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Complication of laparoscopic burch procedures
August 1995, Vol. 2, No. 4. Supplement The Journal of the American Association of Gynecologic Laparoscopists
Identification of Peritoneal Macrophage Population by Fungal Derived Mannan
Review of 24 Cases of Uterine Ablation Failure AC Pagedas, IH Bae, HE Perkins. St. Francis Hospital, Medical College of Wisconsin, Milwaukee, Wl.
1DE Ott, 2RE Garner, 2AN Walker. 1Mercer University, School of Engineering, 2Mercer University, School of Medicine, Macon, GA.
Between July 1990 and September 1994, 305 women underwent uterine ablation for abormal uterine bleeding. Twelve months (average) later, 24 of them (average age 47 yrs) underwent exploratory laparotomy with abdominal hysterectomy (16 women) or laparoscopic-assisted vaginal hysterectomy (8 women). Reasons for hysterectomy were pelvic pain in 18 women (75%), persistent vaginal spotting in 4 (16.7%), incontinence with atypical endometrial hyperplasia in 1, and cancer in 1. The histopathologies were adenomyosis in 18 patients (75%), leiomyomata in 9 (37.5%), both pelvic adhesions and endometriosis in 5 (20.8%), atypical endometrial hyperplasia in 2, and adenocarcinoma in 1; in 1 woman the pathology was undetermined. We identified several risk factors for failure of uterine ablation, including preexisting pelvic pain.
Inflammation due to infection or endometriosis causes more than one endogenous population of macrophages to prevail. A method employing fungalderived mannan was developed to determine these groups. Peritoneal macrophage response to gramnegative bacterial lipopolysaccharide (LPS) and mannan were determined by analyzing tumor necrosis factor-or (TNF) production. Peritoneal macrophages were removed from the abdominal cavity of women undergoing laparoscopy. The macrophages were separated by centrifugation and adherence to plastic culture plates for 3 hours. Macrophage was cultured in the presence of LPS or mannan. Production of TNF was analyzed. A marked response was found to LPS by increased TNF production in patients with endometriosis and pelvic infection. All patients (normal, postinfection, endometriosis) responded to LPS. Only those with adhesions from an infectious origin responded to mannan. A population of macrophages in patients with endometriosis was identified in which no production of TNF to fungal derived mannan occurs. Macrophage activation results from cytokine and metabolic production mad elicits an immune response either by enhanced host resistance or depression of a critical function(s) and contributes to the inflammatory process.
Utility, Acceptance, and Cost-Benefit Analysis of Office Laparoscopy Under Local Anesthesia for Chronic Pelvic Pain SF Palter, DL Olive. Department of Obstetrics and Gynecology, Division of Reproductive Endoscopy, Yale University School of Medicine, and the Yale Office Laparoscopy Program, New Haven, CT.
The utility, tolerance, and costs associated with office laparoscopy under local anesthesia using fiberoptic microlaparoscopes (<2 mm) and accessory instrumentation (<2 mm) to evaluate women with chronic pelvic pain (CPP) and infertility (INF) were evaluated. A prospective nonselected cohort study was conducted on all patients with CPP or INE A specific questionnaire was developed to follow all aspects of patient acceptance and tolerance of the procedures. In addition, the women were screened preoperatively, and 30 minutes and 1 week postoperatively. Pain was evaluated with a modification of the McGill pain inventory and a visual analog scale. A specific subset of questions evaluated the recovery period and time to return to usual activities. Patients were also screened for anxiety and general acceptance of the procedure. All costs and length of all aspects of the procedure and recovery were recorded. Women with CPP experienced greater intraoperative and postoperative pain and anxiety during laparoscopy under local anesthesia
Complication of Laparoscopic Burch Procedures CS Ou, J Presthus, E Beadle. Northwest Hospital, Seattle, WA.
Since 1992 we have performed more than 250 laparoscopic Burch procedures by suture and mesh staples techniques. Complications such as bladder injuries, infection, trocar injuries, urinary rection, bleeding, enterocele, detrusor instability occurred. Many of these have been reported with the open Burch, but the laparoscopic approach adds potential complications not described with the open procedure. Specific concems are related to mesh and staples. Complications can and do occur with any operative procedure, but they are more likely to occur as the surgeon gains experience. We hope our experience will encourage other laparoscopists to reduce their complications and perform the procedure safely.
$39
Identification of Peritoneal Macrophage Population by Fungal Derived Mannan
Review of 24 Cases of Uterine Ablation Failure AC Pagedas, IH Bae, HE Perkins. St. Francis Hospital, Medical College of Wisconsin, Milwaukee, Wl.
1DE Ott, 2RE Garner, 2AN Walker. 1Mercer University, School of Engineering, 2Mercer University, School of Medicine, Macon, GA.
Between July 1990 and September 1994, 305 women underwent uterine ablation for abormal uterine bleeding. Twelve months (average) later, 24 of them (average age 47 yrs) underwent exploratory laparotomy with abdominal hysterectomy (16 women) or laparoscopic-assisted vaginal hysterectomy (8 women). Reasons for hysterectomy were pelvic pain in 18 women (75%), persistent vaginal spotting in 4 (16.7%), incontinence with atypical endometrial hyperplasia in 1, and cancer in 1. The histopathologies were adenomyosis in 18 patients (75%), leiomyomata in 9 (37.5%), both pelvic adhesions and endometriosis in 5 (20.8%), atypical endometrial hyperplasia in 2, and adenocarcinoma in 1; in 1 woman the pathology was undetermined. We identified several risk factors for failure of uterine ablation, including preexisting pelvic pain.
Inflammation due to infection or endometriosis causes more than one endogenous population of macrophages to prevail. A method employing fungalderived mannan was developed to determine these groups. Peritoneal macrophage response to gramnegative bacterial lipopolysaccharide (LPS) and mannan were determined by analyzing tumor necrosis factor-or (TNF) production. Peritoneal macrophages were removed from the abdominal cavity of women undergoing laparoscopy. The macrophages were separated by centrifugation and adherence to plastic culture plates for 3 hours. Macrophage was cultured in the presence of LPS or mannan. Production of TNF was analyzed. A marked response was found to LPS by increased TNF production in patients with endometriosis and pelvic infection. All patients (normal, postinfection, endometriosis) responded to LPS. Only those with adhesions from an infectious origin responded to mannan. A population of macrophages in patients with endometriosis was identified in which no production of TNF to fungal derived mannan occurs. Macrophage activation results from cytokine and metabolic production mad elicits an immune response either by enhanced host resistance or depression of a critical function(s) and contributes to the inflammatory process.
Utility, Acceptance, and Cost-Benefit Analysis of Office Laparoscopy Under Local Anesthesia for Chronic Pelvic Pain SF Palter, DL Olive. Department of Obstetrics and Gynecology, Division of Reproductive Endoscopy, Yale University School of Medicine, and the Yale Office Laparoscopy Program, New Haven, CT.
The utility, tolerance, and costs associated with office laparoscopy under local anesthesia using fiberoptic microlaparoscopes (<2 mm) and accessory instrumentation (<2 mm) to evaluate women with chronic pelvic pain (CPP) and infertility (INF) were evaluated. A prospective nonselected cohort study was conducted on all patients with CPP or INE A specific questionnaire was developed to follow all aspects of patient acceptance and tolerance of the procedures. In addition, the women were screened preoperatively, and 30 minutes and 1 week postoperatively. Pain was evaluated with a modification of the McGill pain inventory and a visual analog scale. A specific subset of questions evaluated the recovery period and time to return to usual activities. Patients were also screened for anxiety and general acceptance of the procedure. All costs and length of all aspects of the procedure and recovery were recorded. Women with CPP experienced greater intraoperative and postoperative pain and anxiety during laparoscopy under local anesthesia
Complication of Laparoscopic Burch Procedures CS Ou, J Presthus, E Beadle. Northwest Hospital, Seattle, WA.
Since 1992 we have performed more than 250 laparoscopic Burch procedures by suture and mesh staples techniques. Complications such as bladder injuries, infection, trocar injuries, urinary rection, bleeding, enterocele, detrusor instability occurred. Many of these have been reported with the open Burch, but the laparoscopic approach adds potential complications not described with the open procedure. Specific concems are related to mesh and staples. Complications can and do occur with any operative procedure, but they are more likely to occur as the surgeon gains experience. We hope our experience will encourage other laparoscopists to reduce their complications and perform the procedure safely.
$39