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Comparison of laparoscopic appearance of appendix and resulting pathology
Results: Of the 132 patients included in the study, 27 underwent laparoscopic supracervical hysterectomy and 105 underwent laparoscopically assisted vaginal hysterectomy. Groups were similar with respect to gravidity, parity, uterine weight, and preoperative diagnosis. Patients undergoing laparoscopic supracervical hysterectomy had significantly shorter operating times (median 181 minutes versus 220 minutes, P ⫽ 0.007) despite cystoscopy, adnexectomy, and adhesiolysis being performed more frequently. Hospital stays (median 1.0 days versus 2.0 days, P ⫽ 0.0001) and blood loss (median 125 mL versus 400 mL, P ⫽ 0.0001) were also lower in the laparoscopic supracervical group. None of the patients undergoing laparoscopic supracervical hysterectomy experienced morbidity, compared with 13% for laparoscopically assisted vaginal hysterectomy (bladder injury [n ⫽ 3], blood loss greater than 1000 mL [n ⫽ 7], vaginal cuff hematoma [n ⫽ 4], 0 versus 13%, P ⫽ 0.04). Conclusion: Laparoscopic supracervical hysterectomy has shorter operating times, shorter length of stays, and less morbidity than laparoscopically assisted vaginal hysterectomy.
women, decreased in 15, and persisted in 7. No follow-up information was available for 8 patients. Conclusions: Histologic examination of the appendix does not always detect the disease state identified during laparoscopy. Incorporating color photographs in the operative report seems to provide good documentation for future retrospective review. Also, it appears to be safe to perform an appendectomy when there is suspicion for involvement of the appendix.
The Role of Proctosigmoidoscopy in Laparoscopic Pelvic Surgery Ceana H. Nezhat, MD Stanford University School of Medicine, Stanford, CA
D. Seidman, F. Nezhat, and C. R. Nezhat
Comparison of Laparoscopic Appearance of Appendix and Resulting Pathology Ceana H. Nezhat, MD Stanford University School of Medicine, Stanford, CA
D. Seidman, F. Nezhat, and C. R. Nezhat Objective: To report histologic discrepancies of obviously abnormal-appearing appendixes in a series of patients who had laparoscopic appendectomy. Representative samples of color pictures and histology will be presented. Method: A retrospective chart review of 65 patients who underwent appendectomy at the time of laparoscopy for treatment of associated pelvic pathology in a tertiary private care center in Atlanta, Georgia and Palo Alto, California between March 1994 and August 1999. The color photographs, operative descriptions, and histologic findings of the appendixes were compared. Results: Sixty-five patients, ages 18 – 67 years (mean 35.8) were identified. Pelvic pain, associated with known endometriosis (62%) and adhesions (23%), was the main indication for surgery in the majority of cases (91%). Thirty-two percent of the cases had other indications as well. Visual examinations and operative descriptions revealed abnormal appendixes in all suspected cases. Histology was positive in only 40 patients, however, and failed to identify the obvious gross pathology in 32 patients, missing mainly fibrosis and adhesions. There were no major intraoperative or postoperative complications. Two patients had suture granulomas, 1 patient, diagnosed with ovarian cancer, had mild pleural effusion which resolved without problem, and 7 patients reported symptoms of urinary tract infections. The pain was completely relieved in 35
34S Monday Posters
Objective: To evaluate the efficiency and safety of rigid sigmoidoscopy during operative laparoscopy in patients at high risk for rectosigmoid and large bowel disease or injury. Methods: We conducted a prospective study of 262 women treated for rectosigmoid endometriosis and adhesions at the Center for Special Pelvic Surgery in Atlanta, Georgia. All of the subjects underwent a rigid sigmoidoscopy during laparoscopy. At the end of surgery, proctosigmoidoscopy was performed for the evaluation of any intraluminal abnormality or rectosigmoid injury. The pelvis was then filled with isotonic fluid to observe laparoscopically any air leakage. Results: Sigmoidoscopy was indicated due to a lesion involving the rectum or sigmoid in 60.7%, the large bowel in 11.1%, and the posterior cul-de-sac in 28.2% of the cases. The primary indication for surgery was pelvic pain, endometriosis, or adhesions in 88.6%. During laparoscopy, endometriosis was found in 30.5%, adhesions in 20.2%, and both in 43.5%. Intentional or unintentional bowel perforation occurred in 44 (16.8%) patients. In four (1.5%) patients, the bowel injury was identified during sigmoidoscopy. All participants were treated by intracorporeal laparoscopic suturing. One incomplete repair was detected by sigmoidoscopy. In 1 (0.4%) case, a rectal polyp was detected. Conclusions: Bowel injury is recognized as one of the most serious complications of laparoscopy. Early recognition and prompt intraoperative management are essential to prevent a potentially catastrophic outcome. Sigmoidoscopy is a relatively easy procedure during laparoscopy and aids in the diagnosis of bowel perforation and in assessment of bowel wall invasion and any potential stricture caused by endometriosis. It is a safe procedure, even when performed immediately after extensive laparoscopic surgical treatment of rectosigmoid endometriosis and adhesions. Sigmoidoscopy may be used with discretion as a diagnostic and risk management tool during laparoscopic surgery of the rectosigmoid colon.
Obstetrics & Gynecology
women, decreased in 15, and persisted in 7. No follow-up information was available for 8 patients. Conclusions: Histologic examination of the appendix does not always detect the disease state identified during laparoscopy. Incorporating color photographs in the operative report seems to provide good documentation for future retrospective review. Also, it appears to be safe to perform an appendectomy when there is suspicion for involvement of the appendix.
The Role of Proctosigmoidoscopy in Laparoscopic Pelvic Surgery Ceana H. Nezhat, MD Stanford University School of Medicine, Stanford, CA
D. Seidman, F. Nezhat, and C. R. Nezhat
Comparison of Laparoscopic Appearance of Appendix and Resulting Pathology Ceana H. Nezhat, MD Stanford University School of Medicine, Stanford, CA
D. Seidman, F. Nezhat, and C. R. Nezhat Objective: To report histologic discrepancies of obviously abnormal-appearing appendixes in a series of patients who had laparoscopic appendectomy. Representative samples of color pictures and histology will be presented. Method: A retrospective chart review of 65 patients who underwent appendectomy at the time of laparoscopy for treatment of associated pelvic pathology in a tertiary private care center in Atlanta, Georgia and Palo Alto, California between March 1994 and August 1999. The color photographs, operative descriptions, and histologic findings of the appendixes were compared. Results: Sixty-five patients, ages 18 – 67 years (mean 35.8) were identified. Pelvic pain, associated with known endometriosis (62%) and adhesions (23%), was the main indication for surgery in the majority of cases (91%). Thirty-two percent of the cases had other indications as well. Visual examinations and operative descriptions revealed abnormal appendixes in all suspected cases. Histology was positive in only 40 patients, however, and failed to identify the obvious gross pathology in 32 patients, missing mainly fibrosis and adhesions. There were no major intraoperative or postoperative complications. Two patients had suture granulomas, 1 patient, diagnosed with ovarian cancer, had mild pleural effusion which resolved without problem, and 7 patients reported symptoms of urinary tract infections. The pain was completely relieved in 35
34S Monday Posters
Objective: To evaluate the efficiency and safety of rigid sigmoidoscopy during operative laparoscopy in patients at high risk for rectosigmoid and large bowel disease or injury. Methods: We conducted a prospective study of 262 women treated for rectosigmoid endometriosis and adhesions at the Center for Special Pelvic Surgery in Atlanta, Georgia. All of the subjects underwent a rigid sigmoidoscopy during laparoscopy. At the end of surgery, proctosigmoidoscopy was performed for the evaluation of any intraluminal abnormality or rectosigmoid injury. The pelvis was then filled with isotonic fluid to observe laparoscopically any air leakage. Results: Sigmoidoscopy was indicated due to a lesion involving the rectum or sigmoid in 60.7%, the large bowel in 11.1%, and the posterior cul-de-sac in 28.2% of the cases. The primary indication for surgery was pelvic pain, endometriosis, or adhesions in 88.6%. During laparoscopy, endometriosis was found in 30.5%, adhesions in 20.2%, and both in 43.5%. Intentional or unintentional bowel perforation occurred in 44 (16.8%) patients. In four (1.5%) patients, the bowel injury was identified during sigmoidoscopy. All participants were treated by intracorporeal laparoscopic suturing. One incomplete repair was detected by sigmoidoscopy. In 1 (0.4%) case, a rectal polyp was detected. Conclusions: Bowel injury is recognized as one of the most serious complications of laparoscopy. Early recognition and prompt intraoperative management are essential to prevent a potentially catastrophic outcome. Sigmoidoscopy is a relatively easy procedure during laparoscopy and aids in the diagnosis of bowel perforation and in assessment of bowel wall invasion and any potential stricture caused by endometriosis. It is a safe procedure, even when performed immediately after extensive laparoscopic surgical treatment of rectosigmoid endometriosis and adhesions. Sigmoidoscopy may be used with discretion as a diagnostic and risk management tool during laparoscopic surgery of the rectosigmoid colon.
Obstetrics & Gynecology