2938 Abdominal ICE Following Laparoscopic Hysterectomy: A Randomized Controlled Trial
To assess impact of abdominal ice packs on opioid use and pain control following laparoscopic hysterectomy.
A 19-year-old woman was referred to our tertiary gynaecology unit from a regional centre with prolonged menstrual bleeding, brown intermenstrual discharge, dysmenorrhoea and a recent diagnosis of uterine didelphys. She had initially presented with pelvic pain and fever and underwent a laparoscopy for suspected appendicitis. She was found to have a normal appendix, infected right endometrioma and two uterine horns. After treatment with antibiotics, magnetic resonance imaging (Figure 1) showed uterine didelphys with a single vaginal lumen, right renal agenesis and a 3cm right endometrioma.
ConclusionAlthough the rate of iatrogenic endometriosis is low after laparoscopic supracervical hysterectomy and sacrocervicopexy, the possibility of the occurrence of iatrogenic endometriosis should be discussed with patients who are diagnosed with apical prolapse to determine the type of surgical intervention. Iatrogenic endometriosis should be kept in mind for differential diagnosis in case of pain after laparoscopic supracervical hysterectomy and sacrocervicopexy.
ConclusionPercutaneous-assisted technique for extrafascial hysterectomy achieved excellent results in terms of feasibility, safety, and efficacy, even in complex cases and advanced surgical procedures. Therefore, the technique appears to balance the limitations and advantages of minimal surgical invasiveness and standard approach efficacy.
AbstractIn this video we present a case of rectal injury, which occurred during laparoscopic mesh removal following sacrocervicopexy. Four years after sub-total hysterectomy with laparoscopic sacrocervicopexy, a 64-year-old patient still suffered from intense proctalgia and pain while sitting. On physical examination, intense pain could be triggered by palpating the left aspect of the levator ani muscle, raising the suspicion of an association with the mesh and leading to the decision for its removal. The left posterior arm of the mesh was removed completely laparoscopically. During this procedure, a rectal lesion was diag...
We report a case of small bowel herniation caused by the ureter in a woman who underwent radical hysterectomy for cervical cancer. Patient concerns: A 53-year-old woman presented with acute abdominal pain and vomiting and reported a history of radical hysterectomy for cervical cancer 6 years prior to presentation. Diagnoses: Computed tomography revealed segmental luminal dilatation of pelvic ileal loops, 2 transition zones with the beak sign in the left-sided pelvic cavity, and reduced enhancement of bowel loops. Hydronephrosis with abrupt luminal narrowing of the left distal ureter was also observed. Interventions:...
Conclusion: Persistent LBP and radiating pain may be the signals of lumbar spondylodiscitis. MRI is the gold standard diagnostic examination for lumbar spondylodiscitis. Awareness of symptoms, such as LBP and radiating pain symptoms, timely diagnosis, mesh removal, and referral to orthopedists are important to prevent more severe complications. Surgical practice needs to be improved further and any other infections should be treated immediately as the most likely causes of lumbar spondylodiscitis are related to the mesh and other infections.
We describe a patient who presented with abdominal pain at 13 weeks of gestation and was diagnosed with placenta percreta during laparoscopy for presumed appendicitis. Intraoperatively, placenta was seen perforating the uterine fundus and 1 l of hemoperitoneum was evacuated. However, the uterus was hemostatic and the patient was stable, so the procedure was terminated. The patient was then transferred to a tertiary care center, where she ultimately underwent an uncomplicated laparoscopic gravid hysterectomy. We conclude that placenta percreta can occur in the first trimester even in patients without traditional risk fa...
CONCLUSION: No difference in pain was observed 2 hours postoperatively when comparing preoperative administration of oral compared with intravenous acetaminophen. Given the ease of administration and lower cost of oral dosing, this study supports the oral route as part of the enhanced recovery after surgery protocol for minimally invasive gynecologic surgery. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov, NCT03391284. PMID: 31764741 [PubMed - in process]
Condition: Ambulatory Laparoscopic Hysterectomy Interventions: Device: Low Impact Laparoscopy; Device: conventional laparoscopy; Other: Visual Analog Scale (VAS) for Pain; Other: Saint-Antoine Pain Questionnaire (QDSA); Other: post-operative questionnaire Sponsor: Hospices Civils de Lyon Not yet recruiting