Laparoscopic treatment of adnexal torsion

Citations $rom the Literature tion, inoculation of the pelvis with cervicovaginal flora during oocyte aspiration, and introduction of bacteria-laden secretions or air into the fallopian tubes during ET. Although rare, the possibility of severe pelvic infection following IVF-ET warrants consideration of prophylactic antibiotic coverage.

hernias after major lsparoscopic

lation syndrome, six with paraovarian cysts and I8 with idiopathic torsion. All of the women had an uneventful recovery, with I4 of I9 patients who claimed desire for pregnancy becoming pregnant within one year after the procedure, emphasizing its advantages and safety. Neovaginal reconstruction with a rectus abdominis myocutaneous

GYNECOLOGICAL SURGERY Incisional cedures

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Kadar N.; Reich H.; Liu C.Y.; Manko G.F.; Gimpelson R. USA AM J OBSTET GYNECOL 1993 l68/5 (1493-1495) Objective: Our purpose was to determine the incidence of incisional hernias after operative laparoscopy. Study design: A retrospective case review was performed. Results: The frequency of incisional hernias at extraumbilical IO and 12 mm trocar insertion sites was one in 429 (0.23%) cases and five in I61 (3. I’%)cases, respectively; the difference is statistically significant (P = 0.007, Fisher’s exact test). Incisional hernias were also significantly more common if the fascia was left open (P = 0.021), although three of the five hernias at I2 mm trocar sites occurred after attempted closure of the underlying fascia. Conclusion: The underlying fascia should be closed whenever a IO mm or larger trocar is placed at an extraumbilical site during laparoscopy. The peritoneum may also require closure at I2 mm trocar sites if the trocar is placed through, rather than lateral to, the rectus sheath. Laparoscopic paraaortic node sampling in gynecologic oncology: A preliminary experience

Querleu D. FRA ONCOL 1993 49/l (24-29) Because of the poor accuracy of nonsurgical methods in the detection of occult paraaortic lymph node metastasis, and because of the cost and discomfort of surgical staging, the feasibility of selective or elective paraaortic lymphadenectomy has been investigated in a preliminary series of four cases. Selective sampling of the lower paraaortic nodes in two cases of cervical carcinoma and of the infrarenal paraaortic nodes in two cases of early ovarian carcinomas were successfully completed by laparoscopy. The potential applications of this new technique are discussed. GYNECOL

Laparoscopic treatment of adnexal torsion

Shalev E.; Peleg D. ISR SURG GYNECOL OBSTET 1993 1760 (448-450) Adnexal torsion remains an infrequent and dificult to diagnose gynecologic emergency. Until recently, laparoscopic diagnosis was followed by laparotomy. Now, with proper laparoscopic technique, it is possible to untwist the adnexa or to remove it with excellent results. We report herein our cumulative four year experience with laparoscopic detorsion or removal of the adnexa in 41 patients. Ten patients were simultaneously pregnant, seven having the ovarian hyperstimu-

Benson C.; Soisson A.; Carlson J.; Culbertson G.; HawleyBowland C.; Richards F. USA OBSTET GYNECOL 1993 81/5 11 SUPPL (871-875) Background: Neovaginal reconstruction after pelvic exenteration has several advantages. Besides the obvious psychosocial benefit to the patient and her partner, the incorporation of viable tissue into the pelvic cavity decreases the incidence of infection and small-bowel complications. Several surgical techniques are available to the gynecologic oncologist for construction of a functional vagina. Recently, myocutaneous flaps incorporating the rectus abdominis and gracilis muscles have been used. Disadvantages of the gracilis myocutaneous flap are the IO-20% incidence of flap loss due to vascular compromise and the potential for prolapse. The rectus abdominis myocutaneous flap is a large flap with a reliable blood supply that allows mobilization without tension on the vascular pedicle, resulting in a much lower incidence of vascular compromise. Case: We present two case reports, a review of the gynecologic and surgical literature, and the techniques for vaginal reconstruction using the rectus muscle as a myocutaneous flap. Conclusions: The outcome for both patients was a satisfactory functional vagina that was technically easy to construct. The rectus abdominis myocutaneous flap can provide an adequate neovagina with minimal morbidity Ureterovesicovaginal

fistulas

Fichtner J.; Voges G.; Steinbach F.; Hohenfellner R. DEU SURG GYNECOL OBSTET 1993 l76/6 (571-574) Our experience with urogenital Iistulas are reviewed and three instances of complex ureterovesicovaginal fistulas, which can be mistaken for pure vesicovaginal fistulas because of diagnostic difficulties, are presented. If the ureterovaginal component of these fistulas is overlooked intraoperatively, urinary leakage will persist despite otherwise successful closure of the vesicovaginal component of the fistula. Because of the involvement of the terminal ureter in the fistulous system, operative therapy must combine the closure of the vesicovaginal fistula with reimplantation of the ureter into the bladder and interposition of omentum or a peritoneal patch between the bladder and vagina. Diagnosis and therapy are illustrated by patient reports and literature review.

FERTILITY AND STERILITY Why are couples satisfied with infertility treatment?

Halman L.J.; Abbey A.; Andrews F.M. USA Int J Gynecol Obstet 44