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Fertility after Laparoscopically Assisted Segmental Bowel Resection for Rectal Endometoriosis
S156
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S156–S168
SCIENTIFIC VIRTUAL POSTER PRESENTATIONS PART 3 516 Management of an 11cm Paraovarian Cyst in a Patient with Type 1 von Willebrand Disease Mama S,1 Donelan E.2 1OB/GYN, Cooper University Hospital, Camden, New Jersey; 2Robert Wood Johnson Medical School, Camden, New Jersey Study Objective: The term paraovarian cyst refers to a wide array of predominately benign adnexal cysts that occupy the region of the broad ligament. Paraovarian cysts are mesothelial, mesonephric or paramesonephric in origin. The majority of paraovarian cysts are small and benign, with very rare malignancies reported in the literature. An initially asymptomatic cyst can occasionally become greatly enlarged, cause pelvic pain and possibly undergo torsion. Removal of paraovarian cysts, especially larger ones in proximity to the fallopian tube, requires consideration of future fertility. This case report details the removal of a large paraovarian cyst adherent to the fallopian tube while maintaining patency. CASE: A 20 year old female with a history of Type 1 von Willebrand Disease and a known pelvic mass presented to the office for a surgery consultation. The presence of an 10.7 cm paraovarian cyst was confirmed by ultrasound and an elective cystectomy was scheduled. Approximately one hour prior to the procedure the patient was given DDAVP 0.3 mcg/kg in 50 cc NSS IV over the course of thirty minutes. The procedure began as a diagnostic laparoscopy. Given the size of the cyst and the possibility of damaging the tube, the procedure was converted to a mini-laparotomy. Careful hydrodissection was done with a 60 cc syringe and a 22 gauge angiocath sheath without the needle. The cyst was removed without rupture and without compromising tubal patency. The mesosalpinx was reapproximated and normal anatomy restored.
Conclusion: Patients with a large paraovarian cyst adherent to the fallopian tube can be managed with mini-laparotomy and hydrodissection if tubal preservation is desired. 517 Fertility after Laparoscopically Assisted Segmental Bowel Resection for Rectal Endometoriosis Oku H, Matsumoto T, Saeki A, Kawamata Y, Chien H, Oonogi A, Ikuma K. Gynecology, Osaka Central Hospital, Osaka, Japan Study Objective: To evaluate the efficacy and safety of laparoscopically assisted segmental bowel resection for rectal endometoriosis and resection of deep infiltrated endometoriosis for infertile women. Design: Retrospective analysis of 9 infertile women with rectal endometoriosis, who underwent laparoscopic operation. Setting: Department of gynecology, Osaka Central Hospital. Patients: Nine (ages 30-42 years) infertile women with rectal endometoriosis. Intervention: Laparoscopically assisted segmental bowel resection for rectal endometoriosis and resection of deep infiltrated endometoriosis. Measurements and Main Results: The average operation time was 332.6 47 min (mean SD) and the average blood loss was 110.6 43.9 ml (mean SD). No conversion to open surgery was required, and all patients recovered without complications. All cases improved their symptoms. In our series of nine women, 7 wished to conceive and 2cases lost their wish for pregnancy. One (14%) became pregnant naturally, one (14%) by means of AIH and two (28%) by means of IVF. Three (42%) did not become pregnant in spite of their assisted reproductive therapy (ART). Severe pelvic pain recurred in 2 patients (22%), who were failed to conceive after repeated ARTs. Conclusion: This study demonstrated that laparoscopically assisted segmental bowel resection is a safe and effective procedure for infertile women with rectal endometoriosis. But, sometimes it causes major complications, we need prudent examination of the operative indication.
518 Think Ectopic Pregnancy – Early Diagnosis and Management Is the Key to Success Shahid A, Odejinmi F, Baskaran L, Deo N, Olufowobi R, Ramdial P. Obstetrics and Gynaecology, Whipps Cross University Hospital, London, Redbridge, United Kingdom Study Objective: To audit the management of ectopic pregnancy at Whipps Cross University Hospital over a two year period from Jan 2009 to Dec 2010, to assess adherence to the hospital protocol. Design: A two year audit of the women with a diagnosis of ectopic pregnancy between Jan 2009 to Dec 2010. Cases were identified from the early pregnancy assessment unit Astraia database, ward log, operating theatre register and pharmacy records. Demographics, risk factors for ectopic pregnancy, management, failure rate and complications of the treatment were recorded for each case. Setting: University Hospital in London, U.K. Patients: All women with a diagnosis of ectopic pregnancy. Intervention: All women with a diagnosis of ectopic pregnancy on ultrasound or at surgery. Measurements and Main Results: There were 216 cases of ectopic pregnancy diagnosed during that period. Ninety five percent of patients were seen in the early pregnancy assessment unit. Sixty four percent of patients had one or more risk factors. Ninety two percent of cases had tubal pregnancy. Seventy six percent of cases were managed surgically and 24% were managed non-surgically. Conclusion: Ninety eight percent of cases were managed according to the hospital protocol. Ninety nine percent of cases referred for surgery underwent successful laparoscopic management resulting in shorter
Abstracts / Journal of Minimally Invasive Gynecology 18 (2011) S156–S168
SCIENTIFIC VIRTUAL POSTER PRESENTATIONS PART 3 516 Management of an 11cm Paraovarian Cyst in a Patient with Type 1 von Willebrand Disease Mama S,1 Donelan E.2 1OB/GYN, Cooper University Hospital, Camden, New Jersey; 2Robert Wood Johnson Medical School, Camden, New Jersey Study Objective: The term paraovarian cyst refers to a wide array of predominately benign adnexal cysts that occupy the region of the broad ligament. Paraovarian cysts are mesothelial, mesonephric or paramesonephric in origin. The majority of paraovarian cysts are small and benign, with very rare malignancies reported in the literature. An initially asymptomatic cyst can occasionally become greatly enlarged, cause pelvic pain and possibly undergo torsion. Removal of paraovarian cysts, especially larger ones in proximity to the fallopian tube, requires consideration of future fertility. This case report details the removal of a large paraovarian cyst adherent to the fallopian tube while maintaining patency. CASE: A 20 year old female with a history of Type 1 von Willebrand Disease and a known pelvic mass presented to the office for a surgery consultation. The presence of an 10.7 cm paraovarian cyst was confirmed by ultrasound and an elective cystectomy was scheduled. Approximately one hour prior to the procedure the patient was given DDAVP 0.3 mcg/kg in 50 cc NSS IV over the course of thirty minutes. The procedure began as a diagnostic laparoscopy. Given the size of the cyst and the possibility of damaging the tube, the procedure was converted to a mini-laparotomy. Careful hydrodissection was done with a 60 cc syringe and a 22 gauge angiocath sheath without the needle. The cyst was removed without rupture and without compromising tubal patency. The mesosalpinx was reapproximated and normal anatomy restored.
Conclusion: Patients with a large paraovarian cyst adherent to the fallopian tube can be managed with mini-laparotomy and hydrodissection if tubal preservation is desired. 517 Fertility after Laparoscopically Assisted Segmental Bowel Resection for Rectal Endometoriosis Oku H, Matsumoto T, Saeki A, Kawamata Y, Chien H, Oonogi A, Ikuma K. Gynecology, Osaka Central Hospital, Osaka, Japan Study Objective: To evaluate the efficacy and safety of laparoscopically assisted segmental bowel resection for rectal endometoriosis and resection of deep infiltrated endometoriosis for infertile women. Design: Retrospective analysis of 9 infertile women with rectal endometoriosis, who underwent laparoscopic operation. Setting: Department of gynecology, Osaka Central Hospital. Patients: Nine (ages 30-42 years) infertile women with rectal endometoriosis. Intervention: Laparoscopically assisted segmental bowel resection for rectal endometoriosis and resection of deep infiltrated endometoriosis. Measurements and Main Results: The average operation time was 332.6 47 min (mean SD) and the average blood loss was 110.6 43.9 ml (mean SD). No conversion to open surgery was required, and all patients recovered without complications. All cases improved their symptoms. In our series of nine women, 7 wished to conceive and 2cases lost their wish for pregnancy. One (14%) became pregnant naturally, one (14%) by means of AIH and two (28%) by means of IVF. Three (42%) did not become pregnant in spite of their assisted reproductive therapy (ART). Severe pelvic pain recurred in 2 patients (22%), who were failed to conceive after repeated ARTs. Conclusion: This study demonstrated that laparoscopically assisted segmental bowel resection is a safe and effective procedure for infertile women with rectal endometoriosis. But, sometimes it causes major complications, we need prudent examination of the operative indication.
518 Think Ectopic Pregnancy – Early Diagnosis and Management Is the Key to Success Shahid A, Odejinmi F, Baskaran L, Deo N, Olufowobi R, Ramdial P. Obstetrics and Gynaecology, Whipps Cross University Hospital, London, Redbridge, United Kingdom Study Objective: To audit the management of ectopic pregnancy at Whipps Cross University Hospital over a two year period from Jan 2009 to Dec 2010, to assess adherence to the hospital protocol. Design: A two year audit of the women with a diagnosis of ectopic pregnancy between Jan 2009 to Dec 2010. Cases were identified from the early pregnancy assessment unit Astraia database, ward log, operating theatre register and pharmacy records. Demographics, risk factors for ectopic pregnancy, management, failure rate and complications of the treatment were recorded for each case. Setting: University Hospital in London, U.K. Patients: All women with a diagnosis of ectopic pregnancy. Intervention: All women with a diagnosis of ectopic pregnancy on ultrasound or at surgery. Measurements and Main Results: There were 216 cases of ectopic pregnancy diagnosed during that period. Ninety five percent of patients were seen in the early pregnancy assessment unit. Sixty four percent of patients had one or more risk factors. Ninety two percent of cases had tubal pregnancy. Seventy six percent of cases were managed surgically and 24% were managed non-surgically. Conclusion: Ninety eight percent of cases were managed according to the hospital protocol. Ninety nine percent of cases referred for surgery underwent successful laparoscopic management resulting in shorter