Laparoscopic Lateral Hysteropexy versus Hysterosacropexy in Women with Stage III Uterine Prolapse.

Background: Minimally invasive techniques in gynecological pathology have well-known benefits, the "gold standard" of uterine prolapse being currently managed laparoscopically. Laparoscopic lateral hysteropexy and hysterosacropexy are surgical techniques that can be performed for uterine prolapse. Laparoscopic management of such cases is recommended, but requires well-trained teams in laparoscopic surgery. Methods: This study is a prospective analysis of patients who required surgical treatment for stage III uterine prolapse, hospitalized in the Surgery Department of Constanta County Hospital, for which laparoscopic lateral hysteropexy or laparoscopic hysterosacropexy was performed. Results: Between 2016-2020, 61 patients were hospitalized with stage III uterine prolapse that required surgery. All patients underwent laparoscopic surgery. Symptomatology was dominated by urinary incontinence (50%, 44.89%) and obstructive defecation (16.66%, 18.36%). Intraoperative complications were encountered in 33.3% of cases undergoing laparoscopic hysterosacropexy and in 8.16% undergoing laparoscopic lateral hysteropexy. At one year, the recurrence rate was 2.04% for patients who underwent lateral hysteropexy and 8.33% for patients who underwent hysterosacropexy. No patient had a recurrence at the 3-year visit. Conclusions: Laparoscopic lateral hysteropexy is emerging as an appropriate, safe, and effective procedure to treat advanced apical prolapse that requires further clinical attention and development to fully understand its surgical place in the treatment of pelvic defects.

Laparoscopic Management of Pelvic Organ Prolapse: A Case Series.

Background: Pelvic static disorders have an important impact on patients' quality of life, constituting a real public health problem, despite the fact that they are not life-threatening. Minimally invasive procedures of pelvic organ prolapse has many advantages, laparoscopic hysteropexy and colpopexy being a standard with real benefits: minimal incisions, reduced postoperative complications, shorter hospital stay and a low recurrence rate. Laparoscopic management of such cases is recommended, but requires teams well trained in minimally invasive surgery. Case presentation: We presented a series of successful cases of two patients with grade III hysterocele, respectively vaginal vault prolapse, who were treated minimally invasively with a lateral laparoscopic hysteropexy, respectively lateral laparoscopic colpopexy. Given the well-known benefits of minimally invasive surgery, we chose laparoscopic surgery because of the smaller surgical impact and faster return to normal life. The surgical procedures were performed successfully, without complications, with rapid recovery, without recurrence. Conclusion: Hysteropexy and laparoscopic colpopexy are safe and effective surgical procedures in selected cases.

Advantages of Laparoscopic Treatment in Pelvic Static Disorders by Lateral Hystero/Colpopexy - A Single Center Experience.

Introduction: Pelvic organ prolapse is the most frequent and common health problem faced by most patients, representing the descent into the vagina or beyond the introitus of one or more pelvic organs, involving three compartments: anterior-bladder, apical-uterus and posterior-rectus. Lateral hystero/colpopexy is an alternative approach in the repair of symptomatic anterior and apical pelvic prolapse. The main objective is to correct pelvic floor defects, restore anatomy, relieve pressure and maintain normal sexual function. Material and Methods: Surgical intervention was applied to patients with prolapse greater than grade II according to the international prolapse quantification system (POP-Q). For apical, anterior prolapse, the bladder peritoneum is dissected and a polypropylene mesh is fitted to the round ligaments with suspension of the isthmus and cervix and fixation of the mesh with CapSure tacks followed by closure of the vaginal peritoneum. Results: During the performance of the technique I had no intraoperative or postoperative complications. Conservation of the uterus proved to be effective for prolapse correction, significant improvements in patient quality of life, frequency of nocturia, degree of dyspareunia and urgency symptoms were observed. Conclusion: Uterine preservation by lateral hystero/colpopexy is a new, feasible and successful method for treating prolapse.

Clostridium Difficile Infection in Rectal Cancer Patients after Diverted Loop Ileostomy Closure.

AIM: Clostridium difficile infection is a cause of increased morbidity and mortality in hospitals, particularly in patients with cancer pathology. There are several factors favouring the development of Clostridium difficile infection among cancer patients, including age, exposure to antibiotic and proton pump inhibitors therapy, and chemotherapy. This study was conducted to observe the prevalence of Clostridium difficile infection after the reversal of ileostomy loop for rectal cancer surgery, which were initially operated either open or laparoscopic. METHOD: A retrospective study was performed on patients who were operated in a single surgical team for rectal cancer who benefited of a diverted loop ileostomy over a 4-year period. Results: 23 patients were documented with Clostridium difficile infection out of a total of 63. All 23 patients underwent ileostomy closure later than 3 months after primary surgery, and postoperatively received antibiotic therapy associated with proton pump inhibitors in the first 24 hours. Conclusions: Closure of ileostomy later than 3 months after primary surgery, combined with chemotherapy, antibiotic therapy and proton pump inhibitors, increases the risk of developing Clostridium difficile infection.

Effectiveness of Continuing Post-Surgery Antibiotic Prophylaxis in Reducing Nosocomial Infections - A Literature Review.

Background: To prevent surgical site infection (SSI), antibiotic prophylaxis is frequently extended for one day or more following surgery. Post-operative, continuing antibiotic prophylaxis may not be advantageous compared to stopping it right away, as it exposes patients to the hazards of taking antibiotics. Although it is routinely recommended, post-procedural prophylaxis is sometimes not necessary. To optimize the effectiveness of antibiotic prophylaxis (AP) in preventing SSIs, healthcare providers should adhere to evidence-based guidelines, such as those provided by the World Health Organization (WHO) or the American Society of Health-System Pharmacists (ASHP). These guidelines provide recommendations on the appropriate selection, timing, and duration of antibiotic prophylaxis for various surgical procedures. In this literature review we looked if the data available support these recommendations. Methods: We searched PubMed database for articles written between 1st of January 2012 up to 31st of December 2022. We looked at randomized control trials (RCTs) of patients hospitalized in surgical departments, who were given postoperative antibiotic prophylaxis comparing them with those that did not receive it. Results: Out of a total of 566 randomized control trials, 15 were included in this literature review, totalling 11,728 patients. We found indications that in many cases it makes a significant difference in continuing antibiotic prophylaxis postoperatively. However, in some cases, this will result in a similar incidence of post-surgery nosocomial infections between the intervention and control groups. Conclusion: While antibiotic prophylaxis is an important strategy to prevent surgical site infections, the decision to extend antibiotic prophylaxis beyond the intraoperative period should be made on a case-by-case basis and led by guidelines.

Is there a relationship in-between ovarian endometriosis and ovarian cancer? Immunohistochemical profile of four cases with coexisting ovarian endometriosis and cancer.

Endometriosis (EMs) is a benign disease characterized by the presence of endometrial tissue outside the uterine cavity. EMs associated with ovarian cancer (OC) has a relative low incidence (5% to 10%), sometimes with evidence of a transition stage through atypical EMs (1.6% cases). We have assessed 135 consecutive patients with either EMs or OC and, out of them, our study reports on four cases of ovarian EMs and OC: two cases with endometrioid OC and two cases with high-grade serous OC (HGSOC). Cases with EMs and HGSOC are extremely rarely reported in the literature - we could find not more than 30 cases. The main objective of our research was to observe the possible similarities between EMs and OC. Secondly, we analyzed the differences between EMs associated with endometrioid OC and EMs associated with HGSOC. We evaluated them in terms of clinical status (age, stages of EMs and OC) and immunohistochemical (IHC) expression of estrogen receptor (ER), progesterone receptor (PR), Ki67, p53, p16, Wilms' tumor 1 (WT1), cluster of differentiation (CD) 34 and CD10 immunomarkers - we could not find in the literature all these markers assessed, in the same time, to such samples. Our results indicated that there are no similarities between EMs and OC and no atypical EMs was identified in our cases. We recorded higher values of ER expression in EMs associated with HGSOC than in EMs associated with endometrioid OC. Higher values of ER expression were also recorded in OC than in endometriotic foci. There were no differences in proliferative rate of endometriotic foci associated with endometrioid OC, compared to EMs associated with HGSOC. An aberrant IHC expression for p53 protein and p16 protein was noted only in HGSOC. Also, a positive immunostaining for Wilms' tumor 1 (WT1) was identified only in HGSOC. Higher values of microvessel density were recorded in OC but not in endometriotic foci. We concluded that there were no similarities between EMs and OC for the cases included in our study, but we noticed differences in terms of Ki67 index and also between hormonal receptors expression in EMs associated with HGSOC, comparing with EMs associated with endometrioid OCs. These results may represent a "brick" for future researches on the less understood EMs associated with type II of OCs, especially with HGSOC. Identifying the best marker, which can predict the risk of developing OC for the patients with EMs, may lead to discover new specific therapeutic agents and, therefore, a better, tailored, therapy.

A simple, effective technique for port-site closure after laparoscopy.

BACKGROUND AND OBJECTIVES: Fascial closure of port sites represents a challenging issue in laparoscopic surgery. The aim of this article is to introduce a procedure that allows the safe suturing of the abdominal fascia in these wounds. METHODS: We herein describe a simple technique for fascial closure after laparoscopy using a transcutaneous approach and standard surgical instruments for suture. RESULTS: The method was used in 34 patients with no intraoperative incidents and no port-site hernias during a mean follow-up of 23.9 months (median 20.5, range 5 to 47). CONCLUSION: The procedure is easy to perform, safe, fast, and inexpensive.