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Do Young Women Regret Their Hysterectomy? a Survey of Women 35 Years of Age and Under
Abstracts / Journal of Minimally Invasive Gynecology 24 (2017) S1–S201 investigation with the determination of a wider range of markers to to evaluate the influense of myoma on reproduction.
164
Open Communications 13 – Reproductive Medicine (12:10 PM - 1:10 PM) 12:56 PM – GROUP B
Myomectomy in Patients with Uterine Myoma after Previously Performed Ineffective Uterine Artery Embolization (UAE), MRI – Guided Focused Ultrasound Ablation Porotikova I,1 Gavrilovа T,1 Demura T,1 Stepanian A,2 Adamyan L1. 1 Department of Operative Gynecology, Federal Research Center for Obstetrics, Gynecology, and Perinatology Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation; 2Academia of Women’s Health and Endoscopic Surgery, Atlanta, Georgia Study Objective: To estimate clinical and morphological changes of the reproductive system in women who have undergone previously ineffective UAE, MRgFUS ablation, and myomectomy. Design: Level II a: prospective cohort study. Setting: Department of Operative Gynecology, Federal Research Center Patients: Women with symptomatic uterine fibroids, previously treated with UAE, MRgFUS ablation, and myomectomy. Intervention: Laparoscopic myomectomy was performed in all these patients. Measurements and Main Results: 110 women were included in the study. Group I: 32 patients with a history of UAE; Group II: 26 patients with a history of MRgFUS ablation; and Group III: 52 patients with previous myomectomy. The age of the patients ranged between 22 and 40 years. The indications for additional treatment (myomectomy or hysterectomy) were: menorrhagia (80.2%), pelvic pain (70%), and infertility (95%). 40% and 26% of patients had degenerative changes in the uterine fibroids after UAE and MRgFUS respectively. Patients after UAE were found to have secondary changes throughout the uterine body, while patients of the second group had such changes in the fibroids themselves. Increased bleeding in the UAE group was observed during surgery in 46.0% of patients, compared with 11.5% in the group after MRgFUS. Morphological findings correlated with the clinical data. Necrosis of myoma was detected in 55.2% and edema in 44.8% of women in the group I and in 34.6% and 38.5% of women in group II respectively. A statistically significant number of the largest growth areas and calcification was detected in the group after UAE [p = .0365]. Conclusion: Reconstructive operations on the uterus after previously ineffective UAE and MRgFUS are technically more challenging surgical interventions and high-risk operations due to the high frequency of degenerative changes in the nodes. This study demonstrates necessity of future research, including the development of clear indications and appropriate informed consent as it relates to management of uterine fibroids in patients of reproductive age.
165
Open Communications 13 – Reproductive Medicine (12:10 PM - 1:10 PM) 1:03 PM – GROUP B
Do Young Women Regret Their Hysterectomy? a Survey of Women 35 Years of Age and Under Suen MWH, Bougie O, McDonald SL, Arendas K, Chen I, Singh SS. Department of Obstetrics & Gynecology, University of Ottawa, Ottawa, Ontario, Canada Study Objective: To determine if young women regret a hysterectomy to manage a benign gynecologic condition. Design: Cross-sectional survey. Setting: Tertiary level academic centre. Patients: Patients aged 35 or under with hysterectomy performed by a single surgeon for benign indications between January 1, 2008 and December 31, 2015.
S67
Intervention: A validated decision regret survey and patient health questionnaire were administered. Measurements and Main Results: Of patients who met inclusion criteria, 22/26 contacted patients agreed to participate and completed the study (response rate 84.6%). No differences in group mean parity, BMI or indication for surgery (p > .05) existed between contacted and non-contacted patients, except a younger age in the latter group (mean difference 2.5 years, p < .05). Median age at time of hysterectomy was 33 years (range 27–35). Median time from hysterectomy to participation was 3 years (range 0.5–8). The most common indications for hysterectomy were chronic pain (58.3% of cases) and heavy bleeding (33.3% of cases). Of the 19/22 participants who disagreed or strongly disagreed to the statement “I regret the choice that was made”, 8 were nulliparous and 9 still had medical management options available. 3/22 participants neither agreed nor disagreed to this statement. 77.3% of participants or their partners did not have a prior form of permanent contraception. 95.5% of participants agreed or strongly agreed that “I would go for the same choice if I had to do it over again”. Most participants (68.2%) felt the decision for hysterectomy was shared between the physician and participant; no participants noted that the decision was made mostly by the physician or by the physician only. Conclusion: The decision to pursue hysterectomy for benign conditions among young women is complicated by concern for patient regret. This pilot study is the first to suggest that patients who are young, nulliparous, or haven’t failed all forms of medical management, do not regret their decision for hysterectomy.
WEDNESDAY, NOVEMBER 15, 2017
166
Open Communications 14 – Pelvic Pain (2:15 PM - 3:15 PM) 2:15 PM – GROUP A
Laparoscopic Neurolysis for Deep Endometriosis Infiltrating Pelvic Wall and Somatic Nerves: a Prospective Cohort Study on 382 Patients Ceccaroni M, Clarizia R, Roviglione G, Bruni F, Verrazzo P. Department of Obstetrics and Gynecology, Gynecologic Oncology and MinimallyInvasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy Study Objective: Review efficacy and feasibility of laparoscopic decompression and neurolysis for cases of endometriosis involving sacral plexus and/or somatic nerves. Design: Prospective case-series, single-centre, single-surgeon study. Setting: Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona - Italy. Patients: 382 patients with deep infiltrating endometriosis with sciatica and ano-genital pain treated by laparoscopic neurolysis of sacral roots and somatic nerves. Intervention: Two different laparoscopic transperitoneal approaches were employed to get access to the lateral pelvic wall in case of: (A) deep pelvic endometriosis with rectal and/or parametrial involvement extending to pelvic wall and somatic nerve (medial approach); (B) isolated endometriosis of pelvic wall and somatic nerves (lateral approach). All the procedures were performed by a gynecologic pelvic surgeon skilled in neuro-anatomy (M.C.). Measurements and Main Results: All the patients had nervous compression of somatic structures and infiltration of their fascial envelope, whereas in 76 patients (19.8%) the same structures were deeply infiltrated, towards the assonal and peri-nevral planes. In all patients a surgical whole decompression and partial neurolysis of nervous structures was performed, where in 76 (19.8 %) cases a complete neurolysis was required. Complete relief from neurologic symptoms was achieved in all patients at 6 month after surgery, whereas post-operative neuritis was reported in 77 patients (20.0%)
164
Open Communications 13 – Reproductive Medicine (12:10 PM - 1:10 PM) 12:56 PM – GROUP B
Myomectomy in Patients with Uterine Myoma after Previously Performed Ineffective Uterine Artery Embolization (UAE), MRI – Guided Focused Ultrasound Ablation Porotikova I,1 Gavrilovа T,1 Demura T,1 Stepanian A,2 Adamyan L1. 1 Department of Operative Gynecology, Federal Research Center for Obstetrics, Gynecology, and Perinatology Ministry of Healthcare of the Russian Federation, Moscow, Russian Federation; 2Academia of Women’s Health and Endoscopic Surgery, Atlanta, Georgia Study Objective: To estimate clinical and morphological changes of the reproductive system in women who have undergone previously ineffective UAE, MRgFUS ablation, and myomectomy. Design: Level II a: prospective cohort study. Setting: Department of Operative Gynecology, Federal Research Center Patients: Women with symptomatic uterine fibroids, previously treated with UAE, MRgFUS ablation, and myomectomy. Intervention: Laparoscopic myomectomy was performed in all these patients. Measurements and Main Results: 110 women were included in the study. Group I: 32 patients with a history of UAE; Group II: 26 patients with a history of MRgFUS ablation; and Group III: 52 patients with previous myomectomy. The age of the patients ranged between 22 and 40 years. The indications for additional treatment (myomectomy or hysterectomy) were: menorrhagia (80.2%), pelvic pain (70%), and infertility (95%). 40% and 26% of patients had degenerative changes in the uterine fibroids after UAE and MRgFUS respectively. Patients after UAE were found to have secondary changes throughout the uterine body, while patients of the second group had such changes in the fibroids themselves. Increased bleeding in the UAE group was observed during surgery in 46.0% of patients, compared with 11.5% in the group after MRgFUS. Morphological findings correlated with the clinical data. Necrosis of myoma was detected in 55.2% and edema in 44.8% of women in the group I and in 34.6% and 38.5% of women in group II respectively. A statistically significant number of the largest growth areas and calcification was detected in the group after UAE [p = .0365]. Conclusion: Reconstructive operations on the uterus after previously ineffective UAE and MRgFUS are technically more challenging surgical interventions and high-risk operations due to the high frequency of degenerative changes in the nodes. This study demonstrates necessity of future research, including the development of clear indications and appropriate informed consent as it relates to management of uterine fibroids in patients of reproductive age.
165
Open Communications 13 – Reproductive Medicine (12:10 PM - 1:10 PM) 1:03 PM – GROUP B
Do Young Women Regret Their Hysterectomy? a Survey of Women 35 Years of Age and Under Suen MWH, Bougie O, McDonald SL, Arendas K, Chen I, Singh SS. Department of Obstetrics & Gynecology, University of Ottawa, Ottawa, Ontario, Canada Study Objective: To determine if young women regret a hysterectomy to manage a benign gynecologic condition. Design: Cross-sectional survey. Setting: Tertiary level academic centre. Patients: Patients aged 35 or under with hysterectomy performed by a single surgeon for benign indications between January 1, 2008 and December 31, 2015.
S67
Intervention: A validated decision regret survey and patient health questionnaire were administered. Measurements and Main Results: Of patients who met inclusion criteria, 22/26 contacted patients agreed to participate and completed the study (response rate 84.6%). No differences in group mean parity, BMI or indication for surgery (p > .05) existed between contacted and non-contacted patients, except a younger age in the latter group (mean difference 2.5 years, p < .05). Median age at time of hysterectomy was 33 years (range 27–35). Median time from hysterectomy to participation was 3 years (range 0.5–8). The most common indications for hysterectomy were chronic pain (58.3% of cases) and heavy bleeding (33.3% of cases). Of the 19/22 participants who disagreed or strongly disagreed to the statement “I regret the choice that was made”, 8 were nulliparous and 9 still had medical management options available. 3/22 participants neither agreed nor disagreed to this statement. 77.3% of participants or their partners did not have a prior form of permanent contraception. 95.5% of participants agreed or strongly agreed that “I would go for the same choice if I had to do it over again”. Most participants (68.2%) felt the decision for hysterectomy was shared between the physician and participant; no participants noted that the decision was made mostly by the physician or by the physician only. Conclusion: The decision to pursue hysterectomy for benign conditions among young women is complicated by concern for patient regret. This pilot study is the first to suggest that patients who are young, nulliparous, or haven’t failed all forms of medical management, do not regret their decision for hysterectomy.
WEDNESDAY, NOVEMBER 15, 2017
166
Open Communications 14 – Pelvic Pain (2:15 PM - 3:15 PM) 2:15 PM – GROUP A
Laparoscopic Neurolysis for Deep Endometriosis Infiltrating Pelvic Wall and Somatic Nerves: a Prospective Cohort Study on 382 Patients Ceccaroni M, Clarizia R, Roviglione G, Bruni F, Verrazzo P. Department of Obstetrics and Gynecology, Gynecologic Oncology and MinimallyInvasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona, Italy Study Objective: Review efficacy and feasibility of laparoscopic decompression and neurolysis for cases of endometriosis involving sacral plexus and/or somatic nerves. Design: Prospective case-series, single-centre, single-surgeon study. Setting: Department of Obstetrics and Gynecology, Gynecologic Oncology and Minimally-Invasive Pelvic Surgery, International School of Surgical Anatomy, Sacred Heart Hospital, Negrar, Verona - Italy. Patients: 382 patients with deep infiltrating endometriosis with sciatica and ano-genital pain treated by laparoscopic neurolysis of sacral roots and somatic nerves. Intervention: Two different laparoscopic transperitoneal approaches were employed to get access to the lateral pelvic wall in case of: (A) deep pelvic endometriosis with rectal and/or parametrial involvement extending to pelvic wall and somatic nerve (medial approach); (B) isolated endometriosis of pelvic wall and somatic nerves (lateral approach). All the procedures were performed by a gynecologic pelvic surgeon skilled in neuro-anatomy (M.C.). Measurements and Main Results: All the patients had nervous compression of somatic structures and infiltration of their fascial envelope, whereas in 76 patients (19.8%) the same structures were deeply infiltrated, towards the assonal and peri-nevral planes. In all patients a surgical whole decompression and partial neurolysis of nervous structures was performed, where in 76 (19.8 %) cases a complete neurolysis was required. Complete relief from neurologic symptoms was achieved in all patients at 6 month after surgery, whereas post-operative neuritis was reported in 77 patients (20.0%)