Round Ligament Of Uterus Research Articles

Perivascular Epithelioid Cell Tumor with Uncertain Malignant Potential Arising in the Round Ligament.

A 12-year-old adolescent was diagnosed with a right-sided solid mass in the round ligament of the uterus. The chief complaints were abdominal pain and pelvic discomfort. She underwent laparoscopic tumor resection. Histological examination demonstrated a trabecular growth pattern of epithelioid cells with mitotic activity (3 per 50 HPF), which expressed melanocytic and myoid markers. Due to aforementioned findings, a final diagnosis of perivascular epithelioid cell tumor (PEComa) with uncertain malignant potential was made. To the best of our knowledge, this localization of PEComa is considered to be infrequent with only occasionally reported cases.

Round ligament management during minimally invasive groin hernia repair in women: a systematic review and meta-analysis.

Female sex has been associated with worse outcomes after groin hernia repair (GHR), including a higher rate of chronic pain and recurrence. Most of the studies in GHR are performed in males, and the recommendations for females extrapolate from these studies, even though females have anatomy intricacies. The round ligament of the uterus (RLU) is associated with pelvic stabilization and plays a role in sensory function. Transection of the RLU during GHR is controversial as it can allow easier mesh placement but can favor genitourinary complications and chronic pain. As no previous meta-analysis compared preserving versus transecting the RLU during minimally invasive (MIS) GHR, we aim to perform a systematic review and meta-analysis evaluating surgical outcomes comparing the approaches. Cochrane Central, Embase, and PubMed databases were systematically searched for studies comparing transection versus preservation of the RLU in MIS groin hernia surgeries. Outcomes assessed were operative time, bleeding, surgical site events, hospital stay, chronic pain, paresthesia, recurrence rates, and genital prolapse rates. Statistical analysis was performed using RevMan 5.4.1. Heterogeneity was assessed with I2 statistics. A review protocol for this meta-analysis was registered at PROSPERO (CRD 42023467146). 1738 studies were screened. A total of six studies, comprising 1131 women, were included, of whom 652 (57.6%) had preservation of the RLU during MIS groin hernia repair. We found no statistical difference regarding chronic pain, paresthesia, recurrence rates, and postoperative complications. We found a longer operative time for the preservation group (MD 6.84min; 95% CI 3.0-10.68; P = 0.0005; I2 = 74%). Transecting the RLU reduces the operative time during MIS GHR with no difference regarding postoperative complication rates. Although transection appears safe, further prospective randomized studies with long-term follow-up and patient-reported outcomes are necessary to define the optimal management of RLU during MIS GHR.

Dilatation of suprapubic veins as a manifestation of pelvic varicose veins: description of a clinical case

The presence of dilated suprapubic veins (suprapubic shunt) is considered to be a classic symptom of post-thrombotic and non-thrombotic venous outflow obstruction. Meanwhile, the descriptions of isolated cases of the creation of a suprapubic shunt during pregnancy in women with pelvic varicose disease are presented in the literature. We present a clinical case report of successful treatment of pelvic varicose disease with the presence of dilated veins in the suprapubic region. A 33-year-old patient complained of the presence of varicose veins in the lower extremities, in the perineum and suprapubic region, heaviness and pain in the lower extremities, a periodic heavy feeling and burning in the varicose vein area, painful menstruation and pain during intercourse. The symptoms appeared and progressed during four pregnancies, after the last one the patient noted the appearance of dilated veins in the suprapubic region. The ultrasound angiography of the lower extremity veins revealed valvular incompetence of the saphenofemoral junction and the trunks of the great saphenous vein bilaterally, the left anterior accessory saphenous vein, signs of pelvioperineal reflux, dilated veins of the perineum and round ligament of the uterus. The first stage surgery involved phlebography and embolization of the ovarian veins bilaterally. The patient showed positive response to treatment, which resulted in relief of dyspareunia and reduction of algodismenorrhea. The second stage surgery involved endovenous laser coagulation of the trunks of the great saphenous vein bilaterally and the left anterior accessory saphenous vein. Varicose vein tributaries on the lower extremities were removed by means of miniphlebectomy, while varicose veins of the perineum and suprapubic region were obliterated by foam sclerotherapy. Three months after the intervention, the patient had a stable obliteration of all target veins, clinical improvement, disappearance of dilated veins in the suprapubic region, regression of pain in the lower extremities and complete relief of dyspareunia and algodismenorrhea. Thus, the presence of varicose veins in the suprapubic region can be not only a consequence of venous obstruction, but also a symptom of pelvic varicose disease. If a suprapubic shunt is identified, a detailed examination of the patient, including imaging methods for evaluating abdominal or pelvic veins is required. The results of the tests will help develop an individual treatment plan.

Laparoscopic Inguinal Hernia Repair for Female Patients: Experience from a High-volume Center in 20 years.

Although laparoscopic inguinal hernia repair (LIHR) is widely performed worldwide, few studies have focused on the procedure in female patients. This study investigated the characteristics and outcomes of female patients with inguinal hernias who underwent LIHR. This study retrospectively analyzed the data of 7380 patients with inguinal hernia admitted to the General Surgery Department of Ruijin Hospital and underwent LIHR from January 2001 to December 2020. The clinical characteristics, surgical outcomes, and complications were assessed. In total, 572 female patients were enrolled in this study. The proportion of femoral hernias in female patients was higher in women than in male patients (17.4% vs. 0.3%, respectively). Mesothelial cysts of the round uterine ligament (MCURL) were noted in 74 patients. The mean age of patients with MCURL was lower than that of patients without MCURL (46.4 vs. 55.6, P =0.018). Seventy cases (93.3%) of MCURL were resected laparoscopically, and 5 cases were resected through an auxiliary small incision. The round ligament was cut off in 335 patients and preserved in 237. No significant differences were observed in the number of hospitalization days, recurrence rates, or complications between the transection and preservation groups. None of the cases were converted to laparotomy, and no recurrence was noted during follow-up. LIHR is safe and feasible in female patients. Treatment of femoral hernia, MCURL, and the round ligament of the uterus should be carefully considered during LIHR in female patients.

Surgical Management of Inguinal Endometriosis

Study Objective To demonstrate surgical management of an inguinal endometrioma. Design Stepwise demonstration of surgical techniques with narrated video footage. Setting Yale New Haven Hospital, New Haven, CT. Patients or Participants A 31-year-old woman with a painful right inguinal endometrioma. Interventions The patient underwent diagnostic examination with pelvic MRI, which noted concern for an inguinal endometrioma. Biopsy confirmed endometriosis. She then underwent diagnostic laparoscopy, with resection of intra-pelvic and inguinal endometriosis. The technical steps of management and resection of an inguinal endometrioma have been detailed in the video with an emphasis on anatomic landmarks by utilizing visual illustrations. An incision was made at the inguinal ligament and taken down to the superficial fascia using Bovie cautery. The mass was progressively mobilized from the superficial inguinal ring superiorly, sartorius muscle laterally, and adductor longus muscle medially. Several perforating branches of the femoral vein as well as the round ligament of the uterus, at the level of the external inguinal ring, were ligated and tied off. The mass was removed in full, and the resected bed fulgurated. A drain was placed and the incision was closed in multiple layers. Measurements and Main Results Diagnostic laparoscopy revealed intrapelvic Stage I endometriosis. The right round ligament and internal inguinal ring were without evidence of endometriosis. The 3.1 × 3 × 2.8 cm inguinal mass was fully resected. Final pathology confirmed both intrapelvic and inguinal endometriosis. Conclusion Inguinal endometriosis is exceedingly rare, with an estimated incidence of 0.6%. Given the broad differential diagnosis, imaging should be performed. In addition, biopsy can be considered, provided a hernia has been ruled out. Surgical management should entail diagnostic laparoscopy and excisional surgery. To demonstrate surgical management of an inguinal endometrioma. Stepwise demonstration of surgical techniques with narrated video footage. Yale New Haven Hospital, New Haven, CT. A 31-year-old woman with a painful right inguinal endometrioma. The patient underwent diagnostic examination with pelvic MRI, which noted concern for an inguinal endometrioma. Biopsy confirmed endometriosis. She then underwent diagnostic laparoscopy, with resection of intra-pelvic and inguinal endometriosis. The technical steps of management and resection of an inguinal endometrioma have been detailed in the video with an emphasis on anatomic landmarks by utilizing visual illustrations. An incision was made at the inguinal ligament and taken down to the superficial fascia using Bovie cautery. The mass was progressively mobilized from the superficial inguinal ring superiorly, sartorius muscle laterally, and adductor longus muscle medially. Several perforating branches of the femoral vein as well as the round ligament of the uterus, at the level of the external inguinal ring, were ligated and tied off. The mass was removed in full, and the resected bed fulgurated. A drain was placed and the incision was closed in multiple layers. Diagnostic laparoscopy revealed intrapelvic Stage I endometriosis. The right round ligament and internal inguinal ring were without evidence of endometriosis. The 3.1 × 3 × 2.8 cm inguinal mass was fully resected. Final pathology confirmed both intrapelvic and inguinal endometriosis. Inguinal endometriosis is exceedingly rare, with an estimated incidence of 0.6%. Given the broad differential diagnosis, imaging should be performed. In addition, biopsy can be considered, provided a hernia has been ruled out. Surgical management should entail diagnostic laparoscopy and excisional surgery.

Cyst of canal of Nuck-a rare clinical entity: case series and review of literature

A small evagination of parietal peritoneum forms the canal of Nuck. By the first year of life this extension condenses into a fibrous cord. Cyst of canal of Nuck is a rare developmental anomaly. The inguinal canal is traversed by the spermatic cord in male and the round ligament of uterus in female. The processus vaginalis accompanies the round ligament through the inguinal canal through into the labium majus. This evagination of parietal peritoneum forms the canal of Nuck in the female. These cases are rarely seen in surgical practice. In this case series we described three clinical scenario of canal of Nuck and their management.

Feasibility of ovarian preservation as a stage in correcting the quality of life in young patients after gynecologic surgeries.

e17560 Background: The purpose of the study was to analyze the structure and activity of the blood flow in the preserved ovaries after gynecologic surgeries. Methods: We monitored 50 patients (mean age 35.8±0.5 years) using sonography after ovary-sparing hysterectomy for benign, precancerous and preinvasive malignant uterine diseases. For revascularization, the preserved ovaries were attached to the lateral wall of the small pelvis or to the base of round ligaments of the uterus. Results: Ovarian hypertrophy was recorded in 3 women during the first year of the follow-up; the ovaries returned to the initial size without correction by 24 months. By the third year of observation, 94% of women had normal gonadal sizes, and only 2 women had ovarian hypoplasia. During the entire observation period (3 years), in 91% of cases, we could visualize the regular maturation of follicles in the preserved ovaries, which indicated the preservation of ovulatory function. The use of Doppler techniques during 24 months of the follow-up demonstrated that the blood circulation in the attached ovaries after hysterectomy was decreased on the average by 20.3%, compared to the intact ovaries. Conclusions: After the critical period of hysterectomy, the blood flow in the ovaries in almost all patients remains sufficient during the first 2-3 years, stimulating the regular growth of follicles and maintaining the gonadal activity. The quality of life of the operated patients during the first three years of follow-up remains optimal without additional correction with hormone replacement therapy.

A Clinical Study on Left Sided Indirect Inguinal Hernia Containing Sigmoid Colon

Aim: The aim of this article is “A clinical study on left-sided indirect inguinal hernia containing sigmoid colon”. In this study, we have projected the incidence and management of sliding inguinal hernia containing a Sigmoid colon. Materials and Methods: A three years retrospective clinical study, was done at the “General Surgery department” at Vydehi Institute of Medical Science and Research Centre, White field Bengaluru-560 066. This Institute is a tertiary hospital attached to a medical college. Results: This analysis contained a total of 189 cases. Sliding sigmoid colon occurrence is very rare and only one case, which is less than one percent, was found in this study (0.52 percent). Conclusion: The sigmoid sliding hernia is a peroperative diagnosis among left-sided indirect inguinal hernia. The surgical management/repair is meticulous and needs gentle dissection after identification of the sigmoid colon. Care must be taken to identify the contents of the hernia to avoid inadvertent injury to the structures. The Lichtenstein repair could be considered to lower recurrence and reoperation rates. Surgeons should function according to these standards and it is of utmost significance to be accompanied by a wide variety of prosthetic materials. Key words: Sliding hernia; Amyand’s hernia; Littre’s hernia; Meckel’s diverticulum; Spermatic cord; Round ligament of uterus; Inguinal (Poupart) ligament; Ilioinguinal nerve; Genital branch of the genito-femoral nerve; Midpoint of the inguinal ligament; EOM External oblique muscle IOM Internal oblique muscle PT-Pubic Tubercle; PS Pubic Symphysis; Hesselbach’s triangle; ASIS=Anterior superior iliac spine.

Mesothelial cyst in inguinal hernial sac in a male child: a case report

Mesothelial cysts of inguinal area are extremely rare and few cases have been reported in females, arising from round ligament of uterus. Inguinal hernias are a common surgical problem in children presenting as an inguinal or inguino scrotal swelling. Usually the contents of hernial sac in a male child are intestine or omentum and in females it may contain ovary. Mesothelial cyst of round ligament may present as an inguinal mass in females, but it is very rare to find in side inguinal hernial sac of a male child. Here in we report a case of 2 year 9-month-old male child, who was operated for irreducible right congenital inguinal hernia. A pedunculated cystic mass was found to be the content and was removed. Histopathology confirmed the diagnosis of mesothelial cyst. Because of rarity, we report this case.

Comporative morphomeric characteristics of the round ligament of the uterus of two groups of fetuses

Anomalies in the development of female genital organs account for 4% of all congenital malformations. They occur in 1-3% of the female population, regardless of the preservation of fertile function, and often cause infertility.The purpose of the work is to establish the typical and variant anatomy of the round ligaments of the uterus. Compare the morphometric parameters of the round ligaments of the uterus in two distant fetal groups.Material and methods. The features of the typical and variant anatomy of the round ligaments of the uterus of the fetus were studied on 160 preparations of fetuses and newborns using a complex of morphological research methods: macroscopic, conventional and fine preparation, microscopic, vascular injection, making topographic and anatomical sections, X-ray, computed tomography, three-dimensional computer reconstruction, morphometric and statistical.Results. The round ligaments of the uterus, as well as the own ligaments of the ovaries, in the overwhelming majority of cases, are visualized in the form of dense elongated white cylinders in which it is possible to trace the blood vessels. In our opinion, these ligaments are of unequal decisive importance for establishing one or another topography of the internal female genital organs in the perinatal period. When a displacement of the uterus in the frontal plane was detected, one of the round ligaments of the uterus was shorter, in accordance with the side of its inclination.Conclusions. 1. Already at the beginning of the fetal period, the round ligaments of the uterus provide not only the corresponding inclination of the uterus in the sagittal plane but also its inclination in the frontal plane, giving a defined version of the topography of the internal female genital organs. 2. When comparing the first and second groups of fetuses, there was no significant difference in the length of the right round ligament of the uterus at each of the age stages (p>0.05). However, within the same group, we observe a period of accelerated growth in the length of the round ligaments of the uterus from the 7th month of intrauterine development.

Extra-Inguinal Round Ligament Endometriosis Near to Pubic Bone. Report of a Case

Endometriosis is a chronic, oestrogen-dependent condition, defined as extra-uterine, functional endometrial tissue. We report a case of endometriosis of extra-inguinal part of the round ligament, in near proximity to pubic bone. To our knowledge, this is the first case report in the searched English literature. A 31-year-old female patient, nullipara, presented with an unrelated to menstruation, right suprapubic painful swelling of 6 months duration. Her medical history was free. The patient has been receiving contraception for the last 3 years. Colour Doppler and computed tomography showed a spindle-shaped lobe, of inhomogeneous echomorphology, with dimensions of 2.77 × 1.29 cm and relative contamination, which appeared in continuation with the ipsilateral rectus abdominis muscle. Intraoperatively, under general anaesthesia, a mass of the right round ligament of the uterus was found in the ligament’s insertion to the pubic bone. The extra-inguinal part of the right round ligament was excised and the intra-pelvic part was sutured to the ground of the inguinal canal. The histological and immunohistochemical characteristics of the specimen were consistent with endometriosis. Her recovery was uneventful and the patient was discharged on the 2nd postoperative day. Endometriosis of the round ligament of the uterus, should be taken into consideration in the differential diagnosis in cases of extra-inguinal swelling in women of childbearing ages, even in cases with a free medical history.

Prof. Paul. F. Munde. Ten Years ’experience with Alexander’s operation for schortening the round ligaments of the uterus — sixty-five cases. (American Journal of obstetrics and diseases of Women and children, 1894, August, p. 297). Ten years of experience with shortening of the round uterine ligaments (Alexander's operation), 65 cases.

Munde began to perform this operation in 1884. The results of the operation were so good that in the first year he performed it 6 times, and in 1888 he published 23 cases of it. In three of them M. did not find round ligaments, but in the remaining 20 the goal of the operation was achieved.

Laparoscopic Total Extraperitoneal Groin Hernia Repair in Females: Comparison of Outcomes Between Preservation or Division of the Uterine Round Ligament.

Background: Laparoscopic repair has been recommended as the method-of-choice of groin hernia repair among women. Whether the round ligament of uterus should be divided to facilitate mesh placement remains controversial. This study aims to review the outcomes of laparoscopic total extraperitoneal (TEP) groin hernia repair in women and to evaluate the impact of division of round ligament. Methods: Consecutive female patients with inguinal or femoral hernias who underwent elective laparoscopic TEP repair at a single institution from 2006 to 2017 were included for retrospective analysis. Primary outcomes were postoperative pain, genital prolapse, and recurrence. Outcomes of patients who had the round ligament divided were further compared with those with round ligament preserved and multivariable adjusted analysis was performed. Results: Sixty-eight patients with a total of 77 TEP repairs were included in the 12-year study period. The mean age was 45 ± 16 years old. Incidental femoral hernia was identified in 4 patients (5.9%). There was 1 (1.3%) recurrence upon mean follow-up of 42.9 ± 37.3 months. The round ligament was divided in 67.5% of patients, and upon multivariable adjusted analysis, there were no statistically significant differences in outcomes in terms of chronic pain (odds ratio [OR] = 2.210, P = .357), paresthesia (OR = 0.241, P = .149), and genital prolapse (OR = 0.327, P = .415) when compared with patients with preserved round ligament. Conclusion: Laparoscopic groin hernia repair in women is associated with low recurrence. Division of round ligament intraoperatively facilitates mesh placement and has minimal impact on clinical outcomes.

A Case of Endometriosis in the Right Inguinal Region Connected to the Round Ligament of the Uterus

A Case of Endometriosis in the Right Inguinal Region Connected to the Round Ligament of the Uterus

Differential diagnosis of fat-containing lesions in the inguinal canal using ultrasound.

Abdominal hernias are usually located in the inguinal canals. Differential diagnosis of hernias should consider other pathologies, which typically occur at this site. The aim of this review paper is to present fat-containing lesions located in the inguinal canal based on both our own experience and literature. The first part of the paper describes the embryogenesis and differences in the structure and content of male and female inguinal canal. The canal is clearly wider in men, which results from the presence of the spermatic cord and its components. The female canal contains only the narrow round ligament of the uterus. The second part of the paper discusses the incorrect use of the term “lipoma” for retroperitoneal fat, which penetrated into the lumen of the patent processus vaginalis – the authors using this term acknowledge its incorrectness. These lesions often coexist with oblique inguinal hernia and should be excised during a surgery as they may cause inguinal pain. As for other fat-containing inguinal pathologies, we discussed lipomatosis of the spermatic cord, liposarcoma and the greater omentum. Differential diagnosis of these lesions considers their echogenicity, echostructure and vascularity. Furthermore, attention was paid to the adipose tissue surrounding the lower epigastric vessels, which may be incorrectly localized in the inguinal canal. Finally, the importance of proper diagnostic methodology and knowledge of the inguinal anatomy for the correct ultrasonographic diagnosis was emphasized.

Post-treatment clinical status of patients with cervical cancer.

e17007 Background: Extended hysterectomy with fixation of preserved ovaries to the round ligaments of the uterus and subsequent transposition of the gonads from the irradiation area have already become a routine procedure in the treatment of cervical cancer in young women in order to avoid castration syndrome. The aim of the study was to analyze clinical characteristics of patients with cervical cancer 10 years after treatment. Methods: Clinical and hormonal status of 216 patients with stage Ib cervical cancer after complex treatment was studied. The majority of women (160 patients, 74%) remained fertile at the time of the study, and 56 patients (26%) were peri- and postmenopausal (from 46-55 years). The presence or absence of climacteric symptoms was assessed by a questionnaire; functional ovarian insufficiency (FNU) was determined as mild, moderate, and severe. Plasma levels of steroid and gonadotropic hormones were evaluated by radioimmunoassay. Results: Analysis of menopausal complaints according to questionnaires showed that the symptoms increased with the age of patients. Only 8 patients of the reproductive age reported hot flashes (Table 1). In this group of patients, levels of sex and gonadotropic hormones were common for this age. Patients aged 45-50 years reported also dry skin and mucous membranes, dyspareunia and dysuric disorders, which indicated perimenopause. And in postmenopause, urogenital disorders were very persistent. This group included patients treated 6 and 10 years ago. Conclusions: Thus, the function of preserved ovaries "faded away" independently according to the age, providing a smooth transition to menopause and optimal medical and social rehabilitation of patients.[Table: see text]

Laparoscopic round ligament preserving repair for groin hernia in women: A critical appraisal

BACKGROUND: Our objective was to investigate the clinical characteristics of original laparoscopic round ligament-sparing repair technique for groin hernias in female patients. METHODS: The clinical data of 48 female patients (58 hernias) who underwent laparoscopic transabdominal preperitoneal (TAPP) inguinal hernia repair using original split mesh technique at Orel Regional Hospital (Russia) between March 2009 and January 2019 were analyzed retrospectively. The aim of the study was to provide an overview about female groin hernias, preferred surgical approach, and the management of round ligament of uterus. RESULTS: There were 58 TAPP repairs in 48 patients. The average follow-up period was 43 months (min. – 3, max. – 122, Mo – 12, and Me – 43). Fifteen femoral hernias were noted in ten patients, of which two femoral hernias were incarcerated. Cysts on the round ligament of the uterus were found in four patients, and most of them underwent laparoscopic resection. Round ligaments of the uterus were preserved in all patients. An average operation time was 56 min (min. – 20, max. – 135, Mo – 40 min, and Me – 50 min). None of the cases was converted to laparotomy. All patients returned to normal activity soon and 1 (1.7%) recurrence was noted during follow-up. CONCLUSION: Laparoscopic inguinal hernia repair is well adopted around the world, but still questions remain which are related to female patients, especially regarding the function and preserving the round ligament. Based on this study, it is possible to preserve the round ligament by using the original laparoscopic TAPP keyhole technique.

Laparoscopic Repair for Groin Hernias in Female Patients: A Single-Center Experience in 15 Years.

Our objective was to investigate the clinical characteristics of laparoscopic repair for groin hernias in female patients. The clinical data of 316 female patients (341 hernias) who underwent laparoscopic inguinal hernia repair at Shanghai Minimally Invasive Surgery Center between January 2001 and December 2015 was analyzed retrospectively. The operation-related data were to provide an overview of female groin hernias, preferred surgical approach, and the management of round ligament of uterus. There were 274 transabdominal preperitoneal patch plastic repairs and 67 total extraperitoneal repairs performed on 257 and 59 patients, respectively. The median follow-up period was 48 months. Fifty-eight femoral hernias were noted in 52 patients, of which 18 femoral hernias were incarcerated. Cysts on the round ligament of uterus were found in 39 patients, and most of them underwent laparoscopic resection. Round ligaments of uterus were preserved in 152 patients and transected in 162 patients. The preservation group requires longer operation time and trickier surgical technique. None of the cases was converted to laparotomy. All patients returned to normal activity soon and no recurrence was noted during follow-up. Laparoscopic inguinal hernia repair is well adopted around the world. Meanwhile, there still remain questions to be discussed in female patients. Based on this study, the round ligament cyst could be resected while the operation. Either "open and suture" or keyhole technique will be available to preserve the round ligament of uterus.

The round ligament of the uterus: Questioning its distal insertion

Classically, the round ligament of the uterus (RLU) attaches distally in the ipsilateral labia majora. This attachment has rarely been described in adults. That is why we have performed an anatomical study focused on this distal ending. We performed in 2015 the cadaveric dissection of 19 RLU. In all cases, the RLU was individualized on its entire length from its uterine origin to the inguinal canal. Then this canal was open from its internal orifice to its external orifice. We described the distal attachment of the RLU according four areas: before the internal inguinal ring, after the external inguinal ring, under the pubic bone and in labia majora. We found 3 types of distal attachments with first an attachment after the external inguinal ring in more than half of cases (52.6%). Then, before the internal inguinal ring (26.3%) and under the pubic bone (22.1%). No RLU was found inlabia majora. However, the proximal attachment seems constant at the antero-superior face of uterus, near the tubo-uterine junction like its pelvic path under the broad ligament. In adult, the RLU is a structure, which begins at the cranio-ventral part of the uterine bottom near the tubo-uterine junction. Then it passes under the broad ligament and reaches the inguinal canal, that it crosses in more half of cases. However, 3 distal attachment areas have been identified but never in the labia majora. Indeed, some anatomical information available in anatomical treaties seems not correct and should be amended.

Pelvic exenteration for primary and recurrent malignancies in urology department

Objective The objectives of present study is to investigate the safety and efficacy of pelvic exenteration (PE) for the treatment of pelvic malignancies in urology department. Methods From April 2010 to December 2014, 20 patients with primary or recurrent pelvic malignancy accepted anterior pelvic exenteration (APE) or total pelvic exenteration(TPE) surgery, including 7 males and 13 females, ranged from 35 to 87 years old with an average of 65 years old. Ten case accepted APE and 10 for TPE. The ilium conduit was done in 5 cases for APE and 6 cases for TPE as urinary diversion, cutaneous ureterostomy was done in 5 cases for APE and 4 cases for TPE as urinary diversion. There were 6 cases primary tumor in APE group and 3 primary tumors in TPE. All of the patients had 13 cases of the urinary tract tumor group, and none of the urinary tract tumor group in 7 cases. There were 4 cases received preoperative chemotherapy in the urinary tract tumor group. No case received preoperative radiotherapy. 3 cases received preoperative chemotherapy in none of the urinary tract tumor group, 3 cased received preoperative radiotherapy. After induction of general anesthesia using a laryngeal mask for airway management. All patients took the abdominal incision, then dissected lymph nodes on both sides of the iliac vessels, freed bilateral ureters to the end of the swollen bladder, separated the peritoneal space.The bilateral vas deferens was cutted and ligated, then isolated and ligated the seminal vesicles between the posterior wall of the bladder and the anterior wall of the rectum.Lateral ligaments of bladder was cuted, then cuted ligament of prostate and puboprostatic ligament, sutured and cut deep vein of penis. Urethra of apex prostate was freed and cuted. Female patients needed to free the uterus and the posterior wall, cut the cardinal ligament and round ligament of uterus, isolate the posterior wall of the uterus to the posterior vaginal wall. Rectal resection adopted Miles operation.And sigmoid colostomy was performed on the left side of the abdominal wall. The perioperative characters, pathological results and patients′ survival data were collected and analyzed. Results The average operation time for APE was 3.8 hours and 5.2 hours for TPE (P=0.173). Median length of hospital stay was 17.9 (7-47) days. The median blood loss was 300ml (80-2 500 ml) for APE and 400ml (50-6 000 ml) for TPE (P=0.909). The median follow-up time was 12.5 months (1-41months). The estimated 2-year survival rate for APE was 55.6% and 45.0% for TPE (P=0.642). Urinary system tumors group and non urinary system tumors group were analyzed and compared, The median survival time was 28 months and 13 months (P=0.538) in the two groups.The incidence of gastrointestinal complications of urinary system tumors and non-urinary system tumors was 7.7% and 28.6%, incision complications was 7.7% and 28.6%. Complications of urinary diversion only occurred in the non urologic tumor group, the incidence was 14.3%. The incidence of transfusion in two groups was 46.2% and 28.6%. Conclusions Pelvic exenteration (APE and TPE) could be a safe and reliable choice for local advanced primary and recurrent pelvic malignancy. Even for the recurrent malignancies, the survival results of the patients were satisfactory. Key words: Pelvic malignancy; Anterior pelvic exenteration; Total pelvic exenteration