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Incisional hernia following laparoscopy: A survey of the American Association of Gynecologic Laparoscopists
ELSFVIFR
International Journal of Gynecology & Obstetrics 50 (1995) I1 l-121
Citations from the literature This is a selection of abstracts taken from the literature in field of obstetrics and gynecology which the Journal’s Editors feel may be of interest to our readers’ LAPAROSCOPY
(RARE EVENTS)
Incisional hernia following laparoscopy: A survey of the American Association of Gynecologic Laparoscopists
Montz F.J.; Holschneider C.H.: Munro M.G. USA
OBSTET. GYNECOL 199484/S (881-884) Objective: To estimate the risk factors for and incidence of post-laparoscopy incisional hernia. Methods: A questionnaire was sent to all individuals on a mailing list from the American Association of Gynecologic Laparoscopists. Adequately completed responseswere entered into a computer-based data bank for analysis. Of the 1I 500 surveys mailed, 3293 were returned; of these, 3217 were evaluable. Results: A total of 933 hernias was reported from an estimated 4 385 000 laparoscopic procedures (an incidence of 21 per 100000); 167 (17.9%) were reported to have occurred despite fascial closure. Six hundred sixty-live patients (71.3%) had subsequent surgical repair. Seven hundred twenty-five (86.3%) of the 840 hernias in which the size of the original fascial defect was noted, occurred in sites where ports 10mm in diameter or larger had been placed. The occurrence of hernias is a function of the number of laparoscopiesperformed (P < 0.0001)and is not related to the length of the surgeon’s career (P = 0.41). In at least 157 instances(16.8%), the presenting symptom or morbidity of the hernia was directly related to the involvement of the large or small intestine. Conclusion: Post-laparoscopy incisional hernias occur at an approximate incidence of 21 per 100000 and are associated with significant morbidity. These hernias are most likely to occur when large ports are used. As currently practiced, closure is not completely protective. Further methods or devicesshould be developed to minimize the risk of hernia formation. Postoperative pain after local anesthetics for laparoscopic sterilization
Benhamou D.; Narchi P.; Mazoit J.X.; Fernandez H. FRA
OBSTET. GYNECOL 199484/5 (877-880) Objective: To test the effectivenessof intraperitoneal local ’ Generated from the Excerpta Medica Database, EMBASE.
anesthesia in relieving postoperative pain after laparoscopic sterilization. Methods: In a double-blind, placebo-controlled randomized study of two groups of 25 subjects each, women scheduled for tubal sterilization under general anesthesia received80 ml of 0.5% lidocaine with l/320 000 epinephrine intraperitoneally in the right subdiaphragmatic quadrant at the beginning of the procedure. At the end of the procedure, they received 10 ml of 2% lidocaine with 1180000 epinephrine injected into each mesosalpinx. Controls received saline instead of lidocaine. Shoulder and pelvic pain assessedby visual analogue pain scale, postoperative analgesic requirements, nausea or vomiting, and time to return to normal daily activities were evaluated in the ambulatory unit and after discharge during the first 48 postoperative hours. Blood samples were taken in ten subjectsreceiving lidocaine to evaluate peak plasma concentrations and time to peak plasma concentrations. Results: Pain was significantly lessin patients who received lidocaine, and the differencelasted for the duration of the study (P < 0.05). Analgesicrequirementsand time to return to normal daily activities were significantly reducedin patients who received lidocaine (P < 0.05). Blood samples revealed no toxic concentrations. The peak plasma concentration was 3.22 f 1.21&ml, and the time to peak plasma concentration was 42 f 15 min. Conclusion: Intraperitoneal instillation of lidocaine-epinephrine combined with mesosalpinxinfiltration of lidocaine during tubal sterilization produceseffective, long-lasting analgesia and improves the postoperative course. Pregnancy rates after operative endoscopic treatment of total (neosalpingostomy) or near total (salpingostomy) distal tubal occlusion
Dlugi A.M.; Reddy S.; Saleh W.A.; Mersol-Barg M.S.; JacobsenG. USA
FERTIL STERIL 19946U5 (913-920) Objective: To determine the efficacy of the endoscopic treatment of complete distal tubal occlusion or moderate to severe tubal phimosis and to analyze outcome using contemporary statistical methodologies. Design: Prospective cohort analysis. Setting: Tertiary-care institution. Patients: One hundred thirteen consecutive patients undergoing a neosalpingostomy or salpingostomy. Interventions: KTP/532 laser (Laserscope, Santa Clara, CA) laparoscopy. Additional infertility factors
International Journal of Gynecology & Obstetrics 50 (1995) I1 l-121
Citations from the literature This is a selection of abstracts taken from the literature in field of obstetrics and gynecology which the Journal’s Editors feel may be of interest to our readers’ LAPAROSCOPY
(RARE EVENTS)
Incisional hernia following laparoscopy: A survey of the American Association of Gynecologic Laparoscopists
Montz F.J.; Holschneider C.H.: Munro M.G. USA
OBSTET. GYNECOL 199484/S (881-884) Objective: To estimate the risk factors for and incidence of post-laparoscopy incisional hernia. Methods: A questionnaire was sent to all individuals on a mailing list from the American Association of Gynecologic Laparoscopists. Adequately completed responseswere entered into a computer-based data bank for analysis. Of the 1I 500 surveys mailed, 3293 were returned; of these, 3217 were evaluable. Results: A total of 933 hernias was reported from an estimated 4 385 000 laparoscopic procedures (an incidence of 21 per 100000); 167 (17.9%) were reported to have occurred despite fascial closure. Six hundred sixty-live patients (71.3%) had subsequent surgical repair. Seven hundred twenty-five (86.3%) of the 840 hernias in which the size of the original fascial defect was noted, occurred in sites where ports 10mm in diameter or larger had been placed. The occurrence of hernias is a function of the number of laparoscopiesperformed (P < 0.0001)and is not related to the length of the surgeon’s career (P = 0.41). In at least 157 instances(16.8%), the presenting symptom or morbidity of the hernia was directly related to the involvement of the large or small intestine. Conclusion: Post-laparoscopy incisional hernias occur at an approximate incidence of 21 per 100000 and are associated with significant morbidity. These hernias are most likely to occur when large ports are used. As currently practiced, closure is not completely protective. Further methods or devicesshould be developed to minimize the risk of hernia formation. Postoperative pain after local anesthetics for laparoscopic sterilization
Benhamou D.; Narchi P.; Mazoit J.X.; Fernandez H. FRA
OBSTET. GYNECOL 199484/5 (877-880) Objective: To test the effectivenessof intraperitoneal local ’ Generated from the Excerpta Medica Database, EMBASE.
anesthesia in relieving postoperative pain after laparoscopic sterilization. Methods: In a double-blind, placebo-controlled randomized study of two groups of 25 subjects each, women scheduled for tubal sterilization under general anesthesia received80 ml of 0.5% lidocaine with l/320 000 epinephrine intraperitoneally in the right subdiaphragmatic quadrant at the beginning of the procedure. At the end of the procedure, they received 10 ml of 2% lidocaine with 1180000 epinephrine injected into each mesosalpinx. Controls received saline instead of lidocaine. Shoulder and pelvic pain assessedby visual analogue pain scale, postoperative analgesic requirements, nausea or vomiting, and time to return to normal daily activities were evaluated in the ambulatory unit and after discharge during the first 48 postoperative hours. Blood samples were taken in ten subjectsreceiving lidocaine to evaluate peak plasma concentrations and time to peak plasma concentrations. Results: Pain was significantly lessin patients who received lidocaine, and the differencelasted for the duration of the study (P < 0.05). Analgesicrequirementsand time to return to normal daily activities were significantly reducedin patients who received lidocaine (P < 0.05). Blood samples revealed no toxic concentrations. The peak plasma concentration was 3.22 f 1.21&ml, and the time to peak plasma concentration was 42 f 15 min. Conclusion: Intraperitoneal instillation of lidocaine-epinephrine combined with mesosalpinxinfiltration of lidocaine during tubal sterilization produceseffective, long-lasting analgesia and improves the postoperative course. Pregnancy rates after operative endoscopic treatment of total (neosalpingostomy) or near total (salpingostomy) distal tubal occlusion
Dlugi A.M.; Reddy S.; Saleh W.A.; Mersol-Barg M.S.; JacobsenG. USA
FERTIL STERIL 19946U5 (913-920) Objective: To determine the efficacy of the endoscopic treatment of complete distal tubal occlusion or moderate to severe tubal phimosis and to analyze outcome using contemporary statistical methodologies. Design: Prospective cohort analysis. Setting: Tertiary-care institution. Patients: One hundred thirteen consecutive patients undergoing a neosalpingostomy or salpingostomy. Interventions: KTP/532 laser (Laserscope, Santa Clara, CA) laparoscopy. Additional infertility factors