[Pelvic inflammatory disease and intrauterine contraceptive device. Monocentric continuous study of 70 cases over 5 years]. / Stérilet et infections pelviennes sévères. Étude monocentrique en continu de 70 cas en cinq ans.

BACKGROUND: Evaluation of relation between uterine devices and severe pelvic inflammatory disease. PATIENTS AND METHODS: Medical and surgical data for 5 years were collected in an universitary center. RESULTS: Seventy patients were found whose seven needed reanimation and ten, two or more surgical procedures. Risks factors were old age (>45 years) and time exposure (>5 years). DISCUSSION AND CONCLUSION: Severe pelvic inflammatory disease and uterine devices in not uncommon association. Prolonged use seems to be a risk factor.

[Laparoscopic creation of a neovagina by Vecchietti's technique: anatomic and functional results]. / Plastie vaginale par technique de Vecchietti cœlioscopique : résultats anatomiques et fonctionnels.

OBJECTIVES: To evaluate vaginoplasty by Vecchietti technique adapted to laparoscopy and the anatomical and functional long term outcomes. PATIENTS AND METHODS: We retrospectively studied the patients with vaginal agenesis (a Mayer-Rokitansky-Küster-Hauser syndrome for seven of young adults) operated from 1997 to 2011. The data of eight patients with a median age of 18years old was collected. Surgical complications were analysed. The functional outcomes were compared to a control group with the Female Sexual Function Index (FSFI). RESULTS: No major complication occurred during surgery. The postoperative mean vaginal measurement was 7.2cm (4.4-10). The total FSFI scores did not differ from that of the control group (19.2 versus 18 p=0.82). Desire, arousal, lubrication, orgasm, satisfaction, and pain of the patients were similar to controls. DISCUSSION AND CONCLUSION: Laparoscopic Vecchietti technique is a fast, simple and safe procedure to create a neovagina, and guarantees good anatomic and functional results.

Fertility and pregnancy following pelvic arterial embolisation for postpartum haemorrhage.

OBJECTIVES: To determine and compare the fertility and pregnancy outcomes following embolisation with or without uterine-sparing surgery for postpartum haemorrhage, and to attempt to identify specific risk factors associated with an increased likelihood of intrauterine synechia. DESIGN: Retrospective study. SETTING: University-affiliated tertiary referral centre. POPULATION: All consecutive women who had an embolisation with or without uterine-sparing surgery (vessel ligation and/or uterine compression) for postpartum haemorrhage between 1994 and 2007 were included. METHODS: Data were retrieved from medical files and telephone interviews. MAIN OUTCOME MEASURE(S): Fertility and pregnancy outcomes, synechia. RESULTS: Data were available for 68 of the 85 women (80%) included in the study. Among the 15 women who complained of amenorrhoea or decreased flow of menstruation, synechia was found in all those who decided to undergo an ambulatory hysteroscopy (n = 8). Seventeen women had 26 pregnancies with 19 term deliveries, one ectopic pregnancy, two abortions and four miscarriages. The clinical courses of the 19 complete gestations were uneventful, but postpartum haemorrhage recurred in six women (31.6%) (caused by placenta accreta in two women). Fertility and pregnancy outcomes did not differ between women who had undergone embolisation versus both embolisation and a uterine-sparing surgical procedure. The occurrence of synechia was significantly associated with a higher rate of placenta accreta/percreta (P < 0.001) and postpartum fever above 38.5 degrees C (P = 0.04). CONCLUSIONS: Embolisation, whether or not associated with a uterine-sparing surgical procedure, for postpartum haemorrhage does not appear to compromise a woman's subsequent fertility and obstetric outcome. Nevertheless, these women should be considered at high risk for postpartum haemorrhage during future deliveries.

[Laparoscopic surgery of profund endometriosis with rectal affect]. / Chirurgia laparoscopica a endometriozei profunde cu atingere rectala.

OBJECTIVE: To present the principles of laparoscopic treatment for rectal endometriosis and to discuss possible postoperative outcomes. MATERIAL AND METHODS: Our series included women managed for rectal endometriosis during consecutive 20 months in the Department of Gynecology and Obstetrics, Rouen University Hospital, Rouen--France. Patient's characteristics, symptoms, imaging examination results, surgical treatment and postoperative outcomes were all evaluated retrospectively. RESULTS: Sixteen patients presenting with rectal endometriosis were managed surgically, (mean age was 35.9 +/- 6.5 years). All women presented at least one severe painful symptom which was typical of a digestive involvement in 12 cases. MRI results suggested a rectal involvement in 14 cases, and endorectal ultrasound examination clearly showed rectal wall infiltration in all patients. The gynaecological stage of surgical treatment was carried out laparoscopically in 13 cases, and the digestive surgical stage in 7 cases. Two limited and 14 segmental rectal resections were performed. Transitory stoma was carried out in 9 women. The length of the surgical procedure depended on the number of endometriosis localizations with a median value of 6 h 30 min. Postoperative complications occurred in 6 women: 2 anastomosis stenosis, 1 anastomosis fistula, 1 abscess of the parietal wall and 1 bladder atonia. Complains of pain were completely or significantly improved in all cases. CONCLUSION: Surgical treatment for rectal endometriosis may be carried out laparoscopically. It should be reserved for women presenting with severe painful condition and may contribute to significant improvement. However, the balance of benefit and risks must also be assessed on a case to case basis prior to any decision for or against surgical treatment.