Improvement of Post-Operative Quality of Life in Patients 2 Years after Minimally Invasive Surgery for Pain and Deep Infiltrating Endometriosis.

This study addressed the improvement in the quality of life of patients 2 years after minimally invasive surgery for painful deep infiltrating endometriosis (DIE), evaluated with EHP-5 (Endometriosis Health Profile-5) scores and the intensity of dysmenorrhea and dyspareunia. This was a retrospective study, performed in a referral centre for endometriosis, between January 2010 and January 2019. EHP-5 scores were complete for 54 patients, and two subgroups were analysed: classic laparoscopy (CL) vs. robotic laparoscopy (RL), and conservative surgery (ConservS) vs. total surgery (TS). There was an important decrease in 2-year post-operative EHP-5 scores in the global population (pre-op: 61.36 (42.18−68.75) and 2-year post-op: 20.45 (0−38.06); p < 0.001). The Visual Analogic Scale (VAS) was also lower for dysmenorrhea (pre-op: 8 (7−9.75) vs. 2-year post-op: 3 (2−5.25); p < 0.001) and dyspareunia (pre-op: 6 (3.1−8.9) vs. 2-year post-op: 3 (0−6); p < 0.001). In the subgroup analysis, EHP-5 scores were improved in the RL group (pre-op: 65.9 (59.09−71.02) vs. 2-year post-op: 11.4 (0−38.06); p < 0.001) and the CL group (pre-op: 50 (34.65−68.18) vs. 2-year post-op: 27.27 (14.20−40.90); p < 0.001), with a slight advantage for RL (p = 0.04), and the same improvements were found for ConservS (pre-op: 61.4 (38.06−71.59) vs. 2-year post-op: 22.7 (11.93−38.07); p < 0.001) and TS groups (pre-op: 61.59 (51.70−68.75) vs. 2-year post-op: 13.63 (0−44.30); p < 0.001). Minimally invasive surgery improved the quality of life for DIE patients 2 years after surgery, and conservative surgery showed comparable results to total surgery.

Breast Reconstruction by Exclusive Lipofilling after Total Mastectomy for Breast Cancer: Description of the Technique and Evaluation of Quality of Life.

BACKGROUND: The objective of this work was to describe the technique of exclusive lipofilling in breast reconstruction after total mastectomy, to evaluate the satisfaction and quality of life of the patients, and to explore current literature on the subject. METHODS: We conducted a retrospective observational multicentric study from January 2013 to April 2020. The modalities of surgery, esthetic result, and patient satisfaction were evaluated with the breast reconstruction module of BREAST-Q. RESULTS: Complete data were available for 37 patients. The mean number of sessions was 2.2 (standard deviation 1.1), spread over an average of 6.8 months (SD 6.9). The average total volume of fat transferred was 566.4 mL. The complication rate was 18.9%. No severe complication was observed (Clavien-Dindo 3/4). Two patients were diagnosed with recurrence, in a metastatic mode (5.4%). The average satisfaction rate was 68.4% (SD 24.8) for psychosocial well-being and 64.5% (SD 24.1) for sexual well-being. The satisfaction rate was 60.2% (SD 20.9) for the image of the reconstructed breast and 82.7% (SD 21.9) for locoregional comfort. CONCLUSIONS: Breast reconstruction by exclusive lipofilling after total mastectomy provides satisfactory quality of life scores. The simplicity of the surgical technique and equipment required, and the high satisfaction rate confirm that lipofilling should be included in the panel of choice of breast reconstruction techniques.

Relevance of Laparoscopic Surgery for Ovarian Cancer in Well-selected Patients: A Propensity-matched Comparison With Laparotomy.

BACKGROUND/AIM: This study aimed to evaluate the relevance of laparoscopy in comparison with laparotomy in the management of ovarian cancer in well-selected patients. PATIENTS AND METHODS: Data of consecutive ovarian cancer patients treated by laparoscopy were matched 1:1 to a cohort of patients operated by laparotomy using a propensity score matching. The inclusion criteria included patients who underwent a complete staging procedure in the early stages and optimal upfront or interval debulking surgery for advanced ovarian cancer. RESULTS: In total, 153 patients were included. Propensity score matching led to the analysis of 41 well-balanced pairs of patients. For a median follow-up of 34.0 [19.0-64.0] months and 38.0 [24.5-75.0] months, respectively, no difference was found between the two groups in regards to overall survival (p=0.28) and disease-free survival (p=0.89). CONCLUSION: In well-selected patients, laparoscopic surgery may be a safe and effective alternative to laparotomy.

Development of a French version of the Endometriosis Health Profile 5 (EHP-5): cross-cultural adaptation and psychometric evaluation.

PURPOSE: The Endometriosis Health Profile 5 (EHP-5) is a short version of an endometriosis-specific quality of life questionnaire. The objective of the study was to assess the psychometric validity of its French version. METHODS: A total of 125 patients with histologically proven endometriosis who underwent surgery for painful symptoms and 80 asymptomatic controls completed the EHP-5. Principal components analysis was performed to determine the dimensions of the instrument. Internal consistency was assessed using Cronbach's alpha. Construct validity was assessed by testing the relationship between the EHP-5 and the characteristics of endometriosis. RESULTS: For each item of EHP-5, endometriosis patients scored significantly higher than control women (p > 0.0001). Eleven items of the EHP-5 were unidimensional with excellent internal consistency (Cronbach's alpha = 0.92), and a summary aggregated index was then constructed. The EHP-5 index was sensitive to the presence of endometriosis, the type, location, severity of the disease, and pain or infertility as the main complaint with effect sizes ranging from 0.48 (95 % CI 0.11-0.85) for superficial endometriosis to 2.56 (95 % CI 2.18-2.93) for deeply infiltrating endometriosis. CONCLUSION: The French version of EHP-5 is valid and can be used for reporting patient-orientated outcome in future studies of French-speaking patients with endometriosis.

Pyomyoma after abortion: Uterus conserving surgery is possible to maintain fertility. Case report.

INTRODUCTION: Pyomyoma is a rare complication associated with high rates of morbidity and mortality. PRESENTATION OF CASE: We report the case of a 28-year-old nulligravida patient presenting pyomyoma following a spontaneous abortion at fourteen weeks and four days. Fourteen days following spontaneous miscarriage she was referred to the hospital with abdominal pain and fever. An antibiotic treatment was initiated. However, after ten days, the patient's condition deteriorated and a decision for an emergency laparotomy made. The pyomyoma was successfully resected and the patient's postoperative recovery was uneventful. A new pregnancy was confirmed two years later. DISCUSSION: The diagnosis of pyomyoma can be difficult but surgical treatment is often indicated. Performing a prompt myomectomy avoids the need for hysterectomy, preserving future fertility. CONCLUSION: Pregnancy is possible following uterine sparing treatment of pyomyoma.