Metronidazole for Prevention of Pelvic Cellulitis and Abscess after Laparoscopic Hysterectomy: A Triple-blinded, Randomized, Placebo-controlled Clinical Trial.

STUDY OBJECTIVE: To determine whether a postoperative 5-day treatment schedule with vaginal metronidazole added to conventional antibiotic prophylaxis with 2 g cefazolin modifies the risk of pelvic cellulitis (PC) and pelvic abscess (PA) after total laparoscopic hysterectomy (TLH). DESIGN: A randomized, controlled, triple-blind, multicenter clinical trial. SETTING: Two centers dedicated to minimally invasive gynecologic surgery in Colombia. PATIENTS: A total of 574 patients were taken to TLH because of benign diseases. INTERVENTION: Patients taken to TLH were divided into 2 groups (treatment group, cefazolin 2 g intravenous single dose before surgery + metronidazole vaginal ovules for 5 days postoperatively, control group: cefazolin 2 g intravenous single dose + placebo vaginal ovules for 5 days postoperatively). MEASUREMENTS AND MAIN RESULTS: The absolute frequency (AF) of PC and PA and their relationship with the presence of bacterial vaginosis (BV) were measured. There was no difference in AF of PC (AF, 2/285 [0.7%] vs 5/284 [1.7%] in the treatment and placebo groups, respectively; risk ratio, 1.75; 95% confidence interval, 0.54-5.65; p = .261), nor for PA (AF, 0/285 [0%] vs 2/289 [0.7%]; p = .159, in the treatment and placebo groups, respectively). The incidence of BV was higher in the metronidazole group than the placebo group (42.5% vs 33.4%, p = .026). CONCLUSION: The use of vaginal metronidazole ovules during the first 5 days in postoperative TLH added to conventional cefazolin prophylaxis does not prevent the development of PC or PA, regardless of the patient's diagnosis of BV.

Traquelectomía radical vaginal con linfadenectomía pélvica por laparoscopia para cáncer de cérvix temprano: reporte de dos casos / Radical vaginal trachelectomy with laparoscopic pelvic lymphadenectomy for early cervical cancer: a report of two cases

Introducción: el cáncer de cérvix es la neoplasia ginecológica más común en países en desarrollo donde las pacientes con deseo reproductivo no tenían en el pasado posibilidades quirúrgicas de tratar el cáncer y al mismo tiempo conservar la fertilidad. El objetivo de la presentación de estos casos es reportar la factibilidad de realizar el procedimiento en nuestro medio. Casos clínicos: se presentan dos casos de pacientes con cáncer de cérvix IA2 y IB1, de 29 y 24 años respectivamente, con deseo de conservar la fertilidad, a quienes se les realizó traquelectomía radical vaginal y linfadenectomía pélvica por laparoscopia con buen resultado quirúrgico. Conclusión: las técnicas de tratamiento mínimamente invasivas en pacientes con cáncer invasor de cérvix surgen como una alternativa para considerar cuando se quiere conservar la fertilidad.