Previous Abdominopelvic Surgery Research Articles

Laparoscopic totally extraperitoneal hernia repair in patients with a history of previous abdominopelvic surgery.

A retrospective cohort study of patients undergoing laparoscopic inguinal hernia repair compared short- and long-term outcomes between individuals with or without history of previous abdominopelvic surgery, aiming to determine the feasibility of totally extraperitoneal (TEP) repair within this population. All patients who underwent elective TEP inguinal hernia repair by one consultant surgeon across three London hospitals from January 2017 to May 2023 were retrospectively analysed to assess perioperative outcomes. Two hundred sixty-two patients were identified, of whom two hundred forty-three (93%) underwent laparoscopic TEP repair. The most frequent complications were haematoma (6.2%) and seroma (4.1%). Recurrence occurred in four cases (1.6% of operations, 1.1% of hernias). One hundred eighty-four patients (76%) underwent day-case surgery. There were no mesh infections or explanations, vascular or visceral injuries, port-site hernias, damage to testicle, or persisting numbness. There were no requirements for blood transfusion, returns to theatre, or readmissions within 30days. There was one conversion to open and one death within 60days of surgery. Eighty-three (34%) had a history of previous AP surgery. There was no significant difference in perioperative outcomes between the AP and non-AP arms. This finding carried true for subgroup analysis of 44 patients whose AP surgical history did not include previous inguinal hernia repair and for those undergoing repair of recurrent hernia. In expert hands, laparoscopic TEP repair is associated with excellent outcomes and low rates of long-term complications, and thus should be considered as standard for patients regardless of a history of AP surgery.

Radiological Evaluation of Uterine Tubes in Infertile Women with Previous Pelvic Surgery

Abstract Background: Infertility is a disease that affects 8%–12% of couples at their reproductive age. Tubal factors account for 20%–30% of infertility cases. Tubal infertility can be caused by infections, endometriosis, and complications from previous abdominopelvic surgery. Objectives: The objective of the study is to determine the impact of pelvic surgery on future fertility by examining the fallopian tubes for any potential damage using a hysterosalpingography (HSG) examination. Materials and Methods: A cross-sectional study was conducted at Nineveh Governorate, Iraq, in two clinics from March 2022 to September 2022 by examining 317 infertile females using HSG. The exam was done as part of an infertility workup. Results: The results revealed that the study included 317 infertile women patients with a mean age of 28.82 ± 6.9 years (range 17–49 years), of these, 184 patients (58.04%) with primary infertility, and 133 patients (41.95%) with secondary infertility. The years of infertility ranged between 1 and 20 years and a median of 4 years. The history of one or more previous pelvic interventions was recorded in 39 cases (12.3%). The prevalence of tubal abnormalities was noted in 23.1% of cases with previous pelvic intervention and 13.3% in other patients, with an odds ratio of 1.95 at a 95% confidence interval. Tubal abnormalities do not differ significantly according to the type of infertility, and the mean age of infertile women with tubal abnormalities is not statistically different from those with normal tubes. Conclusion: This study concludes that pelvic surgeries, particularly cesarean operations increase the risk of developing subsequent fallopian tube abnormalities and pelvic adhesions, which can lead to infertility.

Safety of Laparoscopic Surgery in Gynecologic Emergencies: Comparative Analysis with and without Previous Abdominopelvic Surgery

Safety of Laparoscopic Surgery in Gynecologic Emergencies: Comparative Analysis with and without Previous Abdominopelvic Surgery

Laparoscopic Excision of Retroperitoneal Adnexal Cyst

To demonstrate the laparoscopic excision of a retroperitoneal adnexal cyst and describe the advanced surgical techniques and anatomic considerations in a patient with previous abdominopelvic surgery. Stepwise demonstration of advanced laparoscopic techniques with narrated video footage. Adnexal masses after hysterectomy are a common reason for repeat abdominal surgery.1 Up to 9% of patients may require future adnexal surgery if ovarian preservation was chosen at the time of hysterectomy.2 Indications for surgery can include persistent adnexal masses, masses with concern for malignancy, chronic pelvic pain, and risk-reducing surgery.2 This patient is a 53-year-old postmenopausal female with a history of a total abdominal hysterectomy and left salpingectomy who underwent excision of an 8 cm retroperitoneal left adnexal cyst (Still 1). Excision of a retroperitoneal adnexal cyst can be performed through a laparoscopic approach with several key strategies: CONCLUSION: Knowledge of retroperitoneal anatomy is crucial in the surgical management of retroperitoneal adnexal masses because dissection can be technically challenging and anatomy may be distorted due to pelvic adhesive disease. Use of advanced laparoscopic techniques and understanding surgical planes are important for safe dissection. High and early ligation of the infundibulopelvic ligament at the pelvic brim and a complete ureterolysis with parametrial excision are often necessary to remove all ovarian tissue to prevent an ovarian remnant.

The Association Between Low Body-Mass Index and Serious Post-endoscopic Adverse Events.

Low body mass index (LBMI) was associated with longer colonoscopy procedure time and procedural failure, and commonly considered to be a risk factor for post-endoscopic adverse events, but evidence is lacking. We aimed to assess the association between serious adverse events (SAE) and LBMI. A single center retrospective cohort of patients with LBMI (BMI ≤ 18.5) undergoing an endoscopic procedure was matched (1:2 ratio) to a comparator group (19 ≤ BMI ≤ 30). Matching was performed according to age, gender, inflammatory bowel disease or malignancy diagnoses, previous abdomino-pelvic surgery, anticoagulation therapy and type of endoscopic procedure. The primary outcome was SAE, defined as bleeding, perforation, aspiration or infection, following the procedure. The attribution between each SAE and the endoscopic procedure was determined. Secondary outcomes included each complication alone and endoscopy-attributed SAEs. Univariate and multivariate analyses were applied. 1986 patients were included (662 in the LBMI group). Baseline characteristics were mostly similar between the groups. The primary outcome occurred in 31/662 (4.7%) patients in the LBMI group and in 41/1324 (3.1%) patients in the comparator group (p = 0.098). Among the secondary outcomes, infections (2.1% vs. 0.8%, p = 0.016) occurred more frequently in the LBMI group. Multivariate analysis revealed an association between SAE and LBMI (OR 1.76, 95% CI 1.07-2.87), male gender, diagnosis of malignancy, high-risk endoscopic procedure, age > 40years, and ambulatory setting. Low BMI was associated with higher post-endoscopic serious adverse events. Special attention is required when performing endoscopy in this fragile patient population.

Prevalence of pelvic adhesions on ultrasound examination in women with previous abdominopelvic surgery

Background: Pelvic adhesions caused many problems ranging from obstructed tubes associated with infertility, to pelvic tenderness, and painful intercourse, to chronic pelvic pain. Curiously, adhesions could be very extensive, yet relatively silent. They might remain silent indefinitely, or long after the causative event, become symptomatic. The aim of the work was to assess the prevalence and location of pelvic adhesions by ultrasonography in women with a history of abdominopelvic surgery and to identify risk factors and symptoms associated with it. Methods: This prospective observational study was conducted on (110) women at the Department of Gynecology & Obstetrics, Tanta University Hospitals. Starting from September 2019 till July 2022.all cases will included by Special Clinical Tests. Abdominal scar assessment was performed in the operating room while the patient was anesthetized, lying in the supine position under a standard operating light source that was focused on the abdomen and sliding sign will be observed. Results: As a regard of previous operation done for all patients, 13 patients underwent general operations as appendectomy in 11 patients (10%) and Appendectomy and cesarean in 2 patients (1.8%) while 97 patients underwent gynecological operation as cesarean in 87 patients (79.1%), ovarian cystectomy in 4 patients (3.6%), salpingectomy and cesarean in 2 patents (1.8%), laparoscopy in 2 patients (1.8%) and ovarian cystectomy and cesarean in 2 patients (1.8%). Among 110 patients, there was a negative sliding sign in 18 patients (16.4%) while there was a positive sliding sign in 92 patients (83.6%). there were 51 non symptomizing cases, 9 patients (17.6%) out of 51 patients were with adhesions. There were 59 symptomizing cases, 9 patients (15.3%). Conclusion: In conclusion, Sliding sign by abdominal or vaginal ultrasound could be used as an accurate and easy diagnostic tool in predicting intra-abdominal adhesions. This technique may aid clinical decisions in patients undergoing repeat CS.

Clinical Outcome and Risk Factors of Chronic Radiation Proctitis Following Pelvic Radiation Therapy.

Pelvic radiation therapy (RT) is a common treatment for malignancies, including gynecological, genitourinary, and lower gastrointestinal tract cancers. However, chronic radiation proctitis (RP) is an unavoidable side effect, and its clinical presentation varies from asymptomatic to potentially life-threatening. This study evaluated the clinical characteristics and risk factors of chronic RP. Patients with chronic RP (212) following RT for various pelvic cancers between January 2015 and December 2021 were enrolled. Clinical characteristics of RP were analyzed retrospectively. Severity was graded according to the Radiation Therapy Oncology Group (RTOG) modified rectal toxicity score and Vienna rectoscopy score (VRS), and risk factors were statistically analyzed. The most common pelvic cancer observed was cervical cancer. The patients received three-dimensional conformal RT (3D-CRT), intensity-modulated RT, or a combination of 3D-CRT and intracavitary RT (ICR). Rectal bleeding occurred in 70 (33.0%) patients. Previous abdominopelvic surgery and total radiation dose significantly correlated with the RTOG score and VRS. Previous abdominopelvic surgery, ICR, and total radiation dose were associated with chronic hemorrhagic RP. All patients with chronic hemorrhagic RP were treated with argon plasma coagulation (APC). 91.4% of cases required 1-3 APC sessions to resolve the bleeding, with a mean of 1.7 sessions. Our results showed that previous abdominopelvic surgery and total radiation dose were significant risk factors related to chronic RP, while total radiation dose was related to chronic hemorrhagic RP. We also showed that APC was effective and safe for chronic hemorrhagic RP.

OC-029 LAPAROSCOPIC INGUINAL HERNIA REPAIR IS FEASIBLE IN PATIENTS WHO HAVE HAD PREVIOUS ABDOMINO-PELVIC SURGERY WITH NO INCREASED RISK OF COMPLICATIONS COMPARED TO OPEN REPAIR

Abstract Introduction This study aims to understand whether previous abdomino-pelvic (AP) surgery is a predictor of peri-operative complication in inguinal hernia surgery and if there are discrepancies between laparoscopic or open repairs. Material & Methods All patients operated on within a 5-year period were audited and subcategorised based upon history of AP surgery. Patients were also categorised into laparoscopic and open groups. Data collected included complication rates, recurrence rates and readmission within 30 days. Results 205 patients underwent repair of 288 hernias. 80 (39%) patients had a history of AP surgery. 32 patients suffered a complication (15.6%). 85% of the repairs were laparoscopic in the AP group vs 96.4% in the non-AP group (p=0.02). Complication rates were 17.5% and 14.4% in the AP group and non-AP group respectively (p=0.55). These included superficial infection (0% vs 2.4%, p=0.16), haematoma (11.3% vs 4.8%, p=0.08), seroma (5.0% vs 4.8%, p=0.95), persisting numbness (0% vs 0.8%, p=0.42), and chronic pain (1.3% vs 0.8%, p=0.75). There were no mesh infections or explantation in either arm. A greater proportion of patients in AP group required overnight stays (32.5% vs 21%, p=0.08). At median follow up 1.8 years, recurrence rates were 3.8% vs 1.6%, p=0.33 in AP and non-AP groups respectively. Conclusions Laparoscopic inguinal hernia is feasible in most patients with a history of AP surgery. Compared to open repair, there were no significant differences in recurrence or complication rates in patients with previous AP surgery. Therefore, previous AP surgery should not be a contraindication for laparoscopic repair.

Indications and surgical route for hysterectomy for benign disorders: a retrospective analysis in a large Australian tertiary hospital network.

Hysterectomy is a common but expensive and morbid procedure. Alternative treatments for heavy menstrual bleeding (HMB) are effective in up to 80% of cases, but there is substantial variation in surgical approach and pre-operative management of HMB. This study aims to assess the approach to hysterectomies for benign indications including alternative treatments and route of operation. We retrospectively collected patient and surgical data on all hysterectomies for benign indications from 1/4/2018 to 31/6/2020 at our tertiary-led hospital network. Hysterectomies were performed in 582 women at a median age of 49(44-56) with a median BMI of 27.9(24.5-33.3)kg/m2 and 251(43%) were referred from private rooms. Hysterectomies for HMB were performed laparoscopically (TLH)(156, 51.7%) more often than abdominally (TAH)(133, 44%) or vaginally (4.3, 13%), with wide variation between sites. Approach was predicted by a history of previous abdomino-pelvic surgery and uterine size but not by other patient factors (BMI, parity or comorbidities). Referral source, on the other hand, was a significant predictor of route of hysterectomy. In women with HMB without uterine abnormalities, 45% tried a levonorgestrel intrauterine device and 25% tried endometrial ablation before proceeding to surgery. The use of alternative therapies pre-operatively did not vary between sites or referral sources. The variations in route of hysterectomy that are unexplained by patient factors suggest room for improvement and raises the question whether some of the patients undergoing a TAH may have been candidates for less invasive surgery. Uptake of alternative management strategies for HMB could also be improved.

Complications After Hand-Assisted Laparoscopic Living Donor Nephrectomy

ObjectiveTo study the complications of hand-assisted laparoscopic living donor nephrectomy (HALLDN) with an emphasis on complications occurring early after hospital discharge up to 120 days after surgery. Patients and MethodsWe retrospectively categorized complications using the Clavien-Dindo classification in 3002 HALLDNs performed at 1 center from January 1, 2000, through December 31, 2019. In addition to overall summaries, modeling was used to identify correlates of complications before and after living donation. ResultsOf these donors, 87% were White, 59% were female, the mean age was 45 years (range, 18-77 years), 30.3% had a body mass index of at least 30, and 36.3% had previous abdominopelvic surgery. There were no deaths related to the surgery. The incidence of major complications (intraoperative complications plus Clavien-Dindo grade ≥III postoperatively) was 2.5% (n=74). The overall complication rate was 12.4% (n=371), including 15 intraoperative, 76 postoperative before discharge, and 280 after discharge to 120 days. Reoperation was required in 1.8% of patients (n=54), and all but 1 of these were incision-related problems. Seventy-six percent of all complications occurred after discharge, including 85% of the reoperations. For major complications, no risk factor was found. Risk factors for any complication included paramedian incision (hazard ratio [HR], 2.54; 95% CI, 1.49 to 4.34; P<.001); a history of abdominopelvic surgery (HR, 1.37; 95% CI, 1.07 to 1.76; P=.01), male sex (HR, 1.37; 95% CI, 1.07 to 1.76; P=.01), non-White race (HR, 1.40; 95% CI, 1.05 to 1.88; P=.02), and early era of the experience. ConclusionMost major complications of HALLDN occur after discharge, suggesting that close follow-up is warranted and that the current literature may underestimate the true incidence.

Endometriosis arising in a cesarean section scar: A case report.

Introduction and importanceScar endometriosis is an uncommon variant of extra pelvic endometriosis, which develops at the scar site of previous abdominopelvic surgery and is seen in women during their reproductive period.Case presentationWe report a 38-year-old female who presented with a nine-months history of a painful ulcerative mass that developed on a cesarean section scar. The mass was removed by a wide excision and confirmed by histology to be endometriosis.Clinical discussionWide surgical resection of ectopic endometriosis is the treatment of choice. It is usually curative and ensures the confirmation of the diagnosis.ConclusionCesarean section scar endometriosis can undergo malignant transformation. This case highlights the need for early detection and treatment.

Evaluation of the recurrence and fertility rate following salpingostomy in patients with tubal ectopic pregnancy

BackgroundEctopic pregnancy is one of the leading causes of pregnancy-related mortality; the treatment strategies associated with this condition entail complications, such as recurrence of ectopic pregnancy or infertility. The objective of this study was to evaluate the recurrence and fertility rate after salpingostomy in patients with tubal ectopic pregnancy.MethodsThis cross-sectional retrospective study was conducted at four referral centers of Obstetrics and Gynecology, under the supervision of Shiraz University of Medical Sciences (Iran). The medical records of 125 patients with tubal pregnancy were reviewed. These patients underwent laparoscopic salpingostomy from April 2009 to March 2016.Data on maternal age, BMI, history of previous EP, genital tract infection, IUD insertion, history of previous surgery, and infertility were further obtained. The patients were followed up for approximately 1 to 7 years. The recurrence of EP and subsequent pregnancy rate were assessed during the follow-up period.ResultsThere was no statistically significant relationship between post-salpingostomy recurrence and maternal age, previous abdominopelvic surgery, and history of infertility(P = .425); however, the post-salpingostomy recurrence of EP was correlated with BMI (P = 0.001), previous history of EP (P = 0.001), genital tract infection (P = 0.001), and IUD insertion (P = 003). Among 95 women who had no contraception, pregnancy occurred in 51 cases (53.6%) and recurrence of EP was observed in 16 patients (12.8%).ConclusionsOur results suggest that salpingostomy is a safe method with a low risk of recurrence and good fertility outcomes for women who consider future pregnancy.

The role of surgical experience in patient selection, surgical quality, and outcomes in robot-assisted radical cystectomy

BackgroundRobot-assisted radical cystectomy (RARC) remains one of the most complex urological procedures. Due to regionalization of bladder cancer care, there is likely an imbalance in experience among urologists performing RARC. We sought to describe changes in patient selection, surgical quality surrogates and rates of complications in relation to surgical experience. MethodsWe retrospectively reviewed 409 consecutive patients with bladder cancer who underwent RARC between 2006 and 2017 by a single surgeon. The cohort was divided into 4 quartiles (Q1–Q4) according to surgical experience, based on the chronologic order at which RARC was performed. Baseline, perioperative and pathologic characteristics of patients were compared among the 4 groups. 30-day and 90-day complications were assessed using the Clavien-Dindo system. The association between surgical experience (quartile) and complications was assessed using multivariable logistic regression analyses. ResultsMedian age (interquartile range [IQR] from 70–73 years), body mass index (IQR from 25 to 27 kg/m2) and preoperative glomerular filtration rate (IQR from 59 to 65 ml/min) were similar among all quartiles (all P > 0.05). Patients in Q4 had higher rates of previous abdominopelvic surgery (46.1% vs. 30.4%, P = 0.031) and American Society of Anesthesiologists score of 3 to 4 (72.3% vs. 47.1%, P = 0.003) compared to patients in Q1. Patients who underwent RARC in Q4 compared to Q1, had less estimated blood loss (250 ml vs. 350 ml, P < 0.001), shorter operative time (346 vs. 360 minutes, P < 0.001), and higher lymph node yield (22 vs. 17 nodes, P < 0.001). The 30-day and 90-day complication rates were 53% and 62%, respectively. Thirty-day complication rates were similar among all 4 quartiles (P > 0.05), but higher among patients in Q4 compared to Q1 within 90 days (74% vs. 54%, P = 0.01). On multivariable analysis, patients in Q4 were more likely to experience any 90-day complication (OR 2.03, 95%Cl 1.11–3.70) compared to Q1. ConclusionOur results show that with surgical experience, more complex cases can be performed while continuing to improve surgical quality. Nonetheless, there appears to be a trade-off between the increase in complexity of cases performed with experience and accepting higher rates of complications.

Surgical adhesions among women undergoing laparoscopic gynecological surgery with or without adhesiolysis - prevalence, severity, and implications: retrospective cohort study at a University Hospital.

Objective:To find out the prevalence of adhesions, severity, and their relation to the current clinical scenario and to the type of previous surgery.Methods and Materials:A retrospective study of patients who already had different previous abdominopelvic surgery and subsequently underwent gynecological laparoscopic surgery for various indications. The patients’ clinical and operative notes were reviewed and analyzed.Results:There were 654 procedures performed. The most common indication for the laparoscopic surgery was secondary infertility 23.5%, followed by adnexal lesions 22.0% and primary infertility 19.6%. Intraoperative adhesions were found in 45.3%. Adhesions were deemed relevant to the clinical scenario in 21.3%. Patients who had a previous history of open (traditional) surgery were more likely to be found with adhesions in comparison with patients with history of laparoscopic surgery (odds ratio: 2.7, 95% confidence interval: 1.4–5.3, p = 0.0025). The presence of adhesions was found to be strongly associated with previous abdominopelvic surgery than non-abdominopelvic surgery (odds ratio: 4.3, p = 0.0078, 95% confidence interval: 1.5–12.5). The most common location of the adhesions was abdominal (36.1%), mixed abdominal and pelvic (35.1%), and pelvic adhesions (28.1%). Severe adhesions were found in 36.1%; 13.6% of converted laparoscopy to open surgery was due to adhesions. Cesarean sections were significantly associated with adhesions. Patients who had cesarean sections were more likely to have adhesions than those who had not (odds ratio: 5.7, 95% confidence interval: 3.8–8.6, p < 0.0001). Adhesiolysis was done without complications in 19.6% of patients with adhesions.Conclusion:Adhesions were prevalent in gynecological patients with previous abdominopelvic surgery. They were a significant contributor to the gynecological and reproductive issues. To minimize the risk of postoperative adhesions, laparoscopic approach should be encouraged instead of traditional surgery and rates of cesarean section should be reduced. Further high-quality studies are needed to establish conclusion and practical guidance toward the use of adhesion barriers.

1253 A Descriptive Analysis of Anomalous Ectopic Pregnancies

Study Objective The majority of ectopic pregnancies implant in the fallopian tube; however, 10% implant in non-tubal locations including the abdominal cavity, cervix, ovary, interstitium of the fallopian tube, broad ligament, uterine cornua, and cesarean section scar. The objective of this study is to describe the characteristics and history of patients presenting with anomalous ectopics encountered at North Shore University Hospital/Long Island Jewish (NSUH/LIJ) from 2016 to 2018. Design A descriptive analysis of the anomalous ectopics encountered at NSUH/LIJ from 2016 to 2018. Setting Patients presented to the emergency room and were treated medically or in an operating room setting at NSUH/LIJ. Patients or Participants 55 women of reproductive age presented to NSUH/LIJ with pelvic pain and a positive bHCG and were determined to have an ectopic pregnancy in a non-tubal location. Interventions Patients with heterotopic, ovarian, cervical, cesarean section scar and interstitial ectopics were primarily treated via minimally invasive laparoscopic excision. Those with cesarean section scar and cervical ectopics were managed with methotrexate and intracervical balloons. Measurements and Main Results The incidence of patients with anomalous ectopics was 13.6%. The average age at diagnosis was 35. 74.5% in this cohort reported to be never smokers. 74.5% reported having previous abdomino-pelvic surgery. 74.5% did not use ART prior to their presenting diagnosis. The breakdown of ectopics was- Cesarean scar (27.3%), Cornual (23.6%), Interstitial (20.0%), Cervical (16.4%), Heterotopic (5.5%), Abdominal (3.6%), and Ovarian (3.6%). Conclusion Anomalous ectopic pregnancies in the NSUH/LIJ population of patients are 3.6% more prevalent than that reported by current data. Although these patients did not report use of ART in association with the anomalous pregnancy, many of these patients reported having previous abdominopelvic surgeries. C-section scar ectopics were the most prevalent, which may be secondary to the higher rate of c-sections in the last decade.

Racial/Ethnic Disparities/Differences in Hysterectomy Route in Women Likely Eligible for Minimally Invasive Surgery

Evaluate racial/ethnic variation in hysterectomy surgical route in women likely eligible for minimally invasive hysterectomy. Cross-sectional study. Multistate including Colorado, Florida, Maryland, New Jersey, and New York. Women aged ≥18 years without diagnoses of leiomyomas, obesity, or previous abdominopelvic surgery who underwent hysterectomy for benign conditions from the State Inpatient and Ambulatory Surgery Databases, 2010-2014. None. Primary exposure is race/ethnicity. Racial/ethnic variation in annual hysterectomy rates and surgical route. To calculate hysterectomy rates per 100000 women/year, denominators were adjusted for the proportion of women with previous hysterectomy. A marginal structural log binomial regression model was used to estimate adjusted standardized prevalence ratios (aPRs) for vaginal or laparoscopic vs abdominal hysterectomy, controlling for clustering within hospitals. In addition, hospitals were stratified into quintiles to examine surgical route in hospitals that serve a higher vs lower proportion of African American patients. A total of 133082 adult women underwent hysterectomy for benign conditions from 2010 to 2014. Annual laparoscopic rates increased more slowly for African Americans (1.6-fold) than for whites (1.8-fold) and Hispanics (1.9-fold). African American and Hispanic women were less likely to undergo vaginal (aPR = 0.93; 95% confidence interval [CI], 0.90-0.96 and aPR = 0.95; 95% CI 0.93-0.97, respectively) and laparoscopic hysterectomy (aPR = 0.90; 95% CI, 0.87-0.94 and aPR = 0.95; 95% CI, 0.92-0.98, respectively) than white women; Asian/Pacific Islander women were less likely to undergo vaginal hysterectomy (aPR = 0.88; 95% CI, 0.81-0.96). Hospitals serving a higher proportion of African American persons performed more abdominal and fewer vaginal procedures across all groups, and more racial/ethnic minority women sought care at those hospitals than white women. African American, Hispanic, and Asian/Pacific Islander women eligible for minimally invasive hysterectomy were more likely than white women to receive abdominal hysterectomy. The proportion of all women undergoing abdominal hysterectomy was highest at hospitals serving higher proportions of African American persons. This difference in treatment type can lead to disparities in outcomes, in part owing to their association with complications.

Association between Severe Gastrointestinal Toxicity and Molecular Targeted Therapy in Patients Received Radiotherapy for Metastatic Bone Tumor or Myeloma

Purpose of this study is to examine the association between severe gastrointestinal (GI) toxicity and molecular targeted therapy in patients received radiotherapy (RT) for bone lesions. This study included the patients who received RT for metastatic bone tumor or myeloma of abdominopelvic region between 2013 and 2014 at 6 institutions. Patient/tumor characteristics, RT dose, molecular targeted therapy, chemotherapy and GI toxicities were analyzed. GI toxicity was graded according to the CTCAE v4.0. Fisher’s exact test was used to examine the statistical significance. In total, 403 patients were included. Follow-up period was median 168 days (1-1798). Previous abdominopelvic surgery was performed in 145 patients. RT regimens were various, and major regimens were 30 Gy in 10 fractions and 20 Gy in 5 fractions. Total 21 different molecular targeted agents were administered in 185 patients. Vascular epidermal growth factor inhibitor (VEGFI) was administered in 85 patients; bevacizumab, sorafenib, axitinib, sunitinib, pazopanib, ramucirumab and regorafenib in 41, 24, 9, 13, 5, 1 and 2 patients. There were 30 (7.4%) patients who suffered ≥grade (G) 2 GI toxicities. G2, 3, 4 and 5 toxicities were observed in 15 (3.7%), 7 (1.7%), 4 (1.0%) and 4 (1.0%) patients, respectively. Duration between the beginning of RT and occurrence of GI toxicities was median 48.5 days (1-999 days). Perforation, bleeding, obstruction, diarrhea, gastroenteritis, vomiting and esophagitis were observed in 5 (1.2%), 7 (1.7%), 8 (2.0%), 4 (1.0%), 2 (0.5%), 1 (0.25%) and 3 (0.74%) patients, respectively. Among patients received molecular targeted therapy, there were in 3 (1.6%), 3 (1.6%), 4 (2.2%), 2 (1.1%), 3 (1.6%), 0 and 2 (1.1%) patients, respectively. Use of molecular targeted agents and use of VEGFIs showed no significant difference in occurrence of ≥G3 toxicities (3.8% vs 3.7%, p=1.0, and 7.2% vs 2.8%, p=0.095). History of previous abdominopelvic surgery (6.9% vs 1.6%, p=0.009) was only a significant factor. Among patients with molecular targeted agents use, ≥G3 toxicities in patients with VEGFIs use were significantly more than those in patients with other agents use (7.2% vs 1.0%, p=0.046). Moreover, among patients with VEGFIs use, ≥G3 toxicities in patients with VEGFIs use concurrently or during 7 days before and after RT were significantly more than those in patients with VEGFIs use during other period (18.2% vs 3.3%, p=0.04). Previous abdominopelvic surgery showed significantly higher occurrence rate of severe GI toxicities. Combination of RT with VEGFIs was significantly riskier than with the other agents. Use of VEGFIs concurrently or during 7 days before and after RT seems to be avoided.

Clinical Outcomes of Total Laparoscopic Hysterectomy (TLH): Seven Years’ Experience in a Public Hospital

Objective: The aim of the study was to explore the surgical outcomes of total laparoscopic hysterectomy.&#x0D; Materials and methods: This was a prospective analysis of total Laparoscopic Hysterectomy (TLH) done between January, 2012 to December, 2018 in Shaheed Suhrawardy Medical College and Hospital. Demographic data, clinical criteria, intra operative and postoperative outcome data were recorded. Data were collected in a predesigned Data collection sheet. Follow up records done during discharge from the hospital, one week and four weeks postoperatively.&#x0D; Results: Total 298, laparoscopic hysterectomy were performed during the period. Among them 96 % (n=286) for benign and 4 %( n=12) for malignant condition were included in the study population. Mean age of the patients was 45.4 ± 5.6 years, mean parity was 1.9 ± 0.64 and the mean body mass index was 27.48 ± 0.57. The most common benign disease was leiomyoma, 51.7 %. Among the study cases 21.8% (n=65) had history of at least one previous abdomino-pelvic surgery. Maximum size of uterus removed was 28 weeks and maximum patients, 48% (n=143) had uterine size of 10-14 weeks. The operating time was variable between 50 min to 180 min and in the course of time, the mean operating time dropped from 130 min to 60 min. The mean length of hospital stay was 2 days and the return to normal activities was within 2 weeks. Major complications observed among 3.7 % of cases among them 2(0.67%) bladder injury, 2(0.67%) vesico-vaginal fistula (VVF), 3(1.0%) ureterovaginal fistula (UVF) and 4(1.3%) peroperative hemorrhage requiring blood transfusion. Among the 7 cases of urological complications, one patient with VVF and one patient with UVF needed relaparotomy. Ultimately all cases were managed without any residual problem. Conversion to laparotomy was 0.3 % (n=1) of case.&#x0D; Conclusion: TLH offers the benefit of minimally invasive surgery to the patient and is a safe and acceptable alternative to standard hysterectomy for various gynaecological indications.&#x0D; Bangladesh J Obstet Gynaecol, 2019; Vol. 34(1): 28-35

946: Predictive value of striae gravidarum score for pelvic adhesions at repeat cesarean delivery

Previous abdominal operations might cause severe pelvic adhesions which can complicate cesarean delivery (CD) procedures. The present study aimed to evaluate the possible predictive value of striae gravidarum (SG) assessment on the pelvic adhesions formation. The current study was a cross-sectional study conducted in a tertiary university hospital between November 2016 and March 2018. All women scheduled for elective CD were included if they had pat least previous one CD. We excluded women with history of PID, endometriosis, previous abdomino-pelvic surgery and those with history of wound site infections. Then, preoperative evaluation of SG severity using Davey score which is validated scoring systems was done on the examination bed. Patients with no/mild striae (score 0-2) were classified as group (I) and women with severe striae (score 3-8) were classified as group (II). During surgery, pelvic adhesions were evaluated and classified according to the Nair's scoring system. The primary outcome was the difference in the rate of pelvic adhesions between both groups The study included 300 women in the final analysis; group I included 114 women and group II included 186 women. The mean age of the study participants was 28.43 ± 4.56 years. The mean parity was 3.22 ± 1.26 and the mean gestational age at inclusion was 37.26 ± 1.13 weeks. Eighty women (26.7%) were delivered by 3 CS or more. No statistical significant difference regarding the baseline characteristics of both study groups. Regarding presence of pelvic adhesions during CD, about 90% of women with severe striae versus 82.5% of women with no/mild striae were found to have adhesions with statistical significant difference (p=0.035). Dense adhesions were significantly present in severe striae group (57.4%) versus (41.5%) in no/mild striae group (p=0.022). The mean Davey score in women with group (II) was significantly higher than group (I) (4.25±3.36 vs. 2.95±3.09, p=0.03). Nair's score was positive moderately correlated with Davey score (r=0.541, p=0.016). According to the results of multivariate regression analysis, Davey score > 2 was the only variable associated with increased risk of pelvic adhesions (p=0.010). Therefore, it is considered as significant predictor of pelvic adhesions Assessment of SG status of a patient with a previous CD using Davey score might help predict pelvic adhesions status before planning a new surgery

Accuracy of preoperative real-time dynamic transvaginal ultrasound sliding sign in prediction of pelvic adhesions in women with previous abdominopelvic surgery: prospective, multicenter, double-blind study.

To investigate the role of the transvaginal sonographic (TVS) sliding sign in predicting pelvic adhesions in women with previous abdominopelvic surgery. This was a multicenter, prospective, interventional, double-blind study of patients with a history of abdominopelvic surgery who were undergoing laparoscopy or laparotomy during the 6-month period from March to August 2016 in one of three academic obstetrics and gynecology departments. Prior to surgery, patients were examined by TVS to assess the vesicouterine pouch, uterus, ovaries and pouch of Douglas, using the TVS pelvic sliding sign. Ultrasound findings and medical and surgical data were recorded. We assessed the accuracy of the preoperative TVS sliding sign in the prediction of pelvic adhesions overall and in each compartment separately. During the study period, complete TVS sliding sign and laparoscopic or laparotomic data were available for 107 women. Their mean age was 44.0 (95% CI, 41.6-46.4; range, 20-79) years. Their mean parity was 2.0 (95% CI, 1.7-2.3; range, 0-9) and the mean number of previous abdominal surgical procedures per patient was 1.3 (95% CI, 1.2-1.5; range, 1-4). Adhesions were noted in 27/107 (25.2%) patients. The TVS sliding sign had a sensitivity of 96.3% and specificity of 92.6% in predicting pelvic adhesions. There was a significant relationship between adhesions in each compartment and the TVS sliding sign (P< 0.05). The TVS sliding sign is an effective means to detect preoperatively pelvic adhesions in patients with previous abdominopelvic surgery. Use of such a non-invasive and well-tolerated technique could help in the planning of laparoscopy or laparotomy and counseling of these patients. Copyright © 2017 ISUOG. Published by John Wiley & Sons Ltd.