Risk factors for adverse clinical outcomes in patients with tubo-ovarian abscess.

This study assessed the risk factors for poor clinical outcomes in patients with tubo-ovarian abscess (TOA). Patients managed with medical therapy and discharged within 7 days without complications constituted the favourable prognosis group (n = 22), whereas those who were managed surgically or discharged after 7 days of antibiotic therapy constituted the poor prognosis group (n = 87). Variables including age, gravidity, number of dilation and curettage procedures, caesarean delivery, smoking status, serum C-reactive protein levels, serum white blood count, body temperature, abscess diameter, presence of an intrauterine device (IUD), duration of IUD placement and length of hospitalisation were evaluated to assess their relationship with the clinical prognosis of TOA. Abscess diameter of ≥ 6 cm was a significant parameter that increased the risk eightfold for poor prognosis. No significant differences were observed regarding the other variables.

A prospective randomized trial of postoperative pain following different insufflation pressures during gynecologic laparoscopy.

OBJECTIVE: To determine the effects of different intra-abdominal pressure values on visceral pain following gynecologic laparoscopic surgery in the Trendelenburg position. STUDY DESIGN: This randomized, controlled prospective trial was conducted at a tertiary education hospital and included 150 patients who underwent gynecologic laparoscopy with different abdominal insufflation pressures. There were 54 patients in the 8 mmHg low pressure group (LPG), 45 in the 12 mmHg standard pressure group (SPG), and 51 in the 15 mmHg high pressure group (HPG). We assessed mean age, body mass index (BMI), duration of surgery, analgesic consumption, length of hospital stay, amount of CO2 expended and volume of hemorrhage. Visceral pain and referred visceral pain were assessed 6, 12, and 24 h postoperatively using a visual analog scale (VAS). RESULTS: There was no significant difference in age, BMI, analgesic consumption or length of hospital stay among groups. The mean operative time and total CO2 expended during surgery were higher in the LPG compared with the SPG and HPG. The mean intensity of postoperative pain assessed by the VAS score at 6 and 12 h was less in the LPG than in the SPG and HPG and was reduced significantly at 12 h. VAS scores at 24 h in the LPG and SPG were lower than in the HPG. CONCLUSION: Pain is reduced by low insufflation pressure compared with standard and high insufflation pressure following gynecologic laparoscopic surgery in the Trendelenburg position. However, low insufflation pressure may result in longer operation times and increased hemorrhage.

Long-term surgical outcomes of vaginal sacrospinous ligament fixation in women with pelvic organ prolapse.

AIM: Few studies have demonstrated the effects of the sacrospinous ligament fixation (SLF) in the long-term period. Aim of the study was to evaluate the short- and long-term outcomes of SLF. METHODS: This was a longitudinal cohort study. Fifty-one patients who had undergone SLF were evaluated postoperatively at 1 and 7 years. The characteristics of patients, intra- and postoperative complications, length of hospital stay period, short and long-term outcomes of the surgeries were recorded. Objective success was evaluated by vaginal and POP-Q examination at 1 and 7 years postoperatively. RESULTS: Out of 51 patients, 46 (90.19%) patients underwent vaginal hysterectomy, 36 (70.58%) patients anterior colporrhaphy, 31 (60.78%) patients posterior colporrhaphy and 11 (21.56%) patients transobturator tape concomitantly with SLF. The differences of Aa, Ba, Ap, Bp and total vaginal length (TVL) scores between preoperative, postoperative at 1 and 7 years were statistically significant (P<0.001). Cystocele rate, at 1 year and at 7 years, were 8 out of 51 (15.68%) and 9 out of 35 (25.71%), respectively. The objective cure rate for the apical vaginal vault prolapse at 1 year and at 7 years were 96% (49/51) and 94.28% (33 /35), respectively. CONCLUSION: SLF is an appropriate and safe treatment procedure in patients with vaginal vault prolapse in the seven years of follow-up period.