- Email: [email protected]
Predictive factors for the diagnosis of acute abdominal pain in nonpregnant women undergoing emergency laparoscopic surgery
August ]999, Vol. 6, No. 3 Supplement TheJournal of the American Association of Gynecologic Laparoscopists
laparoscopic Burch colposuspension and insertion of a suprapubic catheter (SPC). Sixteen women chose to be discharged with SPC within 24 hours after the operation and were followed daily by nursing staff at home. The SPC was removed by nursing staff in the hospital once adequate residual urinary volumes were achieved. Conclusion. Discharge 24 hours after laparoscopic Burch colposuspension is safe in selected patients.
laparoscopy in nonpregnant women with acute abdominal pain. Measurements and Main Results. Logistic regression analysis was performed to determine the factors significantly associated with a positive finding. Variables were age, parity, gravidity, main complaint, associated complaints, previous surgery, use of contraception, history of PID, presence of ovarian hyperstimulation syndrome, physical findings, signs of peritoneal irritation, fever, or leukocytosis, and positive preoperative US. In 100 patients an inaccurate diagnosis was significantly more likely in those with acute or chronic abdominal pain (adjusted OR 4.73, 95% CI 1.13-19.8) and significantly less likely in those with a positive ultrasonographic examination (adjusted OR 0.35, 95% CI 0.14-0.86). Conclusion. We were not able to determine specific physical findings strongly associated with an accurate preoperative diagnosis; however, a positive US finding was strongly associated with correct surgical diagnosis. History of acute or chronic abdominal pain led to unnecessary laparoscopies.
31. Uterine Cavity Evaluation after Recurrent Pregnancy Loss--Hysteroscopy or HSG? J Cohen, I Yovel, R Kedar, J Lessing, M David. Lis Maternity Hospital, Sourasky Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
Objective. To evaluate the diagnostic role of hysteroscopy and HSG for investigating the uterine cavity in women with pregnancy loss. Measurements and Main Results. In 91 women with at least 2 consecutive pregnancy losses HSG was followed by continuous-flow diagnostic hysteroscopy with saline or glycine as distention medium. The HSG was normal in 41 women (45%) and pathologic in 50 (55%). Among the former, hysteroscopy confirmed a normal uterine cavity in 17 (41.5%) and detected pathology in 24 (58.5%). Among the 50 women with pathologic HSG, hysteroscopy disclosed uterine pathology in 37 (74%) and no abnormality in 13 (26%). Sensitivity and specificity of HSG were 0.74% and 0.56%, respectively, and false negative and false positive rates were 39.3% and 43.3%, respectively. Conclusion. Diagnostic accuracy of hysteroscopy is superior to that of HSG in evaluating the uterine cavity in women with two or more consecutive pregnancy losses. Hysteroscopy is a simple, safe, and efficient diagnostic procedure that provides an immediate therapeutic option once pathology is disclosed.
33. Retrospective Comparison of Office and Surgery Center Hydro ThermAblator Treatment JM Cooper. University of Arizona, School of Medicine, Tucson, Arizona; Women's Health Research, Phoenix, Arizona.
Objective. To compare efficacy and immediate postoperative pain assessments in women undergoing Hydro ThermAblator (HTA) endometrial ablation in an office-based setting (OBS) versus an ambulatory surgery setting (ASS). Measurements and Main Results. Forty women (age 30-50 yrs) with abnormal uterine bleeding received pretreatment evaluation to rule out intracavity pathology and endometrial pretreatment with GnRh agonists. Women underwent endometrial ablation with the HTA that uses controlled instillation and circulation of heated saline in an outpatient surgery center with general anesthesia or in an office setting with local anesthesia and/or conscious sedation. Conclusion. Clinical results and patient satisfaction are not influenced by site of procedure.
32. Predictive Factors for the Diagnosis of Acute Abdominal Pain in Nonpregnant Women Undergoing Emergency I.aparoscopic Surgery S Cohen, M Goldenberg, B Weisz, S Mashiach, G Oelsner, D Seidman. }. Buchman Gynecology and Maternity Center, Sheba Medical Center and Sackler School of Medicine, TeI-Hashomer, Israel.
Objective. To determine preoperative findings that are most likely to predict pelvic pathology at emergency
$9
laparoscopic Burch colposuspension and insertion of a suprapubic catheter (SPC). Sixteen women chose to be discharged with SPC within 24 hours after the operation and were followed daily by nursing staff at home. The SPC was removed by nursing staff in the hospital once adequate residual urinary volumes were achieved. Conclusion. Discharge 24 hours after laparoscopic Burch colposuspension is safe in selected patients.
laparoscopy in nonpregnant women with acute abdominal pain. Measurements and Main Results. Logistic regression analysis was performed to determine the factors significantly associated with a positive finding. Variables were age, parity, gravidity, main complaint, associated complaints, previous surgery, use of contraception, history of PID, presence of ovarian hyperstimulation syndrome, physical findings, signs of peritoneal irritation, fever, or leukocytosis, and positive preoperative US. In 100 patients an inaccurate diagnosis was significantly more likely in those with acute or chronic abdominal pain (adjusted OR 4.73, 95% CI 1.13-19.8) and significantly less likely in those with a positive ultrasonographic examination (adjusted OR 0.35, 95% CI 0.14-0.86). Conclusion. We were not able to determine specific physical findings strongly associated with an accurate preoperative diagnosis; however, a positive US finding was strongly associated with correct surgical diagnosis. History of acute or chronic abdominal pain led to unnecessary laparoscopies.
31. Uterine Cavity Evaluation after Recurrent Pregnancy Loss--Hysteroscopy or HSG? J Cohen, I Yovel, R Kedar, J Lessing, M David. Lis Maternity Hospital, Sourasky Medical Center and Sackler Medical School, Tel Aviv University, Tel Aviv, Israel.
Objective. To evaluate the diagnostic role of hysteroscopy and HSG for investigating the uterine cavity in women with pregnancy loss. Measurements and Main Results. In 91 women with at least 2 consecutive pregnancy losses HSG was followed by continuous-flow diagnostic hysteroscopy with saline or glycine as distention medium. The HSG was normal in 41 women (45%) and pathologic in 50 (55%). Among the former, hysteroscopy confirmed a normal uterine cavity in 17 (41.5%) and detected pathology in 24 (58.5%). Among the 50 women with pathologic HSG, hysteroscopy disclosed uterine pathology in 37 (74%) and no abnormality in 13 (26%). Sensitivity and specificity of HSG were 0.74% and 0.56%, respectively, and false negative and false positive rates were 39.3% and 43.3%, respectively. Conclusion. Diagnostic accuracy of hysteroscopy is superior to that of HSG in evaluating the uterine cavity in women with two or more consecutive pregnancy losses. Hysteroscopy is a simple, safe, and efficient diagnostic procedure that provides an immediate therapeutic option once pathology is disclosed.
33. Retrospective Comparison of Office and Surgery Center Hydro ThermAblator Treatment JM Cooper. University of Arizona, School of Medicine, Tucson, Arizona; Women's Health Research, Phoenix, Arizona.
Objective. To compare efficacy and immediate postoperative pain assessments in women undergoing Hydro ThermAblator (HTA) endometrial ablation in an office-based setting (OBS) versus an ambulatory surgery setting (ASS). Measurements and Main Results. Forty women (age 30-50 yrs) with abnormal uterine bleeding received pretreatment evaluation to rule out intracavity pathology and endometrial pretreatment with GnRh agonists. Women underwent endometrial ablation with the HTA that uses controlled instillation and circulation of heated saline in an outpatient surgery center with general anesthesia or in an office setting with local anesthesia and/or conscious sedation. Conclusion. Clinical results and patient satisfaction are not influenced by site of procedure.
32. Predictive Factors for the Diagnosis of Acute Abdominal Pain in Nonpregnant Women Undergoing Emergency I.aparoscopic Surgery S Cohen, M Goldenberg, B Weisz, S Mashiach, G Oelsner, D Seidman. }. Buchman Gynecology and Maternity Center, Sheba Medical Center and Sackler School of Medicine, TeI-Hashomer, Israel.
Objective. To determine preoperative findings that are most likely to predict pelvic pathology at emergency
$9