Age at menarche: risk factor for gestational diabetes.

This study examines the relationship between the age at menarche and gestational diabetes mellitus (GDM). This retrospective study included subjects who were diagnosed with GDM at a pregnancy polyclinic in Kocaeli, Turkey between 2014 and 2018. The mean ages at menarche were 12.6 and 13.03 years in the GDM group and control group, respectively. The analysis results showed that pre-pregnancy cycle duration, age at menarche and pre-pregnancy BMI are statistically significant in terms of the development of gestational diabetes. (p < .05).In our study showed that the risk of GDM was found to be 2.3 times higher in pregnant women with a menarche age of <12 years. If the pre-pregnancy BMI value is more than 25 kg/cm2, the risk of GDM was found to be approximately 2 times higher. The study indicated that age at menarche, cycle duration, and BMI were risk factors for GDM. IMPACT STATEMENTWhat is already known on this subject? GDM has a lasting health impact on both the mother and the foetus. While several risk factors have previously been identified for GDM such as family history, obesity, advanced maternal age, significant gaps remain in our understanding of the risk factor and pathogenesis. Recent studies suggested that earlier menarche was significantly associated with an increased risk of GDM.What do the results of this study add? There might be ethnic differences on the relationship between the GDM and menarche age. There is no study examining the relationship between the age of menarche and GDM in Turkey. In presented study, we determined the risk factors of GDM including the age of menarche, cycle duration and BMI.What are the implications of these findings for clinical practice and / or further research? Therefore, a comprehensive evaluation of the menstrual history by healthcare professionals is important for future pregnancy risks. It is important to understand risk factors for GDM and to establish preventive strategies among high-risk populations. In addition, this study will shed light on future epidemiological and cohort studies.

Evaluation of inflammatuar response in hysterectomies: a retrospective study in Kocaeli, Turkey.

OBJECTIVES: The authors aimed to detect the inflammatory marker changes in laparoscopic hysterectomy (LH) and abdominal hysterectomy (AH) and to determine whether oophorectomy affected the results. MATERIAL AND METHODS: The patients who underwent LH and AH with or without oophorectomy between 2018 and 2019 were identified as two groups. The records of patients were reviewed retrospectively. Preoperative and postoperative in the first 24 hours hematocrit (HCT), hemoglobin (HB), white blood cell (WBC), platelet-lymphocyte ratio (PLR), and neutrophil-lymphocyte ratio (NLR) values were compared. RESULTS: WBC, NLR, and PLR were statistically increased, and HB and HCT were decreased in all groups in the postoperative period. However, all changes were more prominent in the AH group than in the LH group. In other words, in the postoperative period, there were fewer changes in the inflammatory markers WBC, NLR, and NLR in the LH group. Oophorectomy did not affect these results. CONCLUSIONS: LH, as in other laparoscopic operations, was associated with lower inflammatory response. The addition of oophorectomy did not increase inflammation in either AH or LH. Clinical Trials registration number is NCT04184765.

Impact of bupivacaine injection to trocar sites on postoperative pain following laparoscopic hysterectomy: Results from a prospective, multicentre, double-blind randomized controlled trial.

OBJECTIVES: Laparoscopic surgery has numerous advantages over open surgery in view of postoperative pain. In this context, to elevate its benefits and patient satisfaction, different pain management interventions have been used so far. This study aimed to evaluate the effect of bupivacaine injection to trocar sites following laparoscopic hysterectomy for the management of postoperative pain. STUDY DESIGN: In this study, patients were randomized into two groups (56 cases; 52 controls). A single injection of bupivacaine (0.5 %, 5 mg/mL) was introduced to trocar sites under subcutaneous tissue at a dose of 4 ml for the umbilicus and 2 ml for each 5-mm ancillary trocar site in the study group. No bupivacaine was administered to the control group. The primary aim was to measure differences in 2 -h postoperative numerical rating scale (NRS) pain scores between the two groups. The secondary aims were to evaluate differences between 1-, 4-, 6-, 24- and 48 -h postoperative NRS pain scores, surgical complications, estimated blood loss, duration of operation and analgesic consumption. RESULTS: The number of postoperative rescue doses of analgesics was found to be lower in the study group compared to the control group (median of 2 vs. 4; p < 0.01). The 1-, 4-, 6-, 24- and 48-hour postoperative NRS pain scores were also found to be lower in the study group compared to the control group (p < 0.01 at each follow-up). The mean duration of surgery and uterus removal, as well as the estimated blood loss, were not significantly different between the two groups. CONCLUSIONS: The present study suggests that bupivacaine injection to trocar sites is an effective and safe method for reducing pain following laparoscopic hysterectomy.

Comparison of pregnant Turkish women and Syrian refugees: Does living as a refugee have an unfavorable effect on pregnancy outcomes?

OBJECTIVE: To compare pregnant Turkish women and Syrian refugee women in terms of demographic data and obstetric and neonatal outcomes. METHODS: In a retrospective study, the records of Turkish women and Syrian refugee women who gave birth at the Health Sciences University Kocaeli Derince Training and Research Hospital, Kocaeli, Turkey, between January 1, 2016, and July 31, 2017 were examined. Maternal characteristics and obstetric and neonatal outcomes were compared between the two groups. RESULTS: The study, which included 7950 Turkish women and 620 Syrian refugee women, found significant differences in maternal age according to nationality. The rate of normal delivery was significantly lower for the Turkish women at 51.6% (P=0.001) compared to 61.3% for the Syrian refugee women. The rate of delivery prior to 37 weeks of gestation was 1.8% for the Turkish women and 3.2% for the Syrian refugee women, indicating earlier delivery for the Syrian refugees than the Turkish women (P=0.017). A significant difference was found between the birth weights of infants born in the two groups (P=0.001). CONCLUSION: According to the study results, Syrian refugees have a higher rate of adolescent birth and low-birth-weight neonates which could be attributed to poor care and insufficient nutrition during pregnancy while living as a refugee in Turkey.

The impact of chewing gum on postoperative bowel activity and postoperative pain after total laparoscopic hysterectomy.

We aimed to investigate the effects of chewing gum on bowel activity and postoperative pain in patients undergoing laparoscopic hysterectomy. Patients were randomised into two groups (n = 58, study; n = 51, control). In the study group, patients started chewing sugarless gum every 2 h for 15 min, beginning at the second postoperative hour. The control group did not chew gum, and they received standard postoperative care. Both groups were compared primarily in terms of the amount of time until the first bowel movement, the time of the first passage of flatus and the time of first defaecation. The amount of time until the first bowel movement, the time of the first passage of flatus and the time of the first defaecation were found to be significantly shorter in the chewing gum group (p < .001). The amount of postoperative analgesics that were needed and VAS scores at 6-hours and 24-hours postoperatively, were found to be lower in the study group than in the control group (p < .001). Chewing gum was found to have beneficial effects on bowel motility and postoperative pain in patients undergoing laparoscopic hysterectomy. This affordable and simple method could be recommended to patients after total laparoscopic hysterectomy.Impact statementWhat is already known on this subject? Postoperative gastrointestinal dysfunction remains a source of morbidity and the major determinant of length of stay after abdominal operation. The mechanism of enhanced recovery from postoperative gastrointestinal dysfunction with the help of chewing gum is believed to be the cephalic-vagal stimulation of digestion which increases the promotability of neural and humoral factors that act on different parts of the gastrointestinal tract.What do the results of this study add? The findings of previous randomised controlled studies have been inconsistent regarding the effect of chewing gum on postoperative bowel function following abdominal gynecological surgery. In this randomised prospective study, we found that chewing gum early in the postoperative period after total laparoscopic hysterectomy hastened time to bowel motility and flatus. To our knowledge this is the first study of the impact of chewing gum on bowel motility after total laparoscopic hysterectomy.What are the implications of these findings for clinical practice and/or further research? Chewing gum early in the postoperative period following laparoscopic hysterectomy hastens time to bowel motility and flatus. The use of chewing gum is a simple and cheap strategy for promoting the recovery of gastrointestinal functions.

Comparison of the pregnancy results between adolescent Syrian refugees and local adolescent Turkish citizens who gave birth in our clinic.

Adolescence is the transition period from childhood to adulthood; the World Health Organization has defined it as the ages between 10 and 19. Approximately 11% of all births in the world are by adolescent mothers. Pregnant adolescent refugees who have been forced to emigrate due to civil wars raging on in their native countries often face difficult social life conditions, have little or no access to hospitals, and experience language barriers and poor nutritional status have been found to experience poor maternal and obstetric outcomes. These include an increase in cesarean births, premature births, intrauterine growth retardation, and low-birth-weight infant rates. The purpose of the article was to share with you the comparative results of the adolescent pregnancies among the immigrants and among the local adolescents who gave birth between January 2016 and July 2017 in Kocaeli Derince Training and Research Hospital Gynecology Clinic in Kocaeli, Turkey. Its materials and method is a comparative study planned retrospectively between 67 adolescent Syrian refugees and 188 adolescent Turkish locals who gave birth between January 2016 and July 2017. The demographic data, obstetric outcomes, hospitalization durations, and neonatal outcomes of the patients were compared between the groups. Results, no statistically significant difference was found between pregnancy numbers, normal birth rates, cesarean sections and interventional birth rates, nullipara-multipara birth rates, or premature birth rates (<37 weeks) of the pregnant Turkish adolescents and pregnant immigrant adolescents (p > .05). The number of days these patients were hospitalized was found to be lower among Syrian immigrants than among the Turkish locals and statistically significant (p = .045 and p < .05, respectively). In addition, an analysis of the birth rates of low-birth-weight infants revealed that said rates were higher among the Syrian refugees than the Turkish local and statistically borderline significant (p = .049, p < .05, respectively). Between January 2016 and July 2017, a total of 8,570 live births were performed in our clinic. In our study of the 255 patients under the age of 19 who gave live births, 188 were Turkish and 67 were Syrian refugees. The average age of Turkish mothers under 19 was found to be 17.30 ± 1.01 years and the average age of immigrant mothers was found to be 17.27 ± 0.82 years. In conclusion, adolescent pregnancies are more common among Syrian refugees. Adolescent pregnancies are at risk for obstetric and neonatal outcomes. Therefore, studies should be done to prevent these pregnancies.

Intraoperative superior hypogastric plexus block during cesarean section: a new technique for pain relief.

Background: With increasing cesarean section rates all around the world, postoperative pain management is an important issue for all women. Good postoperative pain management helps to shorten the recovery period of the mother, improve the mother's feeling of well-being, enable good breastfeeding, and provide optimum maternal-neonatal bonding.Objective: To evaluate the efficacy of intraoperative superior hypogastric plexus block (SHPB) during cesarean section and describe the technique.Study design: This was a prospective quasi-experimental study that was conducted with 69 pregnant women at HSU. Kocaeli Derince Training and Research Hospital Obstetrics and Gynecology Clinics between 15 March 2018 and 15 August 2018. The case group included 34 healthy pregnant women who received SHPB (SHPB+) for postoperative pain relief during cesarean section under general anesthesia, and the control group included 35 healthy pregnant women who did not receive SHPB during cesarean section with general anesthesia (SHPB-). Postoperative 1st hour, 6th hour, 12th hour, 24th hour, and 48th hour visual analog scale (VAS) scores, the amount of analgesics used for pain relief, and the time of the postoperative first gas extraction were assessed.Results: The SHPB (+) group had lower 1st hour VAS scores than the SHPB (-) group (p < .001). The mean postoperative 1st hour VAS score of the SHPB (+) group was 4.74 ± 1.44, and was 6.80 ± 2.08 for the SHPB (-) group. There were no differences in postoperative 6th hour, 12th hour, 24th hour, and 48th hour VAS scores between the groups. When the SHPB (+) and SHPB (-) groups were compared for postoperative analgesic use and for the first postoperative gas extraction time, the SHPB (+) group had lower analgesic use (p < .001), and the SHPB (-) group had earlier gas extraction. The mean analgesic use in the SHPB (+) group was 2.29 ± 1.11 and it was 4 ± 0.84 in SHPB (-) group. The mean gas extraction time for the SHPB (-) group was 18.03 ± 7.2 h, and was 24.56 ± 8.56 h for the SHPB (+) group (p = .001).Conclusion: SHPB performed intraoperatively in cesarean section procedures with general anesthesia is a simple, easy approach to perform during open surgery with direct vision. SHPB helps postoperative pain management extensively with low postoperative VAS scores and low analgesic requirement.

Intermediate-term outcomes of laparoscopic pectopexy and vaginal sacrospinous fixation: a comparative study

ABSTRACT Objective To compare the intermediate-term follow-up results of laparoscopic pectopexy and vaginal sacrospinous fixation procedures. Materials and Methods Forty-three women who had vaginal sacrospinous fixations(SSF) using Dr. Aksakal's Desta suture carrier and 36 women who had laparoscopic pectopexies were re-examined 7 to 43 months after surgery. The PISQ-12 and P-QOL questionnaires were answered by all of the women. Results The apical descensus relapse rates did not differ between the groups (14% in the SSF vs. 11.1% in the pectopexy group). The de novo cystocele rates were higher in the SSF group (25.6% in the SSF vs. 8.3% in the pectopexy group). There were no significant differences in the de novo rectocele numbers between the groups. The treatment satisfaction rates were high in both groups (93% in the SSF vs. 91.7% in the pectopexy group), which was not statistically significant. Moreover, the postoperative de novo urge and stress urinary incontinence rates did not differ; however, the postoperative sexual function scores (PISQ-12) (36.86±3.15 in the SSF group vs. 38.21±5.69 in the pectopexy group) were better in the pectopexy group. The general P-QOL scores were not significantly different between the surgery groups. Conclusion The vaginal sacrospinous fixation maintains its value in prolapse surgery with the increasing importance of native tissue repair. The new laparoscopic pectopexy technique has comparable positive follow-up results with the conventional sacrospinous fixation procedure.

Intermediate-term outcomes of laparoscopic pectopexy and vaginal sacrospinous fi xation: a comparative study.

OBJECTIVE: To compare the intermediate-term follow-up results of laparoscopic pectopexy and vaginal sacrospinous fi xation procedures. MATERIALS AND METHODS: Forty-three women who had vaginal sacrospinous fixations (SSF) using Dr. Aksakal's Desta suture carrier and 36 women who had laparoscopic pectopexies were re-examined 7 to 43 months after surgery. The PISQ-12 and P-QOL questionnaires were answered by all of the women. RESULTS: The apical descensus relapse rates did not differ between the groups (14% in the SSF vs. 11.1% in the pectopexy group). The de novo cystocele rates were higher in the SSF group (25.6% in the SSF vs. 8.3% in the pectopexy group). There were no significant differences in the de novo rectocele numbers between the groups. The treatment satisfaction rates were high in both groups (93% in the SSF vs. 91.7% in the pectopexy group), which was not statistically significant. Moreover, the postoperative de novo urge and stress urinary incontinence rates did not differ; however, the postoperative sexual function scores (PISQ-12) (36.86±3.15 in the SSF group vs. 38.21±5.69 in the pectopexy group) were better in the pectopexy group. The general P-QOL scores were not signifi cantly different between the surgery groups. CONCLUSION: The vaginal sacrospinous fixation maintains its value in prolapse surgery with the increasing importance of native tissue repair. The new laparoscopic pectopexy technique has comparable positive follow-up results with the conventional sacrospinous fixation procedure.

A comparison of novel laparoscopic suturing techniques in single-port surgery.

Objective: To compare the vaginal cuff closure times of a newly developed Turkish-made laparoscopic needle holder (TMLNH) and a Yoon Soon (YS) extracorporeal knot tying technique in the closure of the vaginal cuff during single-port laparoscopic hysterectomy.Material and methods: We retrospectively reviewed a total of 60 consecutive patients who underwent single-port laparoscopic hysterectomy using a TMLNH (n = 30) or a YS extracorporeal knot tying technique (n = 30).Results: The patients' demographic data, operative results, and complications were analyzed. Operative time and the time required for vaginal cuff suturing were significantly shorter in the TMLNH group than in the YS extracorporeal knot tying group (60.1 ± 3.2 vs. 77.3 ± 6.0 min, p = .001 and 24.5 ± 3.7 vs. 36.3 ± 3.8 min, p = .001, respectively). The intraoperative and postoperative complications were comparable in both groups.Conclusion: The use of TMLNH for vaginal cuff closure in single-port hysterectomy reduced the operative time and the time required for vaginal cuff suturing. However, both TMLNH and YS extracorporeal knot-tying technique may enable the surgeons to overcome the surgical challenges of SPA surgery.

Hysterectomy and salpingo-oophorectomy by transvaginal natural orifice transluminal endoscopic surgery (V-NOTES) assisted by an umbilical camera: Case report and new hybrid technique in gynecology.

INTRODUCTION: Natural orifice transluminal endoscopic surgery (NOTES) is a new development in the field of minimally invasive surgery. The aim of this study was to demonstrate a new hybrid NOTES technique in gynecology which can be used for hysterectomy and salpingo-oophorectomy in patients with adnexal pathology and multiple operation histories. PRESENTATION OF CASE: A 50-year-old woman with gravida 2 para 2 was referred to our clinic with left-sided abdominal pain. She had a history of two previous abdominal surgeries and a persistent ovarian cyst for 2 years. An ultrasound examination revealed a left complex hypoechoic ovarian cyst of 10 cm. Tumor markers were normal and the patient had no suspicion for malignancy. The hybrid NOTES technique assisted by an umbilical camera was planned due to the possibility of pelvic adhesions and her concerns about cosmesis. DISCUSSION: The major difference between NOTES and umbilical camera assisted NOTES is seeing all of the major structures, such as the ureters, uterine vessels, bowels, and pelvic adhesions, which can lead to complications during the surgery. In fact, hybrid NOTES can make surgeries more feasible. CONCLUSION: This new hybrid NOTES offers effective and safer surgical management in patients who have had previous surgery and adnexal masses.

Effect of multiparity on bone mineral density, evaluated with bone turnover markers.

OBJECTIVE: Our aim was to investigate the effect of parity on osteoporosis by evaluating bone mineral density, markers of bone turn-over and other factors that are effective in osteoporosis in multiparous (five deliveries or more) and nulliparous women in the post-menopausal period. METHODS: A total of 91 multiparous (five deliveries or more) and 31 nulliparous postmenopausal women were included in this study. All patients were interviewed on sociodemographic characteristics, gynecologic history, personal habits, levels of physical activity, and life-long intake of calcium. Bone mineral density was measured at lumbar (L1-4) and femoral neck regions with Dexa. RESULTS: The mean age of multiparous women was 58.79±7.85 years, and the mean age of nulliparous women was 55.84±7.51. The femoral BMD was 0.94±0.16 and lumbar BMD 1.01±0.16 in multiparous women, femoral BMD was 0.99±0.16 and lumbar BMD 1.07±0.14 in nulliparous women. There were no statistical differences between the femoral and lumbar T scores and BMD values of the two groups. Lumbar T scores and lumbar BMD showed a decrease with increasing total duration of breast-feeding in multiparous women. The independent risk factors for osteoporosis in the regression analysis of multiparous women were found to be the duration of menopause and body weight of 65kg and less. CONCLUSION: There is no difference between the bone mineral densities of multiparous and nulliparous women. Females with lower body-weight and longer duration of menopause should be followed-up more carefully for development of osteoporosis.

Effect of multiparity on bone mineral density, evaluated with bone turnover markers / Efeito da multiparidade sobre a densidade mineral óssea, avaliada por marcadores de remodelação óssea

Abstract Objective: Our aim was to investigate the effect of parity on osteoporosis by evaluating bone mineral density, markers of bone turn-over and other factors that are effective in osteoporosis in multiparous (five deliveries or more) and nulliparous women in the post-menopausal period. Methods: A total of 91 multiparous (five deliveries or more) and 31 nulliparous postmenopausal women were included in this study. All patients were interviewed on sociodemographic characteristics, gynecologic history, personal habits, levels of physical activity, and life-long intake of calcium. Bone mineral density was measured at lumbar (L1-4) and femoral neck regions with Dexa. Results: The mean age of multiparous women was 58.79 ± 7.85 years, and the mean age of nulliparous women was 55.84 ± 7.51. The femoral BMD was 0.94 ± 0.16 and lumbar BMD 1.01 ± 0.16 in multiparous women, femoral BMD was 0.99 ± 0.16 and lumbar BMD 1.07 ± 0.14 in nulliparous women. There were no statistical differences between the femoral and lumbar T scores and BMD values of the two groups. Lumbar T scores and lumbar BMD showed a decrease with increasing total duration of breast-feeding in multiparous women. The independent risk factors for osteoporosis in the regression analysis of multiparous women were found to be the duration of menopause and body weight of 65 kg and less. Conclusion: There is no difference between the bone mineral densities of multiparous and nulliparous women. Females with lower body-weight and longer duration of menopause should be followed-up more carefully for development of osteoporosis.

Resumo Objetivo: Investigar o efeito da paridade sobre a osteoporose por meio da avaliação da densidade mineral óssea, marcadores de remodelação óssea e outros fatores eficazes na avaliação da osteoporose em multíparas (cinco partos ou mais) e nulíparas no período pós-menopausa. Métodos: Foram incluídas neste estudo 91 multíparas (cinco partos ou mais) e 31 nulíparas, todas na pós-menopausa. As pacientes foram entrevistadas para a determinação das características sociodemográficas, história ginecológica, hábitos pessoais, níveis de atividade física e ingestão de cálcio ao longo da vida. A densidade mineral óssea foi medida na região lombar (L1-4) e do colo femoral com a Dexa. Resultados: A média de idade das multíparas e nulíparas foi de 58,79 ± 7,85 anos e 55,84 ± 7,51, respectivamente. Nas multíparas, a DMO femoral e lombar foi de 0,94 ± 0,16 e 1,01 ± 0,16, respectivamente; nas nulíparas, a DMO femoral e lombar foi de 0,99 ± 0,16 e 1,07 ± 0,14, respectivamente. Não houve diferença estatisticamente significativa entre os T-escores femoral e lombar e os valores de DMO dos dois grupos. O T-escore e a DMO lombar mostraram uma diminuição em caso de aumento na duração total da lactação materna em multíparas. Encontrou-se que os fatores de risco independentes para a osteoporose na análise de regressão das multíparas são a duração da menopausa e o peso corporal menor ou igual a 65 kg. Conclusão: Não há diferença entre a densidade mineral óssea de multíparas e nulíparas. As mulheres com menor peso corporal e maior duração da menopausa devem ser acompanhadas com mais atenção para determinar se há desenvolvimento de osteoporose.

Laparoscopic pectopexy: initial experience of single center with a new technique for apical prolapse surgery

ABSTRACT Objective: To share our first experience with laparoscopic pectopexy, a new technique for apical prolapse surgery, and to evaluate the feasibility of this technique. Materials and Methods: Seven patients with apical prolapse underwent surgery with laparoscopic pectopexy. The lateral parts of the iliopectineal ligament were used for a bilateral mesh fixation of the descended structures. The medical records of the patients were reviewed, and the short-term clinical outcomes were analyzed. Results: The laparoscopic pectopexy procedures were successfully performed, without intraoperative and postoperative complications. De novo apical prolapse, de novo urgency, de novo constipation, stress urinary incontinence, anterior and lateral defect cystoceles, and rectoceles did not occur in any of the patients during a 6-month follow-up period. Conclusion: Although laparoscopic sacrocolpopexy has shown excellent anatomical and functional long-term results, laparoscopic pectopexy offers a feasible, safe, and comfortable alternative for apical prolapse surgery. Pectopexy may increase a surgeon's technical perspective for apical prolapse surgery.

Newly Developed Laparoscopic Needle Holder That Facilitates Knot Tying Makes Vaginal Cuff Suturing Easy in Single-Port Laparoscopic Hysterectomy.

BACKGROUND: To evaluate vaginal cuff closure times of a single-port laparoscopic hysterectomy using a newly developed Turkish-made laparoscopic needle holder (TMLNH) with a single-port laparoscopic hysterectomy using a laparoscopic needle holder with pistol handle (LNHPH). METHODS: We retrospectively reviewed 68 patients who underwent single-port laparoscopic hysterectomy using a TMLNH (n = 38) or a LNHPH (n = 30). Patients' age, parity, body mass index, mean operating time, mean vaginal cuff suturing time, uterine weight, estimated blood loss, drop of hemoglobin level, return of bowel activity, hospital stay, conversion to multiport access, conversion to laparotomy, and postoperative and intraoperative outcomes were analyzed. RESULTS: The TMLNH group had a shorter operative time ( P < .001) and a shorter vaginal cuff suturing time ( P < .001) compared with the LNHPH group during a single-port laparoscopic hysterectomy. There was no difference in intraoperative and postoperative complications. CONCLUSION: The TMLNH facilitates vaginal cuff suturing and decreases operation time during a single-port laparoscopic hysterectomy. We proposed that the TMLNH is a promising technique for suturing and vaginal cuff closure in a single-port laparoscopic hysterectomy.

Laparoscopic pectopexy: initial experience of single center with a new technique for apical prolapse surgery.

OBJECTIVE: To share our first experience with laparoscopic pectopexy, a new technique for apical prolapse surgery, and to evaluate the feasibility of this technique. MATERIALS AND METHODS: Seven patients with apical prolapse underwent surgery with laparoscopic pectopexy. The lateral parts of the iliopectineal ligament were used for a bilateral mesh fixation of the descended structures. The medical records of the patients were reviewed, and the short-term clinical outcomes were analyzed. RESULTS: The laparoscopic pectopexy procedures were successfully performed, without intraoperative and postoperative complications. De novo apical prolapse, de novo urgency, de novo constipation, stress urinary incontinence, anterior and lateral defect cystoceles, and rectoceles did not occur in any of the patients during a 6-month follow-up period. CONCLUSION: Although laparoscopic sacrocolpopexy has shown excellent anatomical and functional long-term results, laparoscopic pectopexy offers a feasible, safe, and comfortable alternative for apical prolapse surgery. Pectopexy may increase a surgeon's technical perspective for apical prolapse surgery.

Total laparoscopic hysterectomy: Analysis of the surgical learning curve in benign conditions.

OBJECTIVE: To assess the learning curve for total laparoscopic hysterectomy. METHODS: This study was a retrospective analysis of the learning curve for two surgeons during their first 257 consecutive cases of total laparoscopic hysterectomy at a teaching hospital. Patients were divided sequentially into groups comprising the first 75 patients, the next 75, and the final 107 patients. Age, body mass index, gestational parity, indications for laparoscopic hysterectomy, previous pelvic surgery, operating time, haemoglobin decline, complications, need for transfusion, and length of hospital stay were evaluated. RESULTS: The mean operating time for total laparoscopic hysterectomy reduced significantly from 76.2 min to 68.9 min (p = 0.001) between the first and second 75-patient groups. Linear regression analysis showed a plateau was reached on the learning curve after 71-80 cases. The rate of all complications started at 8% in the first group of 75 patients, reduced to 6.7% in the next group, and decreased further in the final group to 4.7%. The decline was not statistically significant (p = 0.6). The difference in the need for transfusion was statistically significant between the first 75 patients and the second group of 75 (p = 0.04). Conversion from laparoscopy to laparotomy was required in five patients, four in the early group and one in the final group. Age, body mass index, parity, previous pelvic surgery, decline in haemoglobin, and length of hospital stay were similar among the three groups. CONCLUSIONS: A plateau in the learning curve for TLH was reached after the first 75 cases. We can infer that there is a learning curve for TLH as confirmed by the decrease in operating time (accompanied by no change in complications) correlated to gain in experience. On the other hand, one should not disregard the fact that laparoscopy is not a complication-free surgery and achievement of the learning curve does not exclude complications. Gynaecological surgeons can perform TLH securely during the learning curve.

Evaluation of the surgical outcome and complications of total laparoscopic hysterectomy in patients with enlarged uteruses.

OBJECTIVE: The aim of this study was to investigate whether uterine weight has a deleterious effect on the operation time, complication rates, length of hospital stay and incidence of intraoperative haemorrhage during total laparoscopic hysterectomy operation. METHODS: A total of 282 patients who underwent total laparoscopic hysterectomy for benign gynaecologic indications were retrospectively analyzed. The median operation time of 70 min was accepted as an index number, and a cut-off point of ≥300 g was calculated for uterine weight by using reciever operator characteristics (ROC) curve analysis. RESULTS: There was no statistically significant relationship between the uterine weight and haemoglobin drop rate (1.27 ± 0.89 vs 1.21 ± 0.88, p = 0.905), complication rate (10.83% vs 9.26%, p = 0.062) and length of hospital stay (3.27 ± 1.23 vs 3.37 ± 1.35 days, p = 0.505) based on this cut. Lee-Huang point was preferred for abdominal entry in cases with uteruses reached the level of umbilicus -2 cm in physical examination. CONCLUSIONS: Uterine weight was not effected the complication rate, estimated blood loss and length of hospital stay in total laparoscopic hysterectomy operation. A cut-off value of 300 g could be used for an increased operation time.

A Giant Vulvar Mass: A Case Study of Cellular Angiofibroma.

Cellular angiofibroma is a mesenchymal tumor that affects both genders. Nucci et al. first described it in 1997. Cellular angiofibroma is generally a small and asymptomatic mass that primarily arises in the vulvar-vaginal region, although rare cases have been reported in the pelvic and extrapelvic regions. It affects women most often during the fifth decade of life. The treatment requires simple local excision due to low local recurrence and no chance of metastasization. The current study presents a case of angiofibroma in the vulvar region that measured approximately 20 cm.