Vaginal repair of cesarean section scar diverticula.

STUDY OBJECTIVE: To introduce a new vaginal surgery for repair of cesarean scar diverticula and to evaluate the effectiveness of this treatment for correcting the anatomic defect and eliminating abnormal uterine bleeding. DESIGN: Retrospective clinical study (Canadian Task Force classification II-3). SETTING: University-affiliated hospital. PATIENTS: Data for 42 patients were reviewed retrospectively. All patients had abnormal uterine bleeding, prolonged menstrual flow, and/or postmenstrual spotting. The diagnosis of a cesarean scar diverticulum of the uterus was established using transvaginal ultrasound. INTERVENTIONS: Hysteroscopy was performed to visualize the defect if necessary. Vaginal repair involved excision of the scar and surrounding tissue, followed by closure using 2 layers of sutures. MEASUREMENTS AND MAIN RESULTS: The median (range) duration of surgery was 60 (30-120) minutes; blood loss during surgery was 45 (10-100) mL; length of hospital stay was 3 (2-11) days. Perioperative complications occurred in 1 of 42 patients (2.4%). Follow-up ranged from 10 to 23 months. The efficacy of anatomic correction and rate of symptomatic relief was 92.9% (39 of 42 patients). CONCLUSION: Vaginal repair is a minimally invasive and effective surgical approach for treatment of uterine scar diverticula associated with previous cesarean section.

Parecoxib increases muscle pain threshold and relieves shoulder pain after gynecologic laparoscopy: a randomized controlled trial.

OBJECTIVES: Postlaparoscopic shoulder pain (PLSP) remains a common problem after laparoscopies. The aim of this study was to investigate the correlation between pressure pain threshold (PPT) of different muscles and PLSP after gynecologic laparoscopy, and to explore the effect of parecoxib, a cyclooxygenase-2 inhibitor, on the changes of PPT. MATERIALS AND METHODS: The patients were randomly allocated into two groups; group P and group C. In group P, parecoxib 40 mg was intravenously infused at 30 minutes before surgery and 8 and 20 hours after surgery. In group C, normal saline was infused at the corresponding time point. PPT assessment was performed 1 day before surgery and at postoperative 24 hours by using a pressure algometer at bilateral shoulder muscles (levator scapulae and supraspinatus) and forearm (flexor carpi ulnaris). Meanwhile, bilateral shoulder pain was evaluated through visual analog scale score at 24 hours after surgery. RESULTS: Preoperative PPT level of the shoulder, but not of the forearm, was significantly and negatively correlated with the intensity of ipsilateral PLSP. In group C, PPT levels of shoulder muscles, but not of forearm muscles, decreased after laparoscopy at postoperative 24 hours. The use of parecoxib significantly improved the decline of PPT levels of bilateral shoulder muscles (all P<0.01). Meanwhile, parecoxib reduced the incidence of PLSP (group P: 45% vs group C: 83.3%; odds ratio: 0.164; 95% confidence interval: 0.07-0.382; P<0.001) and the intensity of bilateral shoulder pain (both P<0.01). CONCLUSION: Preoperative PPT levels of shoulder muscles are closely associated with the severity of shoulder pain after gynecologic laparoscopy. PPT levels of shoulder muscles, but not of forearm muscles, significantly decreased after surgery. Parecoxib improved the decrease of PPT and relieved PLSP.

[Analysis of 216 cases of total laparoscopic hysterectomy].

OBJECTIVE: To investigate the effectiveness and safety of total laparoscopic hysterectomy (TLH). METHODS: A retrospective study of laparoscopic hysterectomy was conducted in this setting. From March 2002 through March 2004, 216 women were subjected to TLH. The average age of the patients was 45.5 years (38-60 years). Out of the 216 patients, 24 had dysfunctional uterine bleeding, 5 atypical endometrial hyperplasia, 139 uterine fibroid, 46 adenomyosis, 2 cervical carcinoma in situ and 36 had a previous lower abdominal surgery. The TLH was carried out using ultrasonic scalpel and the amputated uterus was removed transvaginally. The vagina and peritoneum were closed under laparoscopy. RESULTS: Of the 216 cases who underwent TLH, 23 had bilateral adnexectomy, 36 had ovarian cystectomy, and 54 had adhesiolysis simultaneously. No case was converted to laparotomy. The mean operating time was (103 +/- 35) min. The average amount of blood loss was 83 +/- 45 ml (60-320 ml) during operation. The average hospital stay after operation was (5.3 +/- 1.9) days. There were 4 patients with urinary tract injury in this study population. One bladder perforation was found during operation and repaired under laparoscopy. Two patients had vesicovaginal fistula formation. One ureteral-vaginal fistula was found after operation. The fistula was all closed spontaneously with a prolonged catheter drainage. CONCLUSIONS: TLH appears a safe, effective and reproducible procedure. It is an alternative method for those women who need hysterotomy.