sponges and instruments before, during, and after surgery. Failure to prevent gossypiboma can result in legal liability for surgeons under negligence laws.
Combined Tissue and Mesh repair for Midline Incisional HerniaKETAN VAGHOLKAR
Repair of incisional hernia continues to pose a challenge to the general surgeon. A combination technique best suited for mid line incisional hernias with loss of domain is presented.
Treatment of small bowel fistulae in the open abdomenFerstman Duran
This article describes the successful use of topical negative pressure (TNP) therapy to treat small-bowel fistulae in patients with an open abdomen. TNP therapy was applied using the VAC device for 9 patients with a total of 17 fistulae. Three fistulae closed spontaneously with TNP therapy alone. For the remaining fistulae, TNP therapy controlled drainage and protected the wound until definitive surgery could be performed a median of 51 days later to resect the bowel and close the abdomen. No additional fistulae developed during TNP therapy. TNP therapy is an effective option for managing enteroatmospheric fistulae in an open abdomen.
Short term endpoints of conventional versus laparoscopic assisted surgerymanjil malla
This randomized controlled trial compared short-term outcomes of laparoscopic versus open surgery for colorectal cancer. It found that laparoscopic surgery was as safe as open surgery based on similar tumor and node status, short-term outcomes, and quality of life. However, laparoscopic rectal resection had higher positive margin rates and more complications, so it cannot yet be routinely recommended for rectal cancer. Overall, the laparoscopic approach provided equivalent cancer resection as open surgery for colon cancer.
Results of incisional hernia repair are poor. Centralized hernia surgery is a prerequisite for improvement of clinical outcomes. Center for a hernia and abdominal wall reconstruction should be an essential component of a university hospital. A hernia and abdominal wall reconstructive surgery is a practical and academic sub-specialization.
Post Operative status in patients undergoing Total Laparoscopic HysterectomyIndraneel Jadhav
To determine the indications and complications of Total Laparoscopic Hysterectomy
Post procedure Hemoglobin fall, pain scoring and total hospital stay
Time interval for regain to work and associated delayed complications
The document discusses surgical meshes and methods of fixation for hernia repair. It covers biologic and synthetic meshes and factors that influence hernia occurrence. Direct closure of hernias has a high recurrence rate of around 50%, which is reduced to around 5-18% when meshes are used. Long stitch lengths during closure are associated with higher rates of surgical site infection and hernia recurrence compared to short stitch lengths. Polypropylene meshes allow for tissue ingrowth but can cause complications like chronic infection, fistulas and erosion over time. Other synthetic mesh options discussed include ePTFE meshes.
The document discusses laparoscopy procedures for various gynecological conditions such as infertility, chronic pelvic pain, ectopic pregnancy, and oncological issues. It notes that laparoscopy can be used for both diagnostic and operative purposes. It then discusses different techniques for laparoscopic access such as direct trocar insertion versus Verres needle insertion. It reviews studies comparing complication rates between different access techniques. The document emphasizes the importance of evidence-based medicine and following guidelines from organizations like NICE when determining appropriate diagnostic tests and treatments for conditions like infertility.
Incisional hernia repair is commonly performed, and minimally invasive approaches using larger mesh that covers the entire previous incision can significantly reduce complications like recurrence. The document discusses a study of 40 patients who underwent laparoscopic incisional hernia repair with intraperitoneal onlay mesh covering the whole previous incision site. Post-operatively, most patients experienced moderate pain that was managed with oral medications. No recurrences were observed during follow-up. The conclusions are that technical modifications like defect closure, larger mesh coverage, and fixation methods can reduce morbidity when performed minimally invasively.
1) The reported recurrence rate of endometriosis was high, estimated at 21.5% at 2 years and 40-50% at 5 years based on a 23 year follow up study.
2) Risk factors for recurrence include disease stage at initial surgery, incomplete excision, and impaired ovarian reserve from extensive surgery.
3) Recurrent endometriosis can impair quality of life due to pain and cause infertility. Treatment options discussed include repeat surgery, medical suppression, and assisted reproductive technology.
MIS Complications: Managing the Emergency ConsultationGeorge S. Ferzli
This document discusses various situations in which an emergency consultation with an expert laparoscopic surgeon may be needed, including: before an operation begins if there are complications entering the abdomen; upon entry into the abdomen if there is a vascular injury; if there are difficulties visualizing structures; upon discovery of an injury to an intra-abdominal structure like the bowel, bladder, or ureter; and in the critical care setting for diagnostic laparoscopy. It provides details on managing different complications like vascular injuries, adhesions, and various organ injuries. The role of a laparoscopic consultant is to prevent injuries, aid in diagnosis and management of injuries, and improve the skills and learning of the consulting surgeon.
The document discusses ureteric injuries during gynecologic surgery. It notes that ureteric injuries can lead to serious complications like ureterovaginal fistulas and renal impairment. The document outlines risk factors for injury including surgical complexity, patient anatomy, and surgeon experience. It provides details on injury prevention, identification, and various surgical and nonsurgical management strategies depending on injury characteristics and timing of detection. The key message is that most ureteric injuries can be prevented through anatomical knowledge and early detection improves prognosis.
1. Midurethral slings are now the gold standard treatment for stress urinary incontinence, replacing pubovaginal slings.
2. Pubovaginal slings are placed at the bladder neck and can be effective for various types of SUI but have higher risks than midurethral slings.
3. Midurethral slings are typically placed at the midurethra using either a retropubic or transobturator approach and have better subjective cure rates than pubovaginal slings.
FIGO guidelines on Placenta Accreta Spectrum Disorders: Conservative manage...Aboubakr Elnashar
This document discusses guidelines for conservative management of placenta accreta spectrum disorders. It describes four primary conservative surgical methods: 1) extirpative technique, 2) leaving the placenta in situ, 3) one-step conservative surgery, and 4) triple-P procedure. It provides details on how to perform each technique and notes they can be used alone or combined with additional procedures. The document also reviews evidence for techniques like tamponade sutures and recommends close monitoring when leaving the placenta in situ.
Complications of mesh in gynecologic surgeryOsama ElSayed
1. Transvaginal mesh was initially found to be safe and effective for treating stress urinary incontinence and pelvic organ prolapse but was later found to have unforeseen complications like mesh exposure, pain, and erosion into organs.
2. Major complications of midurethral slings include short term voiding issues, long term voiding dysfunction, vaginal mesh exposure, bladder/urethral erosion, and pain. Abdominal sacrocolpopexy complications comprise sacral osteomyelitis, discitis, and mesh erosion into viscera.
3. Managing complications involves nonsurgical options like local estrogen but often requires mesh excision along with repair of eroded organs. Care
Laparoscopic surgery is the mainstay of surgical management for gynaecological procedures but can be associated with complications in 0.2-10.3% of cases. Common complications include injuries to the gastrointestinal tract and urinary tract. Urinary tract injuries like bladder trauma can occur in 0.02-8.3% of advanced laparoscopy cases from mechanical or electro-thermal trauma. Risk factors include previous pelvic surgery or endometriosis. Ureteric injuries have a reported incidence of 0.06-21% and most commonly occur near the pelvic brim or lateral to the cervix. Gastrointestinal tract injuries have an incidence of 0.13% and most injuries are to the
Classification & conservative surgeries for prolapseIndraneel Jadhav
This document discusses various classifications and conservative surgical treatments for pelvic organ prolapse. It begins by describing the normal anatomical supports that prevent prolapse, including the bony scaffolding, endopelvic fascia, and pelvic musculature. It then covers several classification systems for prolapse, including the Baden-Walker and POP-Q systems. Conservative surgeries discussed include abdominal sling operations, various sling procedures, anterior and posterior colporrhaphies, paravaginal defect repairs, and perineorrhaphies. Newer procedures like vaginal sacrospinous cervico-colpopexy and posterior intravaginal slingplasty are also mentioned. The document emphasizes that hyster
Tips and Tricks in Laparoscopic Dissection of AdhesionsGeorge S. Ferzli
The document provides information on laparoscopic dissection of adhesions. It discusses the historical perspectives on adhesions, adhesion pathophysiology, prevention of adhesion formation, complications related to adhesions, results of laparoscopic adhesiolysis for small bowel obstruction, operating room set up, laparoscopic management indications and outcomes, laparoscopic approach, peritoneal access and potential trocar injury, optical access trocars, and recommended tools for adhesiolysis.
COMPARISON OF OPEN LICHTENSTEINE UNDER LOCAL AGAINST LAP.TEP UNDER GENERAL AN...chinmay gandhi
This document describes a study comparing open Lichtenstein hernioplasty under local anesthesia to laparoscopic extraperitoneal inguinal hernioplasty under general anesthesia.
For the open procedure, 25 patients underwent Lichtenstein repair with local anesthesia. Post-operative pain was well controlled with oral analgesics. At 3 months, there were no recurrences and only mild chronic pain in a few patients.
For the laparoscopic procedure, 25 patients underwent TEP repair with selective mesh fixation. Operative times were longer for bilateral cases. Post-operative pain was well controlled and patients were discharged on post-op day 2. At 3 months, there were no recurrences or chronic pain.
The
The document discusses rectourethral fistulas, including their causes, presentations, diagnostic evaluations, and various surgical repair techniques. The York-Mason and transanal approaches are commonly used for surgical repair, with the York-Mason approach providing good results for distal fistulas not amenable to transanal repair. Conservative management may be attempted for select small fistulas but surgery is usually required.
This document provides an overview of genitourinary fistulas, including their causes, types, symptoms, diagnosis, and treatment. It discusses that the most common types of genitourinary fistulas are vesicovaginal, ureterovaginal, and urethrovaginal fistulas. The main causes are gynecological or obstetric surgery and trauma. Symptoms include urinary incontinence and irritation. Diagnosis involves tests like dye tests and imaging. Treatment involves conservative management or complex surgical repair procedures. Post-operative care is important to ensure proper healing. Prevention focuses on avoiding prolonged labor and risky childbirth procedures in developing countries.
This document discusses radiation fistula and malignant fistula. It provides information on:
1) Radiation fistula can occur months to 30 years after radiotherapy for pelvic malignancies and presents as pain. Types include urethrovaginal, vesicovaginal, urethrorectal, and others.
2) Malignant fistula can occur with advanced primary cancers or local recurrence in the pelvis. It may present as a fistula between organs.
3) Evaluation and management depends on the type and complexity of the fistula. Surgical repair often requires interposition flaps or grafts to aid healing in irradiated tissue. Diversion procedures may be used in complex
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This document discusses rectal prolapse and various surgical treatments. It provides details on:
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3) Investigations used to evaluate rectal prolapse like imaging, sigmoidoscopy, and manometry.
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Intersphincteric resection is a technique that allows for sphincter-preserving surgery for rectal cancers located 1-2 cm from the anal verge. The procedure involves partial resection of the internal anal sphincter while completely preserving the external anal sphincter. A study of 90 patients who underwent this surgery found that 82% had 5-year overall survival and 75% had 5-year disease-free survival. While 41% had perfect post-operative continence, 76% reported overall subjective satisfaction with functional results. Preoperative radiotherapy was associated with worse functional outcomes.
Similar to Jean pierre-giolitto.laparoscopic sacropexy.swiss endos (20)
The document discusses the laparoscopic sacropexy procedure for treating pelvic prolapse, outlining the preoperative evaluation and preparation, operating strategy including dissection and mesh fixation techniques, reported results including anatomical correction rates and complications, and concluding that laparoscopy has advantages over laparotomy and vaginal approaches for treating pelvic prolapse.
Jean pierre-giolitto.laparoscopic sacropexy.swiss endos
1. Laparoscopic sacropexy:
an approach to pelvic
prolapse
Jean Pierre Giolitto, M.D.
Polyclinique les Bleuets REIMS - France
SWISS-ENDOS December 2004
2. Introduction
19921996 strict reproduction of the technique by
laparotomy.
19962000 innovative aspects
new anatomic spaces
endoscopic vision
pneumo dissection
20002004 simplification of the technique
reproducibility with acceptable
operating time
excellent results with anatomical
correction and good functional results
3. Preoperative evaluation
Evaluation of the prolapse
degree of prolapse: uterus
bladder
rectum
enterocele
cystocele
central: break of vesico vaginal fascia, vaginal
rugae absent
lateral: vaginal rugae present
higher rectocele (fascia detachment)
lower rectocele (deficient levator ani muscle)
4. Preoperative evaluation
Evaluation of the (in)continence
clinical examination
urodynamic investigation
prolapse plus pure SUI
prolapse and hidden SUI
prolapse without urinary problem
Evaluation of the rectal dysfunction
constipation
fecal or gas incontinence
Evaluation of the enterocele
MRI
5. Preoperative evaluation
Evaluation of the feasibility of laparoscopy
general anesthesia with pneumo peritoneum
Trendelenburg position
older and obese patients
the vaginal route will not be forgotten
6. Preoperative preparation
Bowel preparation
empty the bowel and enlarge operating space
low residual diet 4-5 days prior to surgery
local enema one day before
Vaginal oestrogens
3 or 4 weeks before
Vaginal and parietal disinfection
7. Preoperative assessment
Clinical reexamination under general anesthesia
search for new information which might modify the
strategy
Morphology of the abdominal wall
position of trocars
pubis – umbilicus distance
first trocar Ø 10mm: umbilical or supra umbilical
one 5 or 10mm trocar suprapubic on midline; at
least 6cm between 1st and 2nd
two 5mm lateral trocars at level of anterior
superior iliac spines
8. Preoperative assessment
Exposition of the operating field
fixation of the uterus to the anterior abdominal
wall
fixation of the bowel: sigmoid colon to the left
abdominal wall
Use a 5 or 6cm straight needle with a nylon suture
9. Operating strategy
Dissection
promontory: peritoneum to the Douglas
rectovaginal space
( hysterectomy)
anterior bladder dissection
Reconstruction
first posterior mesh with culdoplasty with
immediate peritonization
second anterior mesh
fixation to the promontory
complete reperitonization
10. Operating strategy
Dissection of the promontory
Trendelenburg position
level L5-S1 anterior vertebral ligament
good care should be taken regarding to
left iliac vein
right ureter
median sacral artery and vein
lower bifurcation of aorta and obese patients
Incision of the right lateral peritoneum :
vertical dissection to Douglas pouch
particular attention should be given to the right ureter
11. Operating strategy
Dissection of the rectovaginal space
opening of the peritoneum of the Douglas pouch
between the two uterosacral ligaments
dissection downwards to the posterior vaginal
wall
identify the rectum and the laterally levator ani
muscles
use vaginal retractor
12. Operating strategy
Fixation of the posterior mesh
both lateral sides levator ani muscles – 2 or 4
non absorbable sutures
medially and laterally fixation of the mesh to the
vaginal wall without transfixion
Culdoplasty – Douglas pouch closing without
douglassectomy
Utero sacral ligaments suture and mesh
reperitonization
Restore normal anatomy rectum/vagina
13. Operating strategy
Fixation of the second mesh anteriorly
bladder dissection just above the balloon of the
bladder catheter
fixation of the mesh with 3 or 5 non absorbable
sutures, non transfixing
no staples on vagina wall
passage on the right side through broad ligament
(or bilateral passage)
14. Operating strategy
Sacral colpopexy
1 or 2 non absorbable suture (staples)
proper tension with help of vaginal retractor
++ posterior mesh = no tension
++ anterior mesh = tension to correct cystocele
strong extracorporeal knot
upper reperitonization
if uterus is left in place: avoid a peritoneum
window between right broad ligament and
posterior peritoneum
15. Operating strategy
Post operative care
Foley catheter 1 or 2 days
Antibio prophylaxis
Prevention of phlebitis
Hospital stay 2 or 3 days
No heavy loads for 6 weeks
No sexual intercourse for 4 weeks
16. Results
Few short term or long term studies
Follow-up
Authors Year N 1 year 2 years
Nezhat 1994 15 100%
Vancaillie 1995 42 90%
Ross 1996 89 95%
Gaston 1999 214 90%
Mandron 2003 263 98%
Bruyere 2002 76 96%
17. Results
Kouri, Cosson: Comparaison de la voie
chirurgicale et coelioscopique, à propos de 218
cas
Group I (SCALI) 100 cases 1990-1995
Group II (laparoscopy) 118 cases 1997-2000
CYSTOCELE 2 or 3
Repaired RECTOCELE:
Group I: 14 posterior perineum
Group II: 2nd laparoscopic sling – 7 cases
18. Results
Kouri, Cosson: Comparaison de la voie
chirurgicale et coelioscopique, à propos de 218
cas
Results at 12 months GROUP I GROUP II
Anatomic result 98 94
Per-op complications 2% 8%
Post-op complications 8% 7%
Hospital stay 8D 5D
Re-intervention rate 2 cases 4 cases
25. Results
Post-operative complications
Spondylitis
Giolitto 0
Gaston 2 cases
1 case with post operative haematoma
1 case with hysterectomy
Butreau 1 case
Diagnostic
- at 2 to 6 months
- removal of the meshes
26. Results
Long term complications
Second vagina mesh displacement
Gaston 9 cases/429
posterior mesh but fixation with continuous sutures
(vagina ischemia)
prevention fixation with 3 or 5 separate nonabsorbable
sutures on posterior vagina
Post operative constipation
1 month 6 months
Previous posterior fixation 90% 13%
New posterior fixation with
15% 10%
broad mesh
Mandron 70 cases - 2004
27. Conclusion
Laparoscopy
advantage of the treatment by laparotomy
low morbidity such as the vaginal route
reproducibility of the technique
time: around 90 minutes
further studies required