Laparoscopic Evaluation Research Articles

Prospective Assessment of Direction of Cervical Canal in Routine Hysteroscopy

Introduction: If the direction of the cervical canal is known, the commonly performed procedures as sono salpingography, embryo transfer, IUD insertion, cervical dilation etc. will be easier. The reported resultant trauma to the cervical canal and uterus during these procedures also can be avoided. As we know the cervical canal is tortuous in majority of cases, but the exact course is not yet reported or known. Objective: The objective of the present study was to try to identify the various directions of cervical canal while performing routine hysteroscopic surgeries. Methods: Four-point cervical canal direction was assessed while performing routine hysteroscopic procedures using 5fr Bettocchi operative assembly with 2.9 mm 12-degree telescope (Karl-Storz). The study group was patients with infertility who required hysteroscopy and laparoscopic evaluation as per infertility treatment protocol or else required hysteroscopy for AUB. The study was carried out at tertiary care referral hospital for minimal access surgeries for a period was of 2 yr. 9 months year from May 2017 to Feb 2020. Results: Down-right or left-up-straight combination of movement (DRUS, DLUS) was the most common cervical direction found in 72 % patients. If DURS (down-up-right-straight) movement is added these 3 movements together are seen in about 82% of patients. No cervical dilation is required when 5 fr hysteroscopic assembly was used in study group. No operative complications were found. Conclusion: DRUS and DLUS (down-right or left-up and straight) combination of movements are most frequent direction of cervical canal observed in 72% of patients.

Is there a role of antisperm antibodies in women with unexplained infertility - a Turkish pilot cross sectional case control study

Aim: Although some studies indicate that the presence of antisperm antibody (ASA) is important in the etiology of female infertility, this remains a controversial issue. The aim of this study was to determine whether the presence of ASA was important or not in primary and secondary unexplained infertility patients.Materials and Methods: Female patients (n = 90) were divided into three groups as follows: the primary infertility group (n = 30), the secondary infertility group (n = 28) and a control group (n = 32). In addition to laparoscopic evaluations, the presence of ASA in the study groups was also examined in serum and peritoneal washing liquid. The ASA - immunoglobulin G was measured using the Enzyme-Linked ImmunoSorbent Assay (ELISA) method with a qualitative measurement kit.Results: When the demographic data were analyzed, it was observed that the study groups were homogeneous in terms of age and period of infertility. The results of the study demonstrated that, when compared to the secondary infertility and control groups, the ASA positivity in the serum in the primary infertility group was significant (p 0.05).Conclusion: This study showed that the presence of ASA in serum may be an impact on the etiology of unexplained primary infertility.

Laparoscopic management of ovarian parasitic myoma: a case report

Background: Ovarian leiomyoma is very rare and constitutes 0.5%-1% of ovarian benign masses. Although most adnexal masses are benign, primary purpose of the assessment is to eliminate any malignancies. The most important issue in the evaluation of ovarian masses is to differentiate between malignant and benign masses. Laparoscopy is an important diagnostic and minimally invasive method for these purposes. Case Presentation: In this paper, we present a case report on laparoscopic evaluation of a patient who was diagnosed with right ovarian spontaneous parasitic myoma and who did not have a history of uterine surgery. Conclusion: Uterine ovarian myoma is extremely rare and can be confused with malignant ovarian masses. Laparoscopy option should be considered as the primary approach in the management of masses with suspicious location and appearance and in the differentiation of benign and malignant.

The Role of Diagnostic Laparoscopy in Chronic Pelvic Pain

One of the commonest symptomatology in gynecological outpatient clinics is chronic pelvic pain, it accounts for 10% of gynecologist’s general clinics patients. The study aimed to To evaluate the role of laparoscopy in evaluation of CPP, and its correlation with clinical examination and vaginal ultrasound examination. The present prospective study was done in the Department of Obstetrics and Gynecology Salah Al-Deen general hospital in Tikrit city from 1stApril- 31st August 2020. The study sample consists of 30 patients with chronic pelvic pain, according to the ACOG criteria, with a convenient sampling method. The data collection done through: a designed closed and open-ended questionnaire, physical examination, transvaginal ultrasound & laparoscopic examination for the 30 patients for evaluation of chronic pelvic pain. By laparoscopic examination (90%) of patients had positive findings, pelvic examination identified (89%) of them correctly. Those with negative findings in laparoscopy was (10%) of patient, (33.3%) of them were diagnosed as negative by pelvic examination, there were miss diagnosis in (67%) of the negative patient and (11.1%) of positive diagnosed patient, this was a statically significant relation. Sensitivity of TVS was 85%, versus 89% for the pelvic examination. Specificity for TVS, and pelvic examination was (100%), (33%) respectively. Accuracy of the test for TVS, and pelvic examination was (87%), (83%) respectively. Exploratory laparoscopy provides a definitive diagnosis in 90% of women complaining of unexplained CPP. The surgical treatment of these lesions improves painful symptomatology in 70% of women .

Spinal cord injury level and Phrenic Nerve Conduction Studies do not predict diaphragm pacing success or failure- all patients should undergo diagnostic laparoscopy

BackgroundDiaphragm Pacing(DP) demonstrates benefits over mechanical ventilation(MV) for spinal cord injured(SCI) patients. The hypothesis of this report is that phrenic nerve conduction study(PNCS) results cannot differentiate success or failure in selection of patients for DP. Direct surgical evaluation of the diaphragm should be performed. MethodsObservational report of prospective databases of patients undergoing laparoscopic evaluation of their diaphragms to assess for ability to stimulate to cause contraction for ventilation. ResultsIn 50 SCI patients who could not be weaned from MV, PNCS results showed latencies in stimulated patients (n = 44) and non-stimulated(n = 6) overlapped (7.8 ± 2.5 ms vs 9.4 ± 2.8 ms) and the null hypothesis cannot be rejected (p-value>0.05). Amplitudes overlapped (0.4 ± 0.2 mV vs 0.2 ± 0.2 mV) and the null hypotheses cannot be rejected (P-value >0.05). In 125 non SCI patients with diaphragm paralysis, there were 78(62.4%) with false negative PNCS. ConclusionPNCS are inadequate pre-operative studies. Direct laparoscopic evaluation should be offered for all SCI patients to receive the benefit of DP.

Characteristics of Suspected Endometriosis without Histologic Confirmation

Study ObjectiveWe aim to describe the clinical and laparoscopic features of suspected endometriosis lacking histologic confirmation.DesignRetrospective cohort study.SettingQuaternary community medical center.Patients or ParticipantsAll consecutive pathology reports from patients who underwent surgery for clinically suspected endometriosis by three surgeons from the Division of Minimally Invasive Gynecologic Surgery between 01/01/2016 and 12/31/2019 were reviewed and categorized in two groups: endometriosis histologically confirmed, and endometriosis not histologically confirmed. A retrospective analysis of the patients without confirmed endometriosis was performed by evaluating clinical, surgical, and histologic characteristics.InterventionsLaparoscopic surgery.Measurements and Main ResultsOf 487 patients, endometriosis was histologically confirmed in 419 (86.0%) and not confirmed in 68 (14.0%). Study group age range was 16 to 48 (median 30.5). Patients clinically presented with a variety of symptoms suspicious for endometriosis. 23 (33.8%) of the 68 patients without confirmed endometriosis had other gynecologic abnormalities, including leiomyomata, endometrial polyps or adenomyosis. 39 cases (57.3%) without confirmed endometriosis had non-specific histopathologic findings such chronic inflammation, fibrosis, adhesions, reactive changes, and hemosiderin deposits, while the remaining 29 (42.6%) had no histologic abnormalities. On laparoscopic evaluation, lesions appeared heterogeneous and suspicion of endometriosis was high in 10 (15%), low in 36 (53%), and absent in 22 (32%) patients. Laparoscopically, there were 14 cases without any abnormality visualized in the group with no histologic abnormalities (48%) compared to only 5 cases in the group with histologic findings (13%).ConclusionDespite the absence of histologically confirmed endometriosis, patients with clinically suspected disease still experience significant symptoms and management decisions remain challenging for both patientsand clinicians. Over half of the patients without confirmed endometriosis had non-specific histopathologic findings. Further research should analyze how these findings correlate to the clinical symptoms of patients with suspected endometriosis and role in management in such patients.

Hysteroscopic Resection of an Interstitial Ectopic Pregnancy

Study Objective We demonstrate a novel approach for treatment of an interstitial ectopic pregnancy via hysteroscopic resection under laparoscopic guidance. Design N/A Setting The patient was a 29 year old G2P0010 with an enlarging interstitial pregnancy despite treatment with methotrexate. The surgery was performed in an ambulatory center affiliated with a tertiary teaching hospital. Patients or Participants N/A Interventions We performed a resection of an interstitial ectopic pregnancy hysteroscopically with the aid of laparoscopic visualization. This surgical approach was undertaken after both hysteroscopic and laparoscopic evaluation determined its feasibility. Measurements and Main Results N/A Conclusion Interstitial ectopic pregnancies are rare, and factors such as hemodynamic stability, gestational age, and surgeon expertise must be considered in surgical planning. Hysteroscopic resection of an interstitial pregnancy under laparoscopic guidance can be employed safely in select cases. When appropriate, this technique allows treatment of an ectopic pregnancy with avoidance of more morbid, traditional treatments such as a cornuostomy or cornual wedge resection.

Laparoscopic repair of a Bochdalek hernia in an elderly patient: a case report with a review from 1999 to 2019 in Japan

BackgroundA Bochdalek hernia (BH) is a congenital defect of the diaphragm that generally presents in the newborn as life-threatening cardiorespiratory distress. In contrast, the diagnosis of a BH in adults is rare. Surgical repair for adult BH is recommended, but the optimal surgical method remains unclear.Case presentationA 75-year-old woman presented with progressive dyspnea and back pain, and a diagnosis of BH was made based on chest X-ray and computed tomography. Laparoscopic evaluation revealed a defect in the left posterior attachment of the diaphragm, and a left-sided BH without hernia sac was diagnosed. Parts of the stomach, small intestine, colon, pancreas, and spleen had prolapsed into the left thoracic cavity, without ischemic change, and these herniated organs were reduced to the abdominal cavity. A direct closure of the hernia orifice was possible by the laparoscopic suture technique using a mesh reinforcement. The patient made an uneventful recovery, and no recurrence was found in the 2-year follow-up.ConclusionA recently published study reviewing detailed cases of repair of adult BH from 1999 to 2019 identified 96 cases, including the present case. The number of reports on laparoscopic and/or thoracoscopic surgery for BH in adults has recently increased, and the approach for repairing BH should be selected carefully on a case-by-case basis.

New Diagnosis of Endometriosis is Less Common in Women over Age Forty Presenting with Pelvic Pain

To investigate the incidence of new diagnosis of endometriosis in women at or above the age of 40 who present with previously undiagnosed pelvic pain and no previous surgical or sonographic evidence of endometriosis to a tertiary care clinic specializing in pelvic pain and endometriosis. Retrospective cohort study (on the basis of the Strengthening the Reporting of Observational Studies in Epidemiology guidelines) of the incidence of laparoscopically proven endometriosis in women presenting with previously undiagnosed pelvic pain on the basis of age category (age <40 years or ≥40 years). Adjusted odds ratios and 95% confidence intervals were calculated using a multivariable logistic regression model. Pelvic pain focused gynecology clinic at a tertiary care hospital. Premenopausal women between 18 to 51 years who presented with pelvic pain and were booked for laparoscopy for the diagnosis and the possible treatment of endometriosis between the years 2012 to 2016. Patients who had had previous laparoscopy and those who had sonographic evidence of endometriosis were excluded from the study. Laparoscopic visual evaluation and treatment was carried out in all patients by specialized gynecologists focusing on endometriosis surgery. Presence or absence of visualized endometriosis at laparoscopy. We evaluated 174 women who met the inclusion criteria. Endometriosis was diagnosed in 35% (19/55) of patients aged 40 years and above and in 67% (80/119) of patients below the age of 40 years. Odds ratio adjusted for body mass index and parity was 2.38 (1.09-5.00; p = .03). When assessed as a continuous curvilinear variable without division to age categories, age was significant even in the more comprehensive model including more potential confounders. Secondary outcome analysis demonstrated that deep infiltrating endometriosis was diagnosed in 5% (3/55) of the women at or above 40 years and in 8% (10/119) of women below 40 years (p = .76). In addition, a curvilinear relationship was found with age, and there was also a lower incidence of endometriosis of 50% (19/38) in the youngest cohort of women aged 18 to 25 years. The likelihood of a new diagnosis of endometriosis in women with pelvic pain, no previous laparoscopy and a normal sonogram in our referral center was lower in women aged 40 and above. Careful counseling and consideration of the risks and yield of surgery is recommended before performing a laparoscopy for investigation of pelvic pain in this age group.

Prevalence of occult microscopic endometriosis in clinically negative peritoneum during laparoscopy for chronic pelvic pain.

To determine the prevalence of occult microscopic endometriosis in patients with chronic pelvic pain and negative laparoscopy. A retrospective cross-sectional study included women who underwent laparoscopic evaluation for chronic pelvic pain by three fellowship-trained gynecologic surgeons at a community hospital from January 2011 to December 2016. The aim was to evaluate the prevalence of microscopic endometriosis in this population. In 142 patients with clinically negative peritoneum on laparoscopy, 39% had occult microscopic endometriosis. Cramping pain score during menses was found to be lower in the positive biopsy group (6.9 vs 8.0, P=0.046). No differences were appreciated in age of menarche, pain during various parts of the menstrual cycle, or duration of symptoms. The biopsy-positive group had a younger age at time of evaluation, although not statistically significant (P=0.179). Current use of hormones affected neither biopsy results nor menstrual or pain characteristics. Detection was similar between robotic and laparoscopic cases and operative morbidity was minimal. Occult microscopic endometriosis may be present in approximately 39% of patients with clinically negative appearing peritoneum undergoing laparoscopy for chronic pelvic pain. Given this, biopsies should be performed in patients undergoing laparoscopy who do not have visible lesions.

Laparoscopic Evaluation of Primary and Secondary Subfertility

Background: Prevalence of subfertility in industrialized countries has been quoted as 20%,and seems to be on the rise. Traditional way to assess the uterine cavity, tubal structure andtubal patency was hysterosalphingography but it is now been largely superseded bylaparoscopy and hysteroscopy. With the objective of this study was to highlight the role oflaparoscopy in establishing the diagnosis of primary and secondary female subfertility anddifferent therapeutic procedure done.&#x0D; Method: This cross sectional study was conducted in the Subfertility and ReproductiveMedicine Unit of Gynae and Obstetrics department of Dhaka Medical College Hospital, Dhakafrom January 2015 to June 2018. Total 4256 sub fertile patients attended the Infertility OPD.Out of these 215 patients were selected for laparoscopy. Those patients who hadcontraindication for laparoscopy were excluded from study. Detailed laparoscopic findingswere recorded.&#x0D; Results: Out of 125 selected sub fertile patients 136 (63.26%) patients were in primarysubfertility group while 79 (36.74%) patients were in secondary subfertility group. In primarysubfertility group(n=136), most common laparoscopic finding was PCO in 44 (32.34%) patientsfollowed by peritubal and periovarian adhesions in 24 (17.65%) patients, Bilateral tubalblock in 23(16.91%) patients, Endometriosis in 15(11.03%), Unusual tortuous and lengthytube in 15(11.03%) patients, fibroid in 11(8.09%) patients, Mullerian agenesis and hypoplasiain 3(2.21%) cases. No visible abnormality found in 22(16.18%) cases.The commonest finding by laparoscopy in patients with secondary infertility were PCO in 18(22.78%) patients and peritubal and periovarian adhesions in 18 (22.78%) patients, followedby Bilateral tubal block in 12(15.19%) patients, fibroid uterus in 12(15.19%) patients,Endometriosis in 10(12.66%), Genital tuberculosis in 3(1.40%) cases. No visible abnormalityfound in 12(15.19%) cases.Various laparoscopic procedure like Ovarian drilling. Adhesiolysis, ovarian cystectomy, cystpuncture, salphingostomy, Myomectomy.&#x0D; Conclusion: Laparoscopy helped us to detect and treat important clinical condition in bathprimary &amp; secondary sub fertility.&#x0D; Bangladesh J Obstet Gynaecol, 2018; Vol. 33(2) : 143-148

Dysmenorrhea and Endometriosis in Transgender Adolescents.

To study the presentation of dysmenorrhea and endometriosis in transmasculine adolescents and review their treatment outcomes. A retrospective review. Boston Children's Hospital. Transmasculine persons younger than 26years old who were diagnosed with dysmenorrhea and treated between January 1, 2000 and March 1,2020. Not applicable. An electronic medical record review of the clinical characteristics, transition-related care, and treatment outcomes. Dysmenorrhea was diagnosed in 35 transmasculine persons. Mean age was 14.9years±1.9years. Twenty-nine (82.9%) were diagnosed after social transition. Twenty-three of 35 (65.7%) were first treated with combined oral contraceptives, but 14/23 (61%) discontinued or transitioned to alternative therapy. Twelve patients with dysmenorrhea alone initiated testosterone treatment, and 4/12 (33.3%) experienced persistent symptoms. Seven of 35 patients with dysmenorrhea (20.0%) were laparoscopically evaluated for endometriosis, and it was confirmed in all seven. Six had stage I disease, and one had stage II. Three of the 7 (42.9%) were diagnosed after social transition, with one diagnosed 20months after initiating testosterone treatment. Their endometriosis was treated with combined oral contraceptives, danazol, or progestins; four experienced suboptimal response during treatment with these therapies alone. Two of those with suboptimal response subsequently resolved their dysmenorrhea when using testosterone. Five patients with endometriosis initiated testosterone treatment, and of the 5 (40%) experienced persistent symptomatology with combined testosterone and progestin therapies. To our knowledge, this is the first study to characterize endometriosis in transmasculine persons. Evaluation for endometriosis was underutilized in transmasculine persons with dysmenorrhea, despite those who underwent laparoscopic evaluation and had disease confirmation. Although testosterone treatment can resolve symptoms in some, others might require additional suppression. Endometriosis should be considered in transmasculine persons with symptoms even when they are using testosterone.

A multimodality triage algorithm to improve cytoreductive outcomes in patients undergoing primary debulking surgery for advanced ovarian cancer: A Memorial Sloan Kettering Cancer Center team ovary initiative

ObjectiveTo describe outcomes using a multimodal algorithm to triage patients with advanced epithelial ovarian cancer (EOC) to primary debulking surgery (PDS) versus neoadjuvant chemotherapy (NACT). MethodsAll patients with EOC treated at our institution from 04/2015–08/2018 were identified. We included patients without contraindication to PDS who underwent prospective calculation of a Resectability (R)-score. A low risk score for suboptimal cytoreduction was defined as ≤6, and a high risk score ≥7. Patients were triaged to laparotomy/PDS, laparoscopic evaluation of resectability (LSC), or NACT depending on R-score. ResultsAmong 299 participants, 226 (76%) had a low risk score and 73 (24%) a high risk score. For patients with a low risk score, management included laparotomy/PDS, 181 (80%); LSC, 43 (19%) (with subsequent triage: PDS, 31; NACT, 12); and NACT, 2 (1%). For patients with a high risk score, management included laparotomy/PDS, 9 (12%); LSC, 51 (70%) (with subsequent triage: PDS, 28; NACT, 23); and NACT, 13 (18%). Overall, 83% underwent PDS, with a 75% CGR rate and 94% optimal cytoreduction rate. Use of the algorithm resulted in a 31% LSC rate and a 6% rate of suboptimal PDS. ConclusionsThe multimodal algorithm led to excellent surgical results; 94% of patients achieved an optimal resection, with a very low rate of suboptimal cytoreduction.

Mesh closure of epiploic foramen by ventral laparotomy in 17 horses with entrapment

BackgroundEpiploic foramen entrapment (EFE) of small intestine is a severe cause of strangulating small intestinal obstruction (SSI) with long-term survival seeming lower than for other causes of SSI in horses....

Cystic duct anomaly and pancreaticobiliary maljunction mimicking choledochal cyst

Abstract A choledochal cyst (CC) is an abnormal congenital dilatation of the extrahepatic or intrahepatic biliary tree and is usually diagnosed during childhood. While a magnetic resonance cholangiopancreatography (MRCP) may be helpful for the diagnosis, laparoscopy and intraoperative cholangiography might be the final tool for the diagnosis and evaluation of anatomical variant and an effective surgical treatment. Herein we report a case of a 12-year-old male whose MRCP was suggestive choledochal cyst with gallbladder agenesis. He underwent an elective laparoscopic evaluation, and the intraoperative cholangiography and findings revealed that the patient was not a choledochal cyst but that the infundibulum of the huge gallbladder directly entering the main right hepatic duct with pancreaticobiliary maljunction. This case highlights that these rare entities can mimic each other on imaging; however, a laparoscopic approach and intraoperative cholangiography serves the dual purpose of diagnosing and treating this rare pathoanatomical entity.

Myomectomie vaginale: faisabilité évaluation du risque d’adhérence postopératoire

ObjectivesThe objectives of this series are to evaluate the results of vaginal myomectomy and to assess the postoperative adhesion risk. MethodsIt was a prospective observational study of fifty patients. All patients underwent a vaginal myomectomy, followed six months after laparoscopy to assess and treat postoperative adhesions. ResultsMyomectomies were performed via an anterior, posterior and mixed colpotomy in 42 %, 54 % and 4 % of the cases, respectively. Laparoconversion was necessary in three cases (6 %). Laparoscopic evaluation was performed in 24 patients (48 %). adhesions were present in 14 cases (58.33 %); the adhesions did not affect the Fallopian tubes and ovaries. ConclusionVaginal myomectomy was feasible, not limited to single myomectomy this which is in agreement with previously published series. Post adhesion risk seems weaker and does not concern the appendices, but this requires to be confirmed.

Diagnostic Laparoscopy in Evaluation of Female Subfertility Factors: Experience in Rural Medical College

Diagnostic Laparoscopy in Evaluation of Female Subfertility Factors: Experience in Rural Medical College

Multicenter laparoscopic evaluation of the peritoneum in peritoneal dialysis patients.

Laparoscopic findings have been used to confirm peritoneal degenerations in peritoneal dialysis (PD) therapy. This study evaluated morphological changes in the peritoneum and their clinical relevance in patients undergoing PD. Laparoscopic findings at the rectovesical peritoneumwere evaluated and scored using an imaging system at the time of PD catheter removal in this multicenter study. Angiogenesis evaluated by the vascular score (VS), color changes score (CCS), plaque score (PS), PD duration, history of peritonitis, dialysate/plasma creatinine (D/P Cr) levels, and age at PD termination were statistically analyzed. The VS of patients with PD duration more than 96months was significantly decreased compared with that of the other patients and was negatively correlated with D/P Cr levels at PD termination. The CCS for patients with PD duration more than 96months were significantly higher than those for the other patients and positively correlated with D/P Cr levels at PD termination. The PS of patients with recurring peritonitis were significantly higher than those of the other patients. Diminished vascularity and increased color changes in the peritoneum may be predictive of D/P Cr levels with peritoneal degradation. Laparoscopic evaluation of the abdominal cavity can provide detailed information about peritoneal injury.

73: Endometriosis of the rectus muscle: A single center experience

There is limited data to inform physician’s counseling for endometriosis infiltrating the rectus muscle. The objective of this study was to review patient characteristics, preoperative and intraoperative findings for excised cases of rectus muscle endometriosis. In this IRB approved retrospective case series, we identified all women undergoing surgical resection of endometriosis with confirmed rectus muscle endometriosis on pathology report at a single academic hospital between January 2009 and January 2019. Subjects were excluded if pathologic specimens did not include the muscle or endometriosis was not present histologically. Demographics and perioperative data were extracted from the electronic medical record. Descriptive statistics were performed. Twenty-two patients were included in the analysis. The women were predominantly white, with a median age of 34 years (25 – 42 years) and median BMI of 31.28 kg/m2, (17.79 – 48.65 kg/m2). Twenty-one (95%) patients had at least one prior cesarean section and 5 (22%) had a prior excision of abdominal wall endometriosis. The chief complaint for all patients was pelvic or abdominal pain, and 75% reported cyclic pain. Only one quarter complained of a mass or lump however 54% had a palpable nodule on exam. Forty percent of women attempted medical therapy prior to surgery and all but one had preoperative imaging, the majority (81%) of which were MRI. Fourteen (64%) patients had a laparoscopic procedure and in 71% of those, the endometriosis was removed laparoscopically with 4 (21%) patients having a combined laparoscopic and abdominal procedure. Concurrent pelvic endometriosis was present in 10 (71%) patients who underwent laparoscopy, with the most common location being the bladder (60%). All cases of laparoscopic excision of rectus endometriosis were performed by a minimally invasive gynecologic surgeon (MIGS). Endometriosis nodules excised were on average 4.62 cm and 6 patients required mesh placement, 4 placed open by general surgery and the other 2 were placed laparoscopically by MIGS surgeons. There were no intraoperative complications. Eighteen (82%) of patients were discharged on the day of surgery including all 10 (100%) who had a laparoscopic excision of rectus endometriosis. Three patients in the laparotomy group had 30-day wound complications, with two requiring hospital admission for IV antibiotics. There was one hernia which was repaired 18 months following laparoscopic resection of rectus endometriosis. 94% of patients experienced complete pain relief at their postoperative visit. This case series describes the preoperative and intraoperative characteristics of rectus muscle endometriosis. Both abdominal and laparoscopic resection are effective in eliminating patients’ pain. Even when open excision is planned, laparoscopic evaluation of the pelvis should be considered due to the high incidence of concurrent pelvic endometriosis.

Laparoscopic evaluation and management of 47 patients with late-onset mesh infection after inguinal hernioplasty.

Mesh infection after inguinal hernioplasty can be complicated especially when it is caused by chronic fistula. Explantation of the infected mesh is inevitable when conservative treatment fails and is considered to be the key step toward development of future therapies. Our purpose was to determine the results of laparoscopic exploration and summarize the treatment experience of the late-onset mesh infection. We analyzed 47 patients with late-onset mesh infection treated at our hernia center. The medical records of these patients were retrospectively reviewed, and information regarding presentation, approach of previous hernia repair, type of mesh, operative findings, bacteriological examination result, and postoperative complications were obtained. All of the patients underwent laparoscopic exploration to identify the abscess and fistula, further debridement and treatment was performed afterwards according to the exploration results. All the operative courses were uneventful. Laparoscopy revealed four intestinal fistula and one bladder fistula. Four cases of all underwent debridement and drainage using laparoscopic approach only, and the others were converted to open surgery after laparoscopic exploration to remove the infected mesh. There were two hernia recurrence and nine wound infection during the follow-up period; all the patients had an eventually recovery. Laparoscopic exploration is an effective and minimally invasive method for managing the late-onset infection which can identify whether internal organ was involved and consult for the further treatment. The approach of mesh removal should be tailored according to the exploration results.