Opioid Prescription Usage After Benign Gynecologic Surgery: A Prospective Cohort Study
Publication date: Available online 15 July 2019Source: Journal of Minimally Invasive GynecologyAuthor(s): Insiyyah Patanwala, Chensi Ouyang, Matthew Fisk, Georgine LamvuAbstractStudy ObjectiveTo compare the amount of opioids (tablets and morphine milligram equivalents-MME) prescribed by physicians and used by patients, after benign gynecologic surgery.DesignProspective Cohort StudySettingTertiary Center- Main Hospital Operating Room and Outpatient Surgery CenterPatientsWomen undergoing benign gynecologic surgeryInterventionsMajor and minor gynecologic surgeriesMeasurementsThe surgery groups were: 1) minor laparoscopy (Minor), 2) major minimally invasive (Major) and 3) laparotomy (Laparotomy). Demographic, medical and surgical data was abstracted from electronic medical records. On post-operative day (POD) 7, women completed a telephone survey describing pain levels, prescription use and satisfaction with pain control. Patients who continued to use opioids for pain relief were surveyed on POD 14. If use continued, patients were surveyed again on POD 28. The primary outcome was amount of opioid prescribed compared to used.Main ResultsOf 193 screened participants, 172 were enrolled (89%) and data was analyzed for 154 (90%): 59 (38%) Major, 71 (56%) Minor, and 24 (16%) Laparotomy. The median number of tablets and MME prescribed was lowest for the Minor group (Minor 24 tablets, Major 30 tablets and Laparotomy 30 tablets, p
ConclusionsIn conclusion, LLPJ seems to be a safe, feasible and effective technique in patients with chronic pancreatitis. However, the number of descriptions published to date is very small, and there are no studies with high scientific evidence comparing LLPJ with open surgery or with endoscopic treatment that would allow us to draw firmer conclusions at the present time.
CONCLUSION: The presented case confirms the importance of interdisciplinary cooperation between surgeons, gynaecologists, and pathologists. We also want to emphasize the need for extensive pathological examination of the resected specimens which is essential for a proper diagnosis. KEY WORDS: Endometriosis, Rectum, Spontaneous perforation. PMID: 30898991 [PubMed - in process]
ConclusionIn women with a history of intracavitary interventions such as D&C, omentum incarceration should be considered when hysteroscopy demonstrates a fatlike formation and yellow droplets released by pressing or mobilizing the formation. Surgeons should be cautious, never using electrosurgery on formations whose origin arouses suspicion.
CONCLUSION: The high prevalence of chronic post-hernioplasty pain raises the urgent need for raising awareness regarding this issue among health care professionals. The main areas for improvement are diagnosis, follow-up and treatment of pain. PMID: 30521455 [PubMed - in process]
CONCLUSIONIntestinal malrotation is uncommon amongst adults but its complications can be devastating if not recognised early. Ladd’s procedure either laparoscopically or via laparotomy can provide good resolution of symptoms if performed astutely.
Conclusion In women with a history of intracavitary interventions such as D&C, omentum incarceration should be considered when hysteroscopy demonstrates a fat-like formation and yellow droplets released by pressing or mobilizing the formation. Surgeons should be cautious, never using electrosurgery on formations whose origin arouses suspicion.
A 40-year-old woman, nulligravida, presented with chronic pelvic pain, intermittent obstructive bowel complaints, and a desire to conceive. She had previously undergone 2 surgeries at 2 different hospitals, an open laparotomy for a right ovarian cyst 7 years before and a laparoscopy with minilaparotomy for frozen pelvis 2 years before, and was referred to our tertiary care center (Sunrise Hospital). She had also received ATT for genital tuberculosis 10 years before. The patient had 6 failed in vitro fertilization cycles subsequently.
Endometriosis is an estrogen-dependent, chronic gynecological disorder associated with pelvic pain and infertility, with a prevalence of 6 to 10% in the general population.6,7,12 Affected women experience dysmenorrhea, deep dyspareunia, dyschezia, and dysuria12,35 associated with low quality of life.8 The disorder is underdiagnosed or there is a delay in diagnosis in many cases leading to chronic pelvic pain (CPP).7,26 Diagnosis is made using laparoscopy or laparotomy, where endometrial lesions are found in extrauterine locations, mainly the peritoneum and ovaries.
Endometriosis is a common disease associated with chronic pelvic pain and infertility. For ureteral endometriosis, which is rare, conventional therapy previously consisted of laparotomy. However, laparoscopic ureteroneocystostomy has been reported recently. Laparoscopic surgery for ureteral endometriosis requires greater surgical expertise and takes a longer time to master. The minimally invasive approach is well known to give patients benefits because of its small incision, less pain and shorter hospital stay.
AbstractBackgroundPostoperative adhesions are the major cause of postoperative complications including intestinal obstruction, infertility, and chronic pelvic pain. In order to reduce postoperative adhesions, Terumo Corporation (Tokyo, Japan) has developed an adhesion barrier system (TCD-11091) which is easy to use at the treatment site in various surgical procedures including laparoscopic surgeries. We conducted a prospective randomized single-blind study in patients who underwent laparotomy with ileostomy.Methods and ResultsOne hundred twenty-six patients were randomly assigned to TCD-11091 group (n = 62) or no...