-
Microsurgery Jul 2023Autologous tissue breast reconstruction with free deep inferior epigastric perforator (DIEP) flaps is reliable with reproducible results and very few contraindications....
BACKGROUND
Autologous tissue breast reconstruction with free deep inferior epigastric perforator (DIEP) flaps is reliable with reproducible results and very few contraindications. However, previous surgery may compromise the abdominal donor site due to injury to the vascular pedicle. The purpose of the current study is to evaluate the effects of prior abdominal surgery on need for changes to the operative plan, intraoperative complications, and postoperative flap compromise.
PATIENTS AND METHODS
A retrospective review of all patients undergoing breast reconstruction with free tissue transfer from the abdomen was performed.
RESULTS
A total of 733 free abdominal flaps were performed in 478 patients during the study period. Two hundred sixty-two (54.8%) patients had prior abdominal surgery with 24.8% laparoscopic/robotic versus 56.9% open versus 18.3% both, 21.4% general surgery versus 60.7% gynecological versus 17.9% both, and 97.7% elective versus 1.1% emergent versus 1.1% both. There were 15 total flap losses (2.0%) and 2 partial flap losses (0.3%). Intraoperative complications and changes in the operative plan occurred in 13 flaps (1.8%) with 84.6% having prior gynecological surgery (p = .0001).
CONCLUSIONS
Free DIEP flap breast reconstruction is becoming more commonplace with a low risk of complications. Although DIEP flaps are still possible in the setting of prior abdominal surgery, there is a higher risk of damage to the deep inferior epigastric pedicle in patients who have had emergency Cesarean sections or hysterectomy. Conducting a focused history may prepare the reconstructive microsurgeon to address and to avoid potential intraoperative complications.
Topics: Female; Humans; Rectus Abdominis; Postoperative Complications; Free Tissue Flaps; Retrospective Studies; Mammaplasty; Gynecologic Surgical Procedures; Perforator Flap; Epigastric Arteries
PubMed: 36701238
DOI: 10.1002/micr.31011 -
Gynecology and Minimally Invasive... 2022Adenomyosis is defined as the invasion of the basal endometrium (stroma and glands) into the underlying myometrium. It may lead to abnormal uterine bleeding (AUB),... (Review)
Review
Adenomyosis is defined as the invasion of the basal endometrium (stroma and glands) into the underlying myometrium. It may lead to abnormal uterine bleeding (AUB), pelvic pain, and infertility. The definitive treatment is hysterectomy. Some conservative measures have been used in patients willing to procreate. Ulipristal acetate is a selective progesterone receptor modulator used to treat AUB caused by leiomyomas. This is a systematic review on the use of ulipristal to treat adenomyosis. Eight eligible articles were retrieved from PubMed, SCOPUS, and Cochrane Library. Only one randomized clinical trial was published until date concerning this matter. It seems that ulipristal acetate induces partial or complete remission of AUB caused by adenomyosis, but the evidence concerning its effect on pelvic pain and the radiologic findings of the disease is conflicting. Nevertheless, given the paucity of data, it is still preliminary to draw any conclusion about the subject.
PubMed: 36660320
DOI: 10.4103/gmit.gmit_95_21 -
Obstetrics and Gynecology Feb 2023Uterine artery embolization (UAE) is a minimally invasive procedure for treatment of symptomatic uterine leiomyomas, but long-term complications are under-reported.
BACKGROUND
Uterine artery embolization (UAE) is a minimally invasive procedure for treatment of symptomatic uterine leiomyomas, but long-term complications are under-reported.
CASE
This is the case of a healthy 51-year-old woman who had previously undergone UAE for symptomatic uterine leiomyomas. The patient presented with gross hematuria and pelvic pain 10 years later. She was found to have both a vesicouterine and a uteroduodenal fistula. The patient was successfully treated with hysterectomy, excision of the vesicouterine fistula, partial cystectomy, excision of the duodenal fistula, and primary duodenal repair.
CONCLUSION
Complex gynecologic fistulas may occur as a long-term complication in symptomatic women with a history of UAE.
Topics: Female; Humans; Middle Aged; Uterine Artery Embolization; Uterine Neoplasms; Leiomyoma; Hysterectomy; Fistula; Treatment Outcome; Embolization, Therapeutic
PubMed: 36649323
DOI: 10.1097/AOG.0000000000005055 -
Medicine Dec 2022Undifferentiated uterine sarcoma is a rare histological subtype of uterine sarcoma. This study aimed to summarize the clinical and pathological presentation of this case.
INTRODUCTION
Undifferentiated uterine sarcoma is a rare histological subtype of uterine sarcoma. This study aimed to summarize the clinical and pathological presentation of this case.
CASE REPORT
A 51-years-old patient was admitted to the clinic because of severe pain in the lower abdomen, and scanty bleeding from the genitals. Gynecological examination revealed an enlarged uterus. Conventional and Doppler transvaginal sonography detected a tumorously altered uterus with a maximum diameter of 20 cm a tumefaction with unclear borders and a diameter of 10 cm, with hyperechoic and hypoechoic fields within the tumefaction, presenting pathological vascularization and reduced values of the (Pulsatile index ≤ 1) and (Resistance index ≤ 0.40). Preoperatively, the chest, abdomen, and pelvis were examined. The patient underwent surgery and total abdominal hysterectomy with bilateral salpingo-oophorectomy, and partial omentectomy, with complete removal of the tumor. A pathohistological diagnosis, of undifferentiated uterine sarcoma, was made by excluding other types of uterine sarcomas. At the control examination after completion of chemotherapy, recurrence was ascertained.
CONCLUSION
undifferentiated uterine sarcoma is an aggressive malignant tumor that in most cases shows rapid progression of the disease after complete resection of the tumor, with a poor prognosis.
Topics: Female; Humans; Middle Aged; Uterine Neoplasms; Hysterectomy; Sarcoma; Uterus; Salpingo-oophorectomy
PubMed: 36596037
DOI: 10.1097/MD.0000000000032552 -
Journal of Personalized Medicine Nov 2022Uterine leiomyomas usually arise from the uterine body (95%), and rarely from the cervix (0.6%) or other urogenital sites. Lipoleiomyomas are benign, uncommon variants...
Uterine leiomyomas usually arise from the uterine body (95%), and rarely from the cervix (0.6%) or other urogenital sites. Lipoleiomyomas are benign, uncommon variants of leiomyomas (0.03-0.2%), histologically composed of smooth muscle cells and mature adipocytes; they usually occur in the uterine body and exceptionally in the cervix. We performed the first systematic literature review of cervical lipoleiomyomas (PRISMA guidelines), presenting five new cases. Including our series, thirty-one detailed cases were reported in the literature (mainly in Asia). The age range was 35-74 years, revealing a higher mean age than conventional cervical leiomyomas (46.5 vs. 39.4 years). Patients were usually multiparous (94%), typically complaining of vaginal bleeding (11/31, 36%), pelvic/abdominal pain (10/31, 32%), and/or urinary disturbances (6/31, 19%) 1 week to 10 months before presentation. Clinical examination revealed a pedunculated tumor (48%), or prolapse of ≥1 pelvic organs (16%). Twenty-four (77%) patients underwent total hysterectomy ± additional surgery; simple myomectomy/excision was performed in five (16%) cases. Only one (3%) of our cases recurred 2 years after partial excision; no evidence of disease was found 13 years after recurrence excision. Adipocytes occupied ≤50% of the tumor volume. Hyaline or myxoid changes and cartilaginous metaplasia were uncommon histological findings. Surgically challenging cases or pregnant patients may require expert gynecologists. Interventional radiology or conservative treatments were rarely proposed.
PubMed: 36579603
DOI: 10.3390/jpm12111852 -
Medicina (Kaunas, Lithuania) Nov 2022Uterine artery embolization (UAE) has become an accepted and widely performed therapy for patients with symptomatic (reporting at least two of the following symptoms:...
Uterine artery embolization (UAE) has become an accepted and widely performed therapy for patients with symptomatic (reporting at least two of the following symptoms: severe or prolonged menstrual bleeding, abdominal pain, tension in abdomen, problems with urination, constipation or anemia) uterine fibroids. Although in the majority of cases, bilateral occlusion is required to obtain a successful clinical outcome, there are patients in whom treatment of only one uterine artery could be attempted. There are several reasons for unilateral UAE: hemodynamic conditions, technical difficulties, anatomical variants and unilateral dominancy of blood supply to the fibroid. Our aim is to present our 10-year experience with unilateral UAE and evaluate the radiological and clinical outcomes. Records of 369 patients with fibroids who underwent UAE from 2010 to 2021 were analyzed. We identified 26 patients treated with unilateral uterine artery embolization and analyzed the data of these patients. All patients attended medical consultation, were assessed using a five-grade symptom scale and underwent MRI examination. Clinical response was evaluated at least 6 months after the procedure and was categorized to one of the following groups: complete improvement, partial improvement, no change and a worsening in symptoms. Twenty-two patients (85%) reported at least partial improvement 6 months following the procedure. One patient required secondary embolization due to recanalization. The secondary procedure was successful, and complete improvement was achieved. One patient did not observe any clinical improvement, and in two cases, symptom recurrence was observed. All three patients were referred for surgical treatment. No major complications were noted. Overall, the success rate was 88%. The results of our study support the statement that elective unilateral embolization is an appropriate treatment in patients with a dominant uterine artery.
Topics: Female; Humans; Uterine Artery Embolization; Uterine Neoplasms; Leiomyoma; Hysterectomy; Abdominal Pain; Treatment Outcome
PubMed: 36556934
DOI: 10.3390/medicina58121732 -
Annals of Translational Medicine Nov 2022Hysterectomy is the most common type of gynecological operation in the United States. However, complications can occur during or after the operation. Some studies...
BACKGROUND
Hysterectomy is the most common type of gynecological operation in the United States. However, complications can occur during or after the operation. Some studies suggest that hysterectomy may increase the risk of stroke. However, other studies have found different conclusions on this matter. This inconsistent conclusion may be due to small sample sizes or limited covariates. So, we sought to further investigate the correlation between hysterectomy and stroke.
METHODS
Our analysis was based on the data from 2007-2018 National Health and Nutrition Examination Survey (NHANES). We excluded participants with missing hysterectomy data (Question "Have you had a hysterectomy, including a partial hysterectomy, that is, surgery to remove {your/her} uterus or womb?"), participants with missing stroke data (Question "Has a doctor or other health professional ever told you that you had a stroke?), a total of 15,241 participants were included in our analysis. To estimate the correlation between hysterectomy and stroke, logistic regression models were used after adjusting for sociodemographic and health-related factors, including age, race, education level, marital status, annual family income, body mass index (BMI), alcohol consumption in the past 12 months, having smoked at least 100 cigarettes in a lifetime, hypertension, hypercholesterolemia, and diabetes.
RESULTS
The unadjusted model suggests that women who had undergone a hysterectomy were 3.15 [95% confidence interval (CI): 2.67-3.71] times more likely to have a stroke than women who had not undergone a hysterectomy. In the crude and fully-adjusted models, the correlation between hysterectomy and stroke was consistent [odds ratio (OR) =1.55 (95% CI: 1.30-1.85), OR =1.36 (95% CI: 1.14-1.63)]. In the subgroup analysis stratified by age, hysterectomy seemed to have more risk for stroke occurrence regardless of subgroup, even after adjusting sociodemographic and health-related factors. Interestingly, the women who were less than or equal to 50 years old had greater odds of stroke (OR =1.96) compared with women who were aged older than 50 (OR =1.42).
CONCLUSIONS
In our study, we concluded hysterectomy may increase the risk of stroke. However, as our study is a cross-sectional study and unmeasured covariates may still exist, more researches are required to confirm this conclusion.
PubMed: 36544663
DOI: 10.21037/atm-22-4681 -
Cureus Nov 2022Uterine leiomyomas commonly reduce naturally after menopause. We report a rare case of metastasizing leiomyoma that grew after surgical menopause. A 68-year-old...
Uterine leiomyomas commonly reduce naturally after menopause. We report a rare case of metastasizing leiomyoma that grew after surgical menopause. A 68-year-old woman suffered from pelvic and lung masses without clinical symptoms. Nineteen years ago, she underwent a total hysterectomy and bilateral adnexectomy for multiple uterine myomas and bilateral endometriotic cysts. She has since been regularly prescribed conjugated estrogens. Surgery was scheduled in order to rule out malignancy; abdominal masses resection and thoracoscopic left partial pulmonary resection (S3, S4, S10) were performed. The histological diagnosis was leiomyoma in both abdominal and lung masses, and there was no evidence of gene mutations, which suggested that leiomyosarcoma was indicated. This case may indicate that hormone replacement was augmented via derived nutrient vessels after a surgical ovarian absence.
PubMed: 36540532
DOI: 10.7759/cureus.31549 -
BMC Women's Health Dec 2022The treatment of gestational trophoblastic neoplasia (GTN) is one of the success stories in medical oncology. GTN in the cesarean scar is a rare entity, but most cases...
BACKGROUND
The treatment of gestational trophoblastic neoplasia (GTN) is one of the success stories in medical oncology. GTN in the cesarean scar is a rare entity, but most cases need to be treated with hysterectomy or localized uterine lesion resection because of chemoresistant lesions and/or massive bleeding. We present a patient with post-molar GTN in the cesarean scar who was non-invasively treated with ultrasound-guided high intensity focused ultrasound (HIFU) to preserve the uterus and fertility.
CASE PRESENTATION
A 32-year-old woman was diagnosed with low-risk GTN (FIGO Stage I: 2 prognostic score) after partial hydatidiform mole. The 5th cycle of chemotherapy was interrupted because of persistent hepatic toxicity and impaired ovarian reserve function. However, the uterine lesion persisted (diameter of residual uterine lesion in the cesarean scar: 2.0 cm). Therefore, ultrasound-guided HIFU treatment was performed. A significant gray-scale change was observed during the HIFU treatment. Color Doppler ultrasonography and contrast-enhanced ultrasound (CEUS) was performed to evaluate the ablation effectiveness. Color Doppler ultrasonography showed disappearance of the signal of vascularity and CEUS showed no perfusion in the lesion located in the cesarean scar. The uterine lesion was obviously shrunken one month after HIFU treatment. Menstrual cycle resumed 48 days after HIFU. HIFU treatment decreased the number of chemotherapy cycles and there was complete disappearance of the GTN lesion at 4-month follow-up. The patient has shown no signs of recurrence as of 58-month follow-up.
CONCLUSION
Ultrasound-guided HIFU may be a useful alternative to lesion resection for GTN in the cesarean scar in patients who show chemoresistance or are not suitable for chemotherapy. It has the potential to ablate the residual uterine lesion noninvasively to preserve the uterus and fertility, avoiding perioperative risks of lesion resection, especially acute bleeding.
Topics: Pregnancy; Female; Humans; Adult; Cicatrix; Gestational Trophoblastic Disease; Hydatidiform Mole; Hysterectomy; Ultrasonography, Interventional; Uterine Neoplasms
PubMed: 36522625
DOI: 10.1186/s12905-022-02114-0 -
European Journal of Obstetrics,... Jan 2023To analyze quality of life(QoL) and symptom resolution after surgical removal of Essure devices.
OBJECTIVE
To analyze quality of life(QoL) and symptom resolution after surgical removal of Essure devices.
METHODS
Single-center cohort study which included patients with Essure removal between February 2017 and March 2018. Surgery was performed in 65 patients by laparoscopy (Salpingectomy only or Hysterectomy). Questionnaires were used to assess QoL(SF-36), emotional disorders(HAD) and symptoms preoperatively, at 3 months and 4 years postoperatively.
RESULTS
4(6,1%) and 16(24,6%) patients were lost of follow-up at three months and 4 years postoperatively respectively. Four(6,1%) intraoperative surgical complications occurred. During the three-months postoperative period, 3(4,6%) complications occurred: five Clavien Dindo Grade 1 complications (umbilical hematoma) and one Grade 2 complication (hyperthermia and digestive disorder requiring antibiotic therapy). Preoperative QoL scores were lower than those of general population. Scores were significantly improved at 3 months and 4 years postoperatively. At 4 years postoperatively, 17/49(34,7%) had a complete regression of symptoms, 21/49(42,8%) partial resolution and 11/49(22,4%) no improvement. 27/49(55,1%) patients made the connection between symptoms and ESSURE device after media coverage. 22/49(44,89 %) were influenced by media coverage in their decision of surgery. There was a higher percentage of patients with anxiety disorder before Essure removal than 4 years after [22/44 (50 %) versus 11/44 (25 %); p = 0.0045].
CONCLUSION
Essure removal has a restorative role in terms of QoL in short and long-term. Patients should be informed about possibility of no improvement after surgery and surgical morbidity. Larger prospective cohort is needed to make a well-considered decision about risks of surgery compared with expected benefits.
Topics: Pregnancy; Female; Humans; Hysteroscopy; Cohort Studies; Quality of Life; Sterilization, Tubal; Prospective Studies; Device Removal
PubMed: 36493582
DOI: 10.1016/j.ejogrb.2022.11.017