Radical palliative surgery: new limits to pursue.

This case report describes the radical subtotal palliative resection of a massive recurrent desmoid tumor encompassing the abdomen, pelvis, and groin in a child who was 13 years old at the time of initial resection. Given the extensive distribution of the tumor en bloc resection, which is the standard treatment of desmoid tumors, would have meant performing a hemipelvectomy and repair of a large abdominal wall defect, likely with skin grafts and mesh. The patient's personal goals however were to alleviate the pain and limited mobility that would allow her to re-attend high school and appear normal to her peers. Therefore, palliative surgery was pursued and currently the patient is 5 years out from her last surgery doing well. We believe that the option of surgical palliation in this case was warranted and should be an option for similar cases in the future.

Total laparoscopic hysterectomy for female-to-male transsexuals.

OBJECTIVE: To compare the results of laparoscopic hysterectomy, salpingo-oophorectomy, and incidental appendectomy for female-to-male transsexuals with those of female patients. METHODS: Retrospective chart abstraction of all patients undergoing total laparoscopic hysterectomy, bilateral salpingo-oophorectomy, and appendectomy since September 1996. Significance from analysis of covariance or chi2 was set at .05. RESULTS: Five hundred ninety-three patients underwent total laparoscopic hysterectomy, oophorectomy, and appendectomy. Forty-one were identified as transsexual, 552 as females. The transsexuals were significantly younger (mean 32 years compared with 51 years, median 32 years compared with 49 years, P<.001), with lower parity (mean 0.05 pregnancies compared with 1.34 pregnancies, median 0 pregnancies compared with 1 pregnancy, P<.001), yet had similar body mass index and height. Transsexuals' surgeries had shorter operating times (mean 74 minutes compared with 120 minutes, median 57.5 minutes compared with 116 minutes, P<.001), with less blood loss (mean 27 mL compared with 107 mL, median 20 mL compared with 50 mL, P<.001) and lower uterine weight (mean 118 g compared with 167 g, median 89 g compared with 140.5 g, P<.001). The total complication rates (12.2% compared with 8.3%), as well as the reoperative complication rates (4.9% compared with 4.3%) were not significantly different. CONCLUSION: Total laparoscopic hysterectomy offers appropriate surgical outcomes for those patients identifying themselves as transsexual.