Laparoscopic Management of an Intrauterine Fallopian Tube Incarceration After Curettage for a Non-progressing Pregnancy.

STUDY OBJECTIVE: To report and demonstrate a case of a laparoscopic repair of an intrauterine fallopian tube incarceration as complication of curettage. DESIGN: A step-by-step explanation of the surgery using video (instructive video) (Canadian Task Force classification III). SETTING: University Hospital Estaing, Clermont-Ferrand, France. PATIENT: A 29-year-old woman experiencing a nonevolving pregnancy at 8 weeks underwent curettage. After 9 months, she complained of abnormal vaginal discharge. Ultrasound evaluation showed a right parauterine mass. She reported a maternal medical history of ovarian cancer in a context of Lynch syndrome. Magnetic resonance imaging revealed a right hydrosalpinx 12 mm in diameter, with a suspect fimbriae lesion of the tube and a 7-mm endometriosis nodule of the uterine torus. INTERVENTION: We decided to explore the fallopian tube by laparoscopy and to perform hysteroscopy. A fallopian tube incarceration was suspected during hysteroscopy: a defect of the uterine wall was observed, through which there was protrusion of a tubal fimbriae. The laparoscopic view of the pelvis confirmed incarceration of the right fallopian tube through the uterine wall. It was carefully extracted out of the uterine defect, and the uterine wall defect was repaired with an X-point using Monocryl 1. MEASUREMENTS AND MAIN RESULTS: A tubal patency test was performed, which was positive on both sides. Because phimosis responsible for the hydrosalpinx had been treated, salpingectomy was not performed. CONCLUSION: Curettage for miscarriage or undesired pregnancy is not exempt from complications, such as hemorrhage, simple perforation, and infection. Intrauterine fallopian tube incarceration is uncommon but can affect fertility. This diagnosis is important to avoid destruction of the fimbriae and necrosis of the tube and also to reduce the risk of ectopic pregnancy.

Effects of low intraperitoneal pressure and a warmed, humidified carbon dioxide gas in laparoscopic surgery: a randomized clinical trial.

Laparoscopic surgery technology continues to advance. However, much less attention has been focused on how alteration of the laparoscopic surgical environment might improve clinical outcomes. We conducted a randomized, 2 × 2 factorial trial to evaluate whether low intraperitoneal pressure (IPP) (8 mmHg) and/or warmed, humidified CO2 (WH) gas are better for minimizing the adverse impact of a CO2 pneumoperitoneum on the peritoneal environment during laparoscopic surgery and for improving clinical outcomes compared to the standard IPP (12 mmHg) and/or cool and dry CO2 (CD) gas. Herein we show that low IPP and WH gas may decrease inflammation in the laparoscopic surgical environment, resulting in better clinical outcomes. Low IPP and/or WH gas significantly lowered expression of inflammation-related genes in peritoneal tissues compared to the standard IPP and/or CD gas. The odds ratios of a visual analogue scale (VAS) pain score >30 in the ward was 0.18 (95% CI: 0.06, 0.52) at 12 hours and 0.06 (95% CI: 0.01, 0.26) at 24 hours in the low IPP group versus the standard IPP group, and 0.16 (95% CI: 0.05, 0.49) at 0 hours and 0.29 (95% CI: 0.10, 0.79) at 12 hours in the WH gas group versus the CD gas group.