Bilateral Adnexectomy Research Articles

Is Adnexectomy Mandatory at the Time of Hysterectomy for Uterine Sarcomas? A Systematic Review and Meta-Analysis.

Background and Objectives: Uterine sarcomas represents only 3% of all the female genital tract ones. The tumoral stage is the most significant prognostic factor. The role of the bilateral salpingo-oophorectomy (BSO) in the surgical management of FIGO stage IA and IB appears still controversial. This review aims to investigate the impact of bilateral adnexectomy in the treatment of uterine sarcoma. Methods: Following the recommendations in the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement, we systematically searched the PubMed, Scopus, Cochrane, Medline, and Medscape databases in February 2022. We applied no language or geographical restrictions, but we considered only English studies. We included the studies containing data about Recurrence Rate (RR), Disease-free Survival (DFS), and Overall Survival (OS). We used comparative studies for meta-analysis. Results: Seventeen studies fulfilled the inclusion criteria; 2 retrospective observational studies, and 15 retrospective comparative studies, And 14 out of the 15 comparative studies were enrolled in meta-analysis. A total of 3743 patients were analyzed concerning the use of adnexectomy with hysterectomy in patients with uterine sarcoma and compared with those who did not. Meta-analysis highlighted a non-significant worsening of the OS in the BSO group compared to the OP group and showed that adnexectomy does not improve the DFS (BSO OR 1.23 (95% CI 0.81–1.85) p = 0.34; I2 = 24% p = 0.22). Conclusions: Most studies selected for our review showed that adnexectomy does not significantly affect the RR, OS, and PFS in treating FIGO stage I uterine sarcomas. Therefore, even if there is a unanimous consensus about bilateral adnexectomy in menopausal patients, preservation of ovarian tissue may be considered in premenopausal women. Nonetheless, there are not enough cases in the literature to recommend this procedure.

Management of malignant struma ovarii: is aggressive therapy justified? Case report and literature review

BackgroundStruma ovarii (SO) is a rare ovarian teratoma containing predominantly thyroid tissue. In rare situations SO may develop malignancy. Most cases of malignant struma ovarii (MSO) are diagnosed after surgical removal, based on histopathological examination. There are still controversies regarding the extent of surgery and postoperative management in MSO, due to its unpredictable behavior, possible risk of metastasis and relatively high rate of recurrence. Case PresentationWe present the case of a patient diagnosed with a right ovarian cyst discovered incidentally during routine ultrasound examination. Its rapid growth and pelvic MRI raised the suspicion of a neoplastic process. She underwent total hysterectomy and bilateral adnexectomy. The anatomopathological diagnosis was MSO with follicular variant of papillary thyroid carcinoma. Prophylactic total thyroidectomy was performed, followed by radioactive iodine ablation (RAI), and suppressive therapy with levothyroxine. At 1 year follow-up, the patient was disease free.ConclusionsEven if latest literature reports consider that completion of local surgery with total thyroidectomy and RAI might be too aggressive in cases of MSO without extraovarian extension, in our case it was decided to follow the protocol for primary thyroid carcinoma, in order to reduce the recurrence risk.

Hysterectomies for Benign Utero-Adnexal Lesions: Evolution of the Approach, Indications and Results About 392 Cases Collected at the Department of Gynecology and Obstetrics of Ouakam Military Hospital, Dakar, Senegal Between 2006 and 2016

Objectives: To describe the socio-demographic characteristics of the patients, to analyze the evolution of the approach, the indications, the characteristics of the procedure (type of anesthesia, surgical procedure, per and postoperative complications, associated gestures, blood transfusion And duration of hospitalization) according to the approach and to specify the results of the hysterectomy for benign utero-adnexal lesions. Materials and methods: This was a retrospective, descriptive and analytical study of the hysterectomies performed for benign utero-adnexal lesions at the Department of Obstetrics and Gynecology of the Ouakam Military Hospital over a period of 11 years from 1st January 2006 to December 31st, 2016. Results: During the study period, we performed 392 hysterectomies among the 5,578 programmed gynecological surgeries, ie a frequency of 7%. There were 153 hysterectomies per laparotomy (39.03%), 222 vaginal hysterectomies (56.63%) and 17 coelio-prepared hysterectomies (4.3%). Between 2006 and 2016, laparotomy, vaginal and coelio-prepared hysterectomies rates increased from 76.9% to 23.1%, 39% to 56.6%, and 0 to 4.3%, respectively. Patients were aged 51.8 years (37-83 years) with an average parity of 5 (0-14). Indications were dominated by uterine fibroids (71.2%) in the laparotomy group, severe cervical dysplasia (36.9%) and uterine fibroids (28.8%) in the vaginal Benign endometrial disease (35.3%) and uterine fibroid disease (29.4%) in the "coelio-prepared" group. We performed 346 total interannexual hysterectomies (88.3%) and 46 total hysterectomies with bilateral adnexectomy (11.7%). The procedure was mostly spinal anesthesia (79.8%) and lasted an average of 89 minutes (45-215 minutes). The mean hemoglobin was 13.1 g/dL preoperatively and 11.1 g/dL postoperatively, a difference of 2g/dL on average. We recorded 11 intraoperative complications (2.8%). There were 6 severe haemorrhages, 3 digestive wounds and 2 bladder wounds. The duration of hospitalization was on average 4 days [2-7] and the follow-up was mostly simple (97.7%). Conclusion: This study on hysterectomies at the Military Hospital of Ouakam showed that the rate of laparotomy hysterectomies had decreased over the past decade in favor of vaginal and coelio-prepared hysterectomies. The indications for this procedure were dominated by uterine myomatosis and severe cervical dysplasia, and intraoperative complications, dominated by haemorrhages, were globally rare.

Prophylactic surgery plus hyperthermic intraperitoneal chemotherapy (HIPEC CO2) versus standard surgery in colorectal carcinoma at high risk of peritoneal carcinomatosis: short-term and long-term outcomes from the CHECK study – protocol for a randomised, multicentre, phase 3 trial

IntroductionUp to one-fifth of patients with colorectal cancer will develop peritoneal metastases, frequently without other districts’ involvement. Despite the recent unsuccesses of hyperthermic intraperitoneal chemotherapy (HIPEC) for colorectal cancer peritoneal...

Trends and characteristics of ovarian conservation at hysterectomy for young women with cervical cancer (463)

<b>Objectives:</b> The association between early surgical menopause and increased mortality has been well demonstrated. Prior studies have also demonstrated that ovarian conservation is not associated with worse oncologic outcomes in early-stage cervical cancer. This study examined the contemporary trends and characteristics of ovarian conservation at the time of hysterectomy in young women with cervical cancer. <b>Methods:</b> This is a retrospective observational cohort study examining the National Inpatient Sample. The study population was 4,900 women aged ≤50 with cervical cancer who had hysterectomy-based surgical treatment from October 2015 to December 2018. Exposure allocation was the adnexal procedure status (ovarian conservation vs bilateral adnexectomy). The main outcome measures were temporal trends of ovarian conservation over time and per patient age. A multivariable binary logistic regression model (conditional backward selection) was fitted to identify independent characteristics associated with ovarian conservation. <b>Results:</b> A total of 2,940 (60.0%) women underwent ovarian conservation at hysterectomy. The incidence of ovarian conservation increased from 54.7% in Q4/2015 to 64.4% in Q4/2018 (<i>p</i>=0.002). Ovarian conservation rates remained stable until age 37 years, ranging from 82.5% to 77.9% (<i>p</i>=0.502), after which time the rate sharply and significantly decreased from 77.9% to 28.7% (<i>p</i><0.001). In multivariable analysis, recent surgery remained an independent factor for ovarian conservation (adjusted-odds ratio per year-quar- ter: 1.03, 95% CI: 1.01-1.05). In addition, younger age, Hispanic race, self-pay, large hospital bed capacity, Southern region, and minimally invasive hysterectomy were independently associated with ovarian conservation (all, <i>p</i><0.05). <b>Conclusions:</b> Increasing rates of ovarian conservation at the time of hysterectomy in women undergoing surgical management of cervical cancer are encouraging; however, the marked decrease noted in patients in their mid-30s is striking and warrants further investigation.

Demayo Sandra

Introduction: Usual sex determination and differentiation occurs progressively during the period of embryonic development, involving chromosomal differentiation, gonadal differentiation, and somatic or genital differentiation. Swyer syndrome is a disorder of sex chromosomes and sexual differentiation characterized by 46, XY pure gonadal dysgenesis in a phenotypically female person with primary amenorrhea, and a complete absence of functioning gonadal tissue. Gonadal malignancy occurs in 10-30% of cases, so gonadectomy is indicated at the time of diagnosis. The treatment includes, in addition to the gonadectomy, hormone replacement therapy, and psychological support. Objective: To present a case diagnosed and managed in our institution, in addition to reviewing the recent literature about this rare condition, but with a strong physical, psychological and social impact. Methods: Analysis of clinical history of a patient with Swyer's Syndrome, diagnostic and therapeutic management. Bibliographic review. Presentation of the clinical case: An 18-year-old patient attends our hospital presenting primary amenorrhea. She presents BMI: 22; Tanner stage PH III BD III, gynecological examination with vulva and vagina with normal characteristics. Hormone profile requested: FSH 96.8 mU/ml, LH 32.9 mU/ml, Estradiol &lt;25 pg/ml; Total testosterone 0.15 ng/ml. TV ultrasound shows a hypoplastic uterus of 23x11x29 mm, ovaries are not visualized, and a heterogeneous solid image of 22x23x24 mm in the left adnexal region. 46XY karyotype. In the presence of these results, a diagnosis of Swyer's syndrome is made, so an MRI was requested, which shows a uterus of 14x20x26 mm, ovaries are not visualized, a solid lobulated oval image of 23x33x47 mm poorly vascularized standing out in the left adnexal region and free inguinal canals. It was decided to perform exploratory laparoscopy and gonadectomy. The intraoperative findings were: intrapelvic hypoplastic uterus, uterine tubes without any particularities, enlarged left gonad of approximately 3x4 cm pearly white with a hard elastic consistency, and a fibrous band in the right adnexa. Bilateral adnexectomy was performed, obtaining as a histological result well-differentiated left dysgerminoma SALL4 +, OCT3/4 +, negative Inhibin and CD 117 +, and right streak gonad. Conclusions: In the presence of a person with primary amenorrhea and absence or poor development of secondary sex characteristics, Swyer's syndrome should be suspected, and pertinent studies should be requested to arrive at the diagnosis. It is essential to perform gonadectomy at the time of diagnosis due to the risk of malignant transformation. The importance of a multidisciplinary approach and psychological accompaniment of patients and relatives is highlighted.

An unusual case of acute abdomen

A 60 year old woman presented to A &amp; E complaining of abdominal pain and coffee ground like vomit. Her past medical history included type 2 diabetes, hypertension and a conjunctival melanoma with gastric and right adnexal secondarisms. So, she underwent a laparotomy and bilateral adnexectomy the year before with no further cytoreduction because of its metastatic nature.

HBOC syndrome with an uncharacterized variant in the BRCA1 gene in a patient diagnosed with endometrial cancer after surgery for bilateral breast cancer: A case report.

The association between endometrial cancer and the BRCA1 and BRCA2 genes is not fully understood, and the risk elevation of endometrial cancer in patients with hereditary breast and ovarian cancer (HBOC) is not understood. The present report examines a rare case of HBOC syndrome and an uncharacterized variant of the BRCA1 gene in a patient diagnosed with endometrial cancer. A 46-year-old woman, gravida 1 para 1, was referred to Wakayama Medical University Hospital (Wakayama, Japan) because positron emission tomography/computed tomography (PET/CT) showed a high FDG uptake in the corpus uteri and the left ovary. PET/CT was performed just after mastectomy for left-sided breast cancer (triple negative). The patient had previously undergone partial mastectomy for right-sided breast cancer (triple negative) and was treated with radiation therapy to the right residual breast when she was 39 years old. Laparoscopic hysterectomy and bilateral adnexectomy were performed, and the histological diagnosis was endometrioid carcinoma, grade 1. Her germline BRCA status was tested by blood examination and the result was ‘NM_007294.4(BRCA1):c.49G>C (p.Ala17Pro)’. The variant was evaluated as ‘likely pathogenic’. The patient was diagnosed with HBOC syndrome and endometrial cancer, pT1ANxM0. The patient had no recurrence of breast or endometrial cancer 16 months after gynecologic surgery.

Management of a rare ovarian carcinosarcoma: A case report and literature review.

Ovarian carcinosarcoma (OCS) is a rare and lethal gynecological cancer. The present study reports on the case of a 61-year-old post-menopausal female with abdominal distension who was detected to have a large OCS. The patient underwent cytoreductive surgery, including sub-extensive hysterectomy, bilateral adnexectomy, sigmoid colon and partial rectal resection, and lymph node dissection. Postoperative pathology of the bilateral adnexal masses revealed carcinosarcoma. The main components of the carcinoma included serous carcinoma and a small amount of squamous cell carcinoma. The sarcoma components mainly contained fibrosarcoma, as well as a small amount of chondrosarcoma and rhabdomyosarcoma. Infiltrating cells in cancer tissues or metastasis were observed in the serosal surface, muscular and subserosal layers of the uterus, as well as the sigmoid colon and part of the rectum. The patient was diagnosed postoperatively with International Federation of Gynecology and Obstetrics stage IIIC ovarian carcinosarcoma and T3cN1M0 based on the TNM system. The patient then received six cycles of combination chemotherapy using carboplatin, paclitaxel plus bevacizumab. As severe myelosuppression occurred during and after chemotherapy, and bevacizumab was expensive, bevacizumab therapy was not maintained after chemotherapy. However, following chemotherapy, the patient received niraparib oral maintenance therapy. At 6 months after the sixth chemotherapy, cancer antigen 125 levels dropped to 4.55 U/ml (within normal range). Short-term follow-up of 6 months after the end of chemotherapy indicated that the patient had a remission prognosis based on the ultrasonography, computed tomography, magnetic resonance imaging examinations and serum tumor marker levels. The present study indicated that combined chemotherapy and targeted therapy after cytoreductive surgery may be a promising way for the treatment of OCS.

Case Report: Fortuitous discovery of primary peritoneal psammocarcinoma

Psammocarcinoma is an uncommon subtype of low-grade serous carcinoma. It is characterized by the presence of extensive psammoma bodies and can have either an ovarian or peritoneal origin. To our knowledge fewer than 30 cases of primary peritoneal psammocarcinoma (PPP) have been reported in the English literature. We report a rare case of PPP in a 74-year-old female, discovered fortuitously within a laparotomy for gallbladder lithiasis. At laparotomy, multiple nodular implants involving the omentum, the peritoneum and a magma of intestinal loops in the right iliac fossa were noted. A biopsy from nodules was performed. Gross examination showed multiple nodules of different sizes in the fat tissue. Pathologic examination showed massive psammoma bodies representing more than 75% of the tumor. The final diagnosis was psammocarcinoma. Our patient was referred to the gynecologic department for further investigation and to ascertain whether the tumor arose from the ovaries or peritoneum. Hysterectomy, bilateral adnexectomy and omentectomy were performed. Macroscopic examination showed that both ovaries were intact having a normal size. No invasion of ovarian stroma was shown in microscopic examination. The patient died of SARS-CoV-2 (COVID-19) six days after the surgery. PPP is a rare type of low-grade serous carcinoma. The behavior of this tumor is unclear, and the treatment is not standardized because of its rarity and lack of long-term follow-up. More cases need to be studied for better understanding and improvement of the management protocols.

Bilateral ovarian metastases from pulmonary neuroendocrine tumor. A case report and literature review

Pulmonary cancer is commonly associated with the development of distant metastases at the level of liver, bones, adrenal glands and even brain. However, in certain cases other metastatic sites might be encountered such as the ovaries; however, these situations have been rarely encountered. The aim of the current paper is to present the case of a 39 year old patient with previous history of pulmonary neuroendocrine tumor, submitted to palliative radio-chemotherapy who was diagnosed with two large ovarian tumors and high volume of ascites which impaired even more the respiratory function. The patient was submitted to hysterectomy and bilateral adnexectomy, the histopathological studies demonstrating the metastatic origin of the tumors.

Complete Response to Immunotherapy Combined With Chemotherapy in a Patient With Gynecological Mixed Cancer Mainly Composed of Small Cell Neuroendocrine Carcinoma With High Tumor Mutational Burden: A Case Report

Small cell neuroendocrine carcinoma (SCNEC) is rare in the gynecologic tract, which has high invasive and metastatic ability. Due to the aggressive behavior and lack of treatment, patients have an extremely poor prognosis. Here we report a 66-year-old female diagnosed with SCNEC in the gynecologic tract, mixed with endometrioid adenocarcinoma, squamous cell, and adenosquamous carcinoma. A tumor mutational burden of 13.14 Muts/Mb was detected by next-generation sequencing. The patient underwent a palliative operation of total hysterectomy with bilateral adnexectomy but suffered from disease progression in a short time after the operation. Chemotherapy (paclitaxel + carboplatin) combined with immunotherapy (toripalimab) was conducted every 3 weeks, achieving a partial response after 2 cycles of treatment. After 5 cycles of combined treatment, the patient consolidated with monotherapy of toripalimab for about half a year and achieved a complete response. Until December 2021, the patient has achieved 27 months of progression-free survival and maintains a continued complete response. This case is presented due to the rare combination of pathological types and durable response to treatment especially immunotherapy, suggesting the potential value of immunotherapy in SCNEC of the gynecologic tract.

Appendicular mucocele mimicking a right adnexal mass – a case report and literature review

The correct diagnostic of a cystic lesion at the level of the right iliac fossa in women can be hard to be established in certain cases, different pathological lesions having similar imagistic aspects and being associated with similar biological modifications. In such cases the final diagnostic is established intraoperatively and the type of surgery can be significantly modified. The aim of the current paper is to report a 63 year old woman with preoperative diagnostic of right ovarian mass who was submitted to surgery in order to have a total hysterectomy and bilateral adnexectomy; however intraoperatively the cystic lesion developed at the level of the right iliac fossa proved to be an appendicular tumor and was successfully resected by performing a radical right hemicolectomy.

Laparoscopic En Bloc Pelvic Resection with Rectosigmoid Resection and Anastomosis for Stage IIB Ovarian Cancer: Hudson's Procedure Revisited

To demonstrate a systematic approach to the laparoscopic en bloc pelvic resection with rectosigmoid resection and anastomosis as part of ovarian cancer treatment in a tertiary gynecologic surgery referral center. This video illustrates an en bloc pelvic resection performed par laparoscopy in 10 steps. A 56-year-old patient with an advanced high-grade serous ovarian cancer extending into the rectum was amenable to primary debulking surgery in accordance with the French guidelines [1]. In diagnostic laparoscopy, a bilateral adnexectomy was performed, and the pelvic carcinomatosis was considered primarily resectable. Histopathology of the subsequent en bloc resection was consistent with stage IIB high-grade serous ovarian cancer with an indication for adjuvant chemotherapy. The Hudson's procedure revisited consists of a radical monobloc excision by way of a completely extraperitoneal dissection and total mobilization of the rectum. In this case, owing to rectal invasion, we achieved a laparoscopic radical resection including rectosigmoidectomy and primary anastomosis without the need for a defunctioning stoma [2]. Traditionally, an en bloc pelvic resection with rectosigmoid resection and anastomosis was performed by laparotomy. The feasibility of performing laparoscopic optimal cytoreductive surgery in selected patients with advanced ovarian cancer was recently demonstrated without compromising survival in case of low residual disease. The prognosis depends rather on the resectability than on the operative access. However, the radicality and completeness of the cytoreduction, as well as the potential risk of tumor seeding, remain controversially discussed. Here, we demonstrate the minimally invasive approach following the same operative strategy as in open surgery. In this way, the radicality of the "en bloc resection" entailing avoidance of tumor rupture, less bleeding, and less urethral injury is combined with the benefits of a minimally invasive access. In expert hands, this procedure can be performed laparoscopically for other pelvic malignancies with peritoneal carcinomatosis.

Intensity modulated radiotherapy and targeted therapy for late nonregional para-aortic lymph node metastasis from HER2 positive breast carcinoma

In the case of invasive breast carcinomas (BC) there are extremely rare late nonregional retroperitoneal lymph node recurrences, occurring after 10 years of disease diagnosis. We present a 32-year-old woman, who was diagnosed in 2010 with left HER2 positive invasive ductal BC- pT2N1M0. Complex treatment involving radical mastectomy with axillary dissection and complex adjuvant treatment (chemotherapy, radiotherapy, targeted therapy with trastuzumab, endocrine therapy with LHRH agonist plus tamoxifen) was conducted. After 4 years, disease progression with left supraclavicular lymph node enlargement has been manifested. After surgical resection of supraclavicular lymph node, the patohistological analysis establishes lymph metastasis from HER2 positive invasive ductal carcinoma. After 6 years of multimodal treatment, including eight chemotherapy cycles docetaxel, bilateral adnexectomy, 2 targeted agents trastuzumab/pertuzumab and endocrine therapy with aromatase inhibitor, PET/ CT visualizes a nonregional lymph recurrence of left retroperitoneal lymph nodes. Isolated involvement of distant nodal regions is extremely uncommon. Complex therapy, including a definitive radiotherapy of retroperitoneal para-aortic lymph nodes combined with targeted therapy achieved complete remission in nonregional abdominal lymph recurrence.

Climacteric symptoms in postoperative patients among endometrial cancer, cervical cancer, and ovarian cancer: a cross-sectional study

PurposeTo date, no studies have assessed climacteric symptoms after hystero-adnexectomy for endometrial, cervical, or ovarian cancer. Thus, this study aimed to compare climacteric symptoms among patients who underwent surgery for these three cancer types.MethodsIn this cross-sectional study, we interviewed patients who were registered at a menopausal outpatient clinic between January 1999 and July 2016 after undergoing total hysterectomy, intrapelvic only or intrapelvic plus para-aortic lymph node dissection, and bilateral adnexectomy performed via laparotomy as a cancer treatment. Climacteric symptoms were assessed using a patient-reported questionnaire covering core domains with five symptoms only at the initial consultation. Each symptom was graded from 0 (no symptoms) to 3 (severe symptoms). We evaluated the frequency of symptom severity according to the time elapsed since surgery and the cancer type.ResultsThe numbers of patients with endometrial, ovarian, and cervical cancer were 328, 90, and 107, respectively. Overall, climacteric symptoms were more severe in patients with cervical cancer than in those with endometrial or ovarian cancer; symptom severity decreased with increasing time since surgery. However, symptom severity did not decrease significantly over time in patients with cervical cancer even after > 5 years had elapsed since surgery.ConclusionThe climacteric symptoms were less severe in patients with endometrial or ovarian cancer with longer time elapsed since surgery but not in those with cervical cancer. Patients with cervical cancer may require more prompt interventions, including symptomatic treatment and longer follow-up period, than those with endometrial or ovarian cancer.

A Rare Case of Cardiac Metastatic Uterine Intravenous Leiomyomatosis.

Intravenous leiomyomatosis (IVL) is a distinct uterine leiomyoma, even rare when combined with intracardiac invasion. Although leiomyomas are histologically benign, intracardiac metastasis may cause circulatory failure and death. Herein, we report a 55-year-old woman with a tricuspid chordae mass on echocardiography. Subsequently, gynecological ultrasonography revealed that the patient had masses in the ovaries, internal iliac vein, and inferior vena cava. The patient successfully underwent resection of the tricuspid chordae tendinea mass and implantation of the tricuspid annuloplasty ring. The patient underwent inferior vena cava, common iliac vein, hysterectomy, and bilateral adnexectomy after 4 months. To our knowledge, the present study is the first reported case with such a rare combination.

376 Ovarian remnant syndrome and recurrent ovarian serous cystadenoma

Introduction and aims: Ovarian remnant syndrome (ORS) is a rare gynecological complication, most often induced by difficult salpingoophorectomy that leave residual ovarian tissue on the pelvic wall. Recurrent serous cystadenoma may arise from ORS. Our objective was to enhance the importance of diagnosis and surgical management in patients with ORS. Methods: We describe the case of a patient with continuous interventions before radical surgery for ORS. She had a right nephrectomy at age 43, a total abdominal hysterectomy at 45, and bilateral adnexectomy for serous cystadenoma at age 47. After thirteen years of continuous transvaginal aspirations for recurrent cystadenoma, and two laparotomies for cystectomies she was referred to our center. She presented with an abdomino-pelvic mass of 22cm, pain, and compression symptoms. Basic surgical principles were followed: high religation and resection of gonadal vessels; bilateral stripping and excision of the pelvic side wall peritoneum; wide excision of tissue surrounding the remnant ovary. Results and discussion: She needed partial bladder and sigma resection, and comprehensive ureterolysis for complete surgical resection, without significant postoperative complications. Histollogically, remnant ovarian tissue was associated with serous cystadenoma. After being heavily pretreated the modest risk of bowel, bladder or ureteral trauma caused definitive sidewall stripping and vaginal excision. Nearly two years later it occurred a low-rate growing cystic colonic perianastomosis recurrence of 3cm, which has reached 6 cm to date, and remains completely asymptomatic. Conclusions: Meticulous surgery is advised to assure the best outcome to patients. Even a benign non-threatening lesion such as ovarian serous cystadenoma may become a locorregional problem, with aggressive behavior similar to low-grade malignant lesions.

Prevalence of Hysterectomy in the Obstetrics Gynecology Department of the Sominé Dolo Hospital in Mopti Mali in 2017

Introduction: Hysterectomy is a surgical procedure commonly performed in obstetrics gynecology at the Sominé Dolo hospital in Mopti, but no study had been conducted. The aim of this study was to determine the prevalence of hysterectomy and to review gynecological and peripartum hysterectomies. Methods: This was a descriptive cross-sectional study conducted over a period of 12 months from January 1, 2017 to December 31, 2017 in the obstetrics gynecology department of the Sominé Dolo hospital in Mopti Mali. Eligible patients were represented by all those who had undergone a peripartum or gynecological hysterectomy during the study period in our service. Our supports consisted of patient files, patient interviews, the operating report register, the delivery register and the hospitalization register. Data were entered and analyzed using Epi info3.5.3 software and word processing was performed using Word 2007 software. Results: During the study period, all the surgical interventions represented 522 cases, i.e. an overall prevalence of 9.2% (57/522) among which hysterectomies during the gynecological period represented 70% (38/57) against 30% (19/57) peripartum hysterectomies. The average age of the patients was 46.5 years with the extremes of 18 and 75 years. The types of hysterectomies were represented in the vast majority by total interadnexal hysterectomy 77.2% (44/57) followed by subtotal hysterectomy 15.8% (9/57) and hysterectomy plus bilateral adnexectomy 7% (4 /57). Conclusion: Hysterectomy is one of the most practiced surgical activities at the Sominé Dolo hospital in Mopti. It constitutes an alternative solution for the practitioner to save the life of the patient, particularly in the event of emergency hysterectomies which represented a significant proportion in our study.

Nerve Anatomy Around Lumbo-aortic Lymphadenectomy by Retroperitoneal Approach

To describe the anatomy of the nerves during a laparoscopic retroperitoneal para-aortic lymphadenectomy with prioritization of their preservation. Demonstration of a nerve-preserving para-aortic lymphadenectomy. A 65-year-old woman with no significant medical history underwent diagnostic laparoscopy for evaluation of a right ovarian mass. In the absence of peritoneal carcinomatosis, bilateral adnexectomy wasperformed with pathology revealing a high-grade tubo-ovarian serous carcinoma. In accordance with French Guidelines for management of ovarian cancer, operative staging including pelvic and para-aortic lymphadenectomy was recommended [1]. Final pathology following staging surgery was consistent with stage IA high-grade serous ovarian cancer prompting administration of adjuvant chemotherapy postoperatively. We performed a lumbo-aortic lymphadenectomy with preservation of the following nerves: the superior hypogastric plexus, the lumbar splanchnic nerves and the sympathetic trunk. Although there are conflicting data as to the benefit of staging lymphadenectomy in women with presumed early stage high-grade serous ovarian cancer, current French Guidelines recommend its performance. When doing so, effort should be made to avoid injury to adjacent normal structures, and in doing so, minimize potential morbidity. The neural structures preserved in this case are part of the sympathetic contingent and participate in the innervation of the abdomen and pelvic viscera. The sympathetic contingent is responsible for the vasomotricity but is also involved in the contraction of the internal genitalia during orgasm and in the inhibition of the peristaltic contractions of the rectum. As such, its preservation may avoid certain postoperative complaints. When possible to do so without compromising essential elements of a cancer surgery, preservation of nerves should be considered.