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Rectus abdominis muscle endometriotic mass in a woman affected by multiple sclerosis.

We report a case of a rectus abdominis muscle endometriotic mass in a woman affected by multiple sclerosis. The pathogenesis of endometriosis is poorly understood but an immune system alteration could play a role in its onset and development. To date few studies have investigated the connection between autoimmune diseases and endometriosis. Multiple sclerosis is an inflammatory, autoimmune, demyelinating disease of the central nervous system. An autoimmune background might contribute both in the establishment of extrapelvic endometriotic lesions and in the possible increased risk of women with endometriosis to develop autoimmune diseases.

Pictorial review: rectosigmoid endometriosis on MRI with gel opacification after rectosigmoid colon cleansing.

Posterior deeply infiltrating endometriosis (PDIE) is an invalidating disorder that may involve the rectosigmoid colon. MRI with gel opacification after rectosigmoid colon cleansing improves visualization of rectosigmoid endometriosis. Nonetheless, the depth of bowel wall infiltration is still difficult to assess. In this regard, the use of high-frequency echoendoscope may be needed. Recognition of rectosigmoid endometriosis is important to establish a correct diagnosis and provide counseling and appropriate therapy.

Laparoendoscopic single-site supracervical hysterectomy with endocervical resection.

Laparoendoscopic single-site surgery is an attempt to enhance cosmetic benefits and reduce morbidity of minimally invasive surgery. Total laparoscopic hysterectomy through single-port access has been reported. Supracervical hysterectomy is an alternative to total hysterectomy but requires morcellation, which is challenging through a single umbilical incision. Herein we report and illustrate with a video supracervical hysterectomy performed via single-site laparoscopic surgery with transcervical morcellation after endocervical resection.

[Laparoscopic repair of pelvic organ prolapse by lateral suspension with mesh: a continuous series of 218 patients].

OBJECTIVES: To evaluate the technique of laparoscopic lateral colpo-uterine suspension using a mesh to treat pelvic organ prolapse, with a sufficient follow-up.
PATIENTS AND METHODS: The technique consists of two steps. First, the lateral suspension of the vaginal vault and of the uterus is performed using a polypropylene mesh placed in the vesicovaginal septum as a transversal hammock. The second step is the application of a polypropylene patch to the posterior surface of the vagina and the rectovaginal septum. The transversal hammock is placed laterally by the tension-free fixation of the mesh to the lateral abdominal wall above the iliac crests. Between January 2004 and December 2007, 218 patients were treated. It is a continuous series including all the patients needing a surgical procedure to treat a genital prolapse. We excluded, from the study, the patients with a severe cardiorespiratory disease and the cases of isolated rectocele.
RESULTS: We observed a recurrence of the prolapse in thirty patients (13.76%). A reoperation was performed in 10 patients (4.6%). One complication was related to the technique of lateral suspension (bladder injury immediately sutured 0.46%). A mesh erosion was noted in 13 cases (5.96%), nine were treated by vaginal excision of the mesh (4.12%).
CONCLUSIONS: The laparoscopic lateral colpo-uterine suspension using a mesh corrects the pelvic organ prolapse with a predominant cystocele or rectocele. It is an interesting alternative to the other procedures because of the low risk of complications and the satisfactory results.

[LESS, NOTES and robotic surgery in gynecology: an update and upcoming perspectives].

Laparoscopy revolutionized the gynecological surgical world during the 1980's and 1990's and has changed the approach to surgical procedures ever since. Minimal invasive surgery procedures are now the standard of care for many gynecological operations. At the beginning of the 21st century, robotic gynecological surgery, laparo-endoscopic single site surgery (LESS) and natural orifice transluminal endoscopic surgery (NOTES) may be on the threshold of another such revolutionary breakthrough. In this article, we review the present place of these new techniques in gynecological surgery and discuss their future perspective.

[Endometriosis: review of the literature and clinical management]

Despite numerous studies, endometriosis remains unclear concerning the etiopathogenesis, the natural history and optimal treatment. It occurs preferentially in young women and may be associated with a series of painful symptoms very disabling, together with infertility and significant psychological problems. Because of the multiple consultations, operations and disability it can cause, endometriosis takes an increasing part in health costs. Delays between onset and diagnosis are still long, and it is important to diagnose as early as possible to stop this disease so as to maintain or restore fertility and quality of life for patients. That is why a careful listening and clinical examination with appropriate investigations will improve our global care.

Anatomic distribution of posterior deeply infiltrating endometriosis on MRI after vaginal and rectal gel opacification.

The challenges of imaging posterior deeply infiltrating endometriosis with MRI are to image a small anatomic area encompassing several thin fibromuscular anatomic structures such as uterosacral ligaments, and the vaginal and rectal walls; and to image endometriotic lesions, which are fibromuscular structures and have an MRI signal intensity very close to those of surrounding fibromuscular anatomic structures.
CONCLUSION: We show the capability and potential of MRI in diagnosing and staging of posterior deeply infiltrating endometriosis after vaginal and rectal gel opacification.

Treatment of genital prolapse by laparoscopic lateral suspension using mesh: a series of 73 patients.

STUDY OBJECTIVE: To evaluate the efficacy of laparoscopic lateral suspension using mesh in patients with pelvic organ prolapse (POP).
DESIGN: A prospective cohort study (Canadian Task Force classification II-2).
SETTING: A tertiary referral center for operative laparoscopy.
PATIENTS: In all, 73 patients with POP were assessed in the preoperative and postoperative stages. The assessment included a description of their functional symptoms and the degree of their POP condition, established according to the Baden-Walker prolapse classification system. The patients were followed in the postoperative stage for a median of 19 (range 12-41) months.
INTERVENTIONS: Laparoscopic lateral suspension of pelvic organs using mesh carried out from January 2004 through September 2006.
MEASUREMENTS AND MAIN RESULTS: Satisfactory anatomic results were obtained in 64 (87.7%) patients. Neither major complications, nor postoperative pelvic infection were reported. None of the operations required laparotomy.
CONCLUSION: Laparoscopic lateral suspension using mesh effectively treats POP with low morbidity.

[Laparoscopic treatment of genital prolapse].

Progresses performed in laparoscopic surgery during the last ten years offer the possibility to do complex and difficult gynaecologic operations by laparoscopy, specially surgical treatment of genital prolapse, with interesting results. We report the main laparoscopic techniques to treat genital prolapse. It is clear that most of the laparoscopic procedures are the same than the classical operations performed by laparotomy. The main techniques that we report treat completely the pelvic organ prolapse (POP), without any vaginal scar, avoiding the risks of the dyspareunia in the sexually active patients.

[Practice guidelines: conservative treatment of fibroids].

The conservative treatment of uterine fibroids is essentially based on symptomatology and patient's choice of treatment. The gynaecologist must develop a clear therapeutic protocol based on clinical examination, available test results and consideration of patient preference. The therapeutic options include close surveillance, hormonal treatments, conservative operative endoscopy and arterial embolization.

Laparoscopic supracervical hysterectomy versus laparoscopic-assisted vaginal hysterectomy.


STUDY OBJECTIVE: To compare laparoscopic supracervical hysterectomy (LSH) with laparoscopic-assisted vaginal hysterectomy (LAVH) in terms of indications, pathology, length and weight of removed uteri, operative time, intraoperative blood loss, intra and postoperative complications, and later sexual function.
DESIGN: Cohort retrospective analysis of consecutive cases (Canadian Task Force classification II-3). SETTINGS: Hutzel Hospital, Detroit Medical Center,Wayne State University, Detroit, Michigan; Vert-Pre Nouvelle Clinique, Geneva, Switzerland; and Benha University Hospitals, Egypt.
PATIENTS: Two hundred and fifty-nine women.
MEASUREMENTS AND MAIN RESULTS: Patients in both groups were matched regarding age, indications, and pathology of the removed uteri. Blood loss with the LSH procedure was significantly lower than it was with the LAVH procedure (mean 125 +/- 5 vs 149 +/- 7 mL, p =.001). Patients that underwent LSH had significantly shorter operating times (mean 120 +/- 3 vs 150 +/- 5 minutes, p =.007). The length of the removed uteri was 14.2 +/- 0.5 cm (range 5.2-18) in the LSH group versus 11.8 +/- 0.4 cm (range, 5.6-14) in the LAVH group. Weight of the removed uteri was 280 +/- 6 g (range, 65-750) in the LSH group compared with 235 +/- 8 g (range, 59-560) in the LAVH group. There was no difference between the groups in hospital length of stay. The number of complications was less in the LSH group (3/123, 2.4%) compared with 5/136 (3.7%) in the LAVH group. Sexual function after surgery was better in the LSH group.
CONCLUSION: After exclusion of preoperative cervical disease, LSH can be considered as a safer alternative to LAVH in patients that are candidates for laparoscopic hysterectomy.

Radical splenopancreatectomy with duodenal loop conservation in rats.


In an attempt to find a reproducible method of total splenopancreatectomy (TSP) with duodenal loop conservation in rats, we used the technique recently described by S. Houry and M. Huguier (Eur. Surg. Res. 15: 328, 1983) but were not able to induce a true diabetes. We therefore developed a more radical splenopancreatectomy (RSP) in rats and compared this technique with the TSP. RSP involves a more extensive dissection of the common bile duct, a short choledocoduodenal anastomosis, and total excision of the retroportal pancreatic lobules with the aid of a dissecting microscope. In rats who had undergone the TSP technique, blood glucose levels were maximal 8 hr after operation (270 +/- 16 mg/dl), and thereafter recovered baseline values. In contrast, after the RSP technique all the rats became diabetic as documented by persistent hyperglycemia (347 +/- 20 mg/dl at 8 hr, P = 0.01 compared to TSP; 500 +/- 20 mg/dl at 8 hr, P less than 0.0001). Eight hours after the operation, blood lipase levels increased more significantly after TSP than after RSP (847 +/- 247 IU/liter and 130 +/- 37 IU/liter, respectively, P = 0.01), and then decreased to 92 +/- 19 IU/liter at 24 hr in the TSP group and less than or equal to 30 IU/liter in the RSP group (P = 0.003), suggesting a more radical dissection of pancreatic tissue with the RSP technique. At sacrifice at 48 hr, no complications were found with either technique on macroscopic and microscopic examination, except for marked gastric distension with RSP. A third group of rats underwent RSP and were followed until natural death.

[Full-contact and dissecting aneurysm of the thrombosed left internal carotid artery associated with encephalomalacia].


Full-contact, a sport which is becoming more and more popular in our society as a means of self-defence, is not without its hazards. We describe the case of a 32-year-old man who, shortly after an intensive practice match, presented symptoms consistent with cerebral damage which resulted in his death within three days. The main pathological findings were confined to the left internal carotid artery, which presented a dissecting aneurysm as a result of rupture of its intima with thrombosis of its lumen. The thrombus extended as far as the intracranial portion of the artery, resulting in massive cerebral infarction as cause of death. Furthermore, there were histological modifications of both main carotid arteries and their branches which suggested repeated microtraumatic events. The causal relation between the lesions observed and the practice of full-contact are discussed.


© Dr. Jean-Marie Wenger 2016
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