Robotic Management of Recurrent Rectal Endometriosis After Previous Segmental Bowel Resection.

OBJECTIVE: To describe the management of recurrent bowel endometriosis after previous colorectal resection. DESIGN: Surgical video article. The local institutional board review was omitted due to the narration of surgical management. Patient consent was obtained. SETTING: A tertiary referral center. The patient first underwent segmental bowel resection for deep infiltrating endometriosis of the rectum in the ENDORE randomized controlled trial in 2012 and then received a total hysterectomy in 2018. Five years later, she presented with recurrent nodules in the rectovaginal, left parametrium, and abdominal wall after discontinuing medical suppressive treatment. INTERVENTION: Laparoscopic management using robotic assistance was employed to complete excision of the rectovaginal nodule. Disc excision was performed to remove rectal infiltration. The procedure started with rectal shaving and excision of vaginal infiltration . A traction stitch was placed over the limits of the rectal shaving area. The general surgeon placed a 28 mm circular anal stapler transanally and performed complete excision of the shaved rectal area. Anastomotic perfusion was checked with indocyanine green. A methylene blue enema test was conducted to rule out anastomotic leakage. Outcomes were favorable, with systematic self-catheterization during 5 postoperative weeks. No specific symptoms were related to the other 2 nodules, which were not removed. CONCLUSION: Rectal recurrences may occur long after colorectal resection and outside the limits of the previous surgery site. To accurately assess this risk, long-term follow-up of patients is mandatory.. Postoperative medical amenorrhea may play a role in recurrence prevention. Surgical management of recurrences may be challenging and focus on only those nodules responsible for symptoms so as to best preserve the organ's function and reduce postoperative morbidity.

Incisional hernia after ovarian debulking surgery.

OBJECTIVES: The purpose of our study was to explore the incidence and contributing variables of an incisional hernia after debulking surgery for advanced ovarian cancer. MATERIAL AND METHODS: The imaging of patients who underwent debulking surgery with an extended vertical incision was re-evaluated for incisional hernias at one-year follow-up, and their medical records were reviewed. We performed univariate and multivariate analysis to find out the risk factors for an incisional hernia. RESULTS: The overall annual incidence of incisional hernia was 26.7 percent (46 of 172). Univariate analysis revealed a statistically significant relationship between age, body mass index (BMI), and the length of the incision and the incidence of an incisional hernia. The only factor identified by multivariate analysis as being independently related with the development of an incisional hernia within a year of the operation was BMI (OR 1.12, 95% CI 1.01-1.25, p = 0.04). CONCLUSIONS: Incisional hernia rates were high after ovarian cancer surgeries, and BMI was the independent factor significantly linked to hernia formation. To reduce the high ratio of incisional hernia among these group of patients, preventative strategies should be researched and applied.

Comparison of transumbilical and periumbilical median incisions in ovarian cancer surgery

Objective: The umbilicus is traditionally circumvented while performing a vertical midline abdominal incision. There is a gap in knowledge pertaining to avoiding the umbilicus. Our aim was to investigate whether a transumbilical (TU) or periumbilical (PU) midline incision conferred any advantage to the patient. Material and Methods: This was a retrospective cohort study of patients undergoing ovarian cancer surgery with a midline incision, from the pubic tubercle to the xiphoid. All surgery was performed by the same team of gyneacological oncologists. Patients were classified into two groups according to the midline incision used, TU or PU. The primary endpoint was the incision wound complication rate. Results: TU and PU midline incisions were performed in 54 and 68 patients, respectively. There were no differences between the two groups in terms of patient characteristics and operative details. The two groups had comparable rates of complications, including wound infection (7.4% vs. 10.3%, p=0.75), deep surgical site infection (11.1% vs. 4.4%, p=0.18), evisceration (3.7% vs. 4.4%, p=0.99) and incisional hernia (33.3% vs. 33.8%, p=0.99). Conclusion: Our findings suggest that circumventing the umbilicus during laparotomy did not have any advantage. Future prospective randomized trials are warranted to validate this finding.

Salvage for Postpartum Massive Haemorrhage in a Jehovah's Witness with Intravenous Iron Therapy and Cell Saver System.

Intraoperative cell salvage (ICS) system performs autologous transfusion by filtering and reinfusing the shed blood into corporeal circulation during the surgery. Especially for pregnant Jehovah's Witnesses, the ICS system could be a life-saving intervention. This report describes the successful use of intravenous iron therapy and ICS during the cesarean delivery of a Jehovah's Witness diagnosed with placenta previa totalis who refused to receive any type of blood or blood product transfusion. Intravenous iron treatment initiated in the preoperative period can reduce the need for blood and blood product transfusion. The ICS system provides recognised advantages; however, its utilisation requires high technology equipment and skilled health staff. Key Words: Jehovah's witness, pregnancy, Iron therapy, Intraoperative cell salvage.