Combined conservative surgical and medical treatment of a uterocutaneous fistula.

Uterocutaneous fistula is a rare complication that may follow cesarean section. Herein is described a rare case of uterocutaneous fistula. The patient, a 28-year-old woman with a history of American Society for Reproductive Medicine stage IV endometriosis (Douglas pouch obliteration), underwent a cesarean section at 25 weeks of gestation (twin pregnancy). Postoperatively, the patient returned to the emergency service because of the appearance of pus through the cesarean section abdominal scar, and was treated for a subcutaneous abscess. Because drainage continued, the presence of a uterocutaneous fistula was suspected. Magnetic resonance imaging confirmed this diagnosis. Hysteroscopy clearly revealed the uterine neck of the fistula tract. Leuprolide acetate (gonadotropin-releasing hormone agonist) deposit suspension was administered subcutaneously monthly for 6 months. Surgery via laparoscopy and laparotomy was performed. This combined medical and conservative surgical treatment was successful. At 6-month follow-up, hysteroscopy revealed a normal uterine cavity. We conclude that magnetic resonance imaging and hysteroscopy are helpful in diagnosis of uterocutaneous fistula. Conservative surgical treatment associated with medical therapy can be an efficient procedure in women who desire subsequent pregnancies.

Outcomes and feasibility of laparoscopic sacrocolpopexy among obese versus non-obese women.

OBJECTIVE: To compare complication rates and short-term outcomes of laparoscopic sacrocolpopexy among obese and non-obese women. METHODS: A retrospective multicenter study of 39 obese women and 111 non-obese women was conducted. Obesity was defined as a body mass index (BMI, calculated as weight in kilograms divided by the square of height in meters) above 30. Operative parameters (length of operation, associated procedures, complication rate, and length of hospitalization) and short-term (2 months) objective and subjective results were evaluated. RESULTS: The median BMI in the obese group was 30.5 (interquartile range [IQR] 30-32) versus 23 (IQR 21-25) in the non-obese group (P<0.0001). Short-term anatomic results (postoperative stage of prolapse) were comparable in the obese and non-obese groups: stage 0-1, 87.1% versus 91.6% (P=0.60); stage 2, 10.2% versus 5.5% (P=0.60); stage 3-4, 2.5% versus 2.5% (P=0.60). Complication rates were also similar in the obese and non-obese groups: bladder injury, 2.5% versus 5.4% (P=0.77); laparoconversion, 5.1% versus 4.5% (P=0.77). Rates of reoperation (excluding women with de novo urinary stress incontinence) were 12.8% in the obese group and 8.1% in the non-obese group (P=0.58). CONCLUSION: Laparoscopic sacrocolpopexy has similar complication rates and short-term outcomes among both obese and non-obese women.

The role of oncoplastic breast surgery in the management of breast cancer treated with primary chemotherapy.

OBJECTIVE: The purpose of this study was to evaluate the benefit of Oncoplastic Breast Conserving Surgery (BCS) compared to standard BCS after primary CT, in terms of oncologic safety and cosmetic outcomes. BACKGROUND: The development of new drugs has led to greater use of primary chemotherapy (CT) for bulky breast cancer (BC) and has allowed wider indications for conservative surgery. PATIENTS AND METHODS: We identified 259 patients consecutively treated with BCS for primary BC from January 2002 to November 2010. All patients had undergone Oncoplastic Breast Surgery (OBS) or standard BCS after primary CT. Mastectomy rates, and oncological and cosmetic outcomes were compared. RESULTS: A total of 45 OBS and 214 standard BCS were analyzed. The median tumor size was 40 mm in the two groups (p = 0.66). The median operative specimen volumes were larger in the OBS group than in the standard group (respectively, 180 cm3 and 98 cm3, p < 0.0001). Re-excision (9% vs. 2%) and mastectomy (24% vs. 18%) rates were similar (p = 0.22 and p = 0.30) in the standard BCS group and in the OBS group respectively. At a median follow-up of 46 months, local relapse (p = 0.23) and distant relapse (p = 0.35) rates were similar. CONCLUSION: OBS allows excision of larger volumes of residual tumor after primary CT. OBS outcomes results were similar to those of standard BCS. Oncoplastic Breast Conserving Surgery (BCS) after primary chemotherapy allows wider breast resection than standard BCS. Survival and relapse probabilities are similar in both groups.