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 15,856 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

The primary use of laparoscopy is as a surgical tool, with sterilizations being the overwhelming indication. The laparoscope is used less frequently as a non-surgical tool, with the major indication being for diagnosing infertility and/or amenorrhea, and for evaluation of obscure pelvic pain. There would seem to be several indications for laparoscopy that have been neglected, these being in confirming the diagnosis of acute pelvic inflammatory disease; in the evaluation of malignancies and abdominal-pelvic trauma; and the surgical treatment of pelvic pain. Lapar-The majority of these contraindications are relative, and depend soley on the laparoscopist's ability and his clinical judgment. The problems of hernias seem to have been over-emphasized. The laparoscopist should be aware of potential problems with umbilical hernia, and he probably can ignore hiatal hernias except when they are large and quite symptomatic. However, generalized abdominal peritonitis, significant hemoperitoneum with intestinal obstruction are felt by most authors to be absolute contraindications. The most frequent complications of laparoscopy involve the physoperitoneum. Except for cardiac arrest the most serious complications involve electrical burns to small bowel.
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PMID:Indications, contraindications and complications of laparoscopy. 12 9

From May 1986 to May 1992, 55 patients with genitourinary prolapse were treated by total hysterectomy, sacral fixation using a prosthetic band and colposuspension. The mean age was 55.5 years (range: 38-78 years). Ten patients (18.8%) developed early postoperative complications: 2 wall haematomas, one surgical revision for haemorrhage, one case of haematemesis secondary to a duodenal ulcer, one intestinal obstruction due to dehiscence of the peritonealisation, two cases of acute urinary retention, one case of complete urinary incontinence, one septic shock and one wall abscess. Three patients (5.4%) developed late postoperative complications: intestinal obstruction secondary to a mesenteric band, one incisional hernia, and one case of pelvic pain. The mean length of hospital stay was 8.9 days (range: 7-25 days) and the mean follow-up was 36 months (range: 6-72 months). The anatomical result was excellent (complete correction of the prolapse and absence of recurrence) in 96.4% of cases. In terms of the functional results, 3 patients (5.4%) remained dysuric and 5 (9.1%) have persistent stress incontinence, either moderate (3 cases) or disabling (2 cases). Marked sphincter insufficiency was demonstrated on the urethral pressure profile in these last two cases. The combination of total hysterectomy with vaginal opening and sacral fixation using a prosthetic band prevents the risk of subsequent disease of the remaining cervix and does not appear to increase the risk of infection or the postoperative morbidity. Without advocating systematic hysterectomy in the sacral fixation technique, we nevertheless believe that it is preferable to perform total hysterectomy rather than supraisthemic hysterectomy when this procedure is indicated.
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PMID:[The treatment of genito-urinary prolapse with promonto-fixation using a prosthetic material combined with complete hysterectomy: complications and results apropos of a series of 55 cases]. 771 68

One hundred patients were treated with laparoscopic techniques for chronic pelvic pain. These procedures included uterosacral nerve vaporization, resection and vaporization of endometriosis, hernia repair, appendectomy, presacral neurectomy, and ovarian surgery. Follow-up over a 3 year period revealed the following results. Women with significant endometriosis had a 75% cure rate with a change in quality of life index from a preoperative level of pain of 8 to a postoperative level of pain of 2. A Score of 1 is no pain and 10 is maximum pain. Patients who did not have endometriosis had an 80% cure rate with a reduction in pain level to an average of 2 from preoperative levels averaging 9. The results and trends from these procedures indicate that approximately 75% of all patients with chronic pelvic pain can be successfully treated by conservative laparoscopic techniques. Adenomyosis has been demonstrated to be the condition resulting in the most failures of treatment.
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PMID:Laparoscopic Treatment for Chronic Pelvic Pain: Results from Three-Year Follow-up 907 64

The source of chronic pelvic pain may be reproductive organ, urological, musculoskeletal-neurological, gastrointestinal, or myofascial. A psychological component almost always is a factor, whether as an antecedent event or presenting as depression as result of the pain. Surgical interventions for chronic pelvic pain include: 1) resection or vaporization of vulvar/vestibular tissue for human papillion virus (HPV) induced or chronic vulvodynia/vestibulitis; 2) cervical dilation for cervix stenosis; 3) hysteroscopic resection for intracavitary or submucous myomas or intracavitary polyps; 4) myomectomy or myolysis for symptomatic intramural, subserosal or pedunculated myomas; 5) adhesiolysis for peritubular and periovarian adhesions, and enterolysis for bowel adhesions, adhesiolysis for all thick adhesions in areas of pain as well as thin ahesions affecting critical structures such as ovaries and tubes; 6) salpingectomy or neosalpingostomy for symptomatic hydrosalpinx; 7) ovarian treatment for symptomatic ovarian pain; 8) uterosacral nerve vaporization for dysmenorrhea; 9) presacral neurectomy for disabling central pain primarily of uterine but also of bladder origin; 10) resection of endometriosis from all surfaces including removal from bladder and bowel as well as from the rectovaginal septal space. Complete resection of all disease in a debulking operation is essential; 11) appendectomy for symptoms of chronic appendicitis, and chronic right lower quadrant pain; 12) uterine suspension for symptoms of collision dyspareunia, pelvic congestion, severe dysmenorrhea, cul-desac endometriosis; 13) repair of all hernia defects whether sciatic, inguinal, femoral, Spigelian, ventral or incisional; 14) hysterectomy if relief has not been achieved by organ-preserving surgery such as resection of all endometriosis and presacral neurectomy, or the central pain continues to be disabling. Before such a radical step is taken, MRI of the uterus to confirm presence of adenomyosis may be helpful; 15) trigger point injection therapy for myofascial pain and dysfunction in pelvic and abdominal muscles. With application of all currently available laparoscopic modalities, 80% of women with chronic pelvic pain will report a decrease of pain to tolerable levels, a significant average reduction which is maintained in 3-year follow-up. Individual factors contributing to pain cannot be determined, although the frequency of endometriosis dictates that its complete treatment be attempted. The beneficial effect of uterosacral nerve ablation may be as much due to treatment of occult endometriosis in the uterosacral ligaments as to transection of the nerve fibers themselves. The benefit of the presacral neurectomy appears to be definite but strictly limited to midline pain. Appendectomy, herniorraphy, and even hysterectomy are all appropriate therapies for patients with chronic pelvic pain. Even with all laparoscopic procedures employed, fully 20% of patients experience unsatisfactory results. In addition, these patients are often depressed. Whether the pain contributes to the depression or the depression to the pain is irrelevant to them. Selected referrals to an integrated pain center with psychologic assistance together with judicious prescription of antidepressant drugs will likely benefit both women who respond to surgical intervention and those who do not. A maximum surgical effort must be expended to resect all endometriosis, restore normal pelvic anatomy, resect nerve fibers, and treat surgically accessible disease. In addition, it is important to provide patients with chronic pelvic pain sufficient psychologic support to overcome the effects of the condition, and to assist them with underlying psychologic disorders.
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PMID:Surgical treatment for chronic pelvic pain. 987 26

This report investigates the concept that severe constipation requiring major abdominal surgery may result from one of three common causes: 1) colonic inertia, 2) pelvic hiatal hernia, or 3) both colonic inertia and pelvic hernia. This study evaluates the symptoms, anatomy and outcome in 201 patients with severe surgical constipation treated by a single surgeon. In 2042 patients with constipation referred to one colon and rectal surgeon, 211 major abdominal surgical procedures were performed on 201 patients for severe constipation between 1989 and 1999. There were 187 women and 14 men. Mean age was 49 years (range, 9-84). Five high-risk patients had ileostomy; 196 had major colonic surgery for anatomic or physiologic causes of constipation, excluding malignancy, diverticular disease, and inflammatory bowel disease. Pelvic hiatal hernia was defined as the herniation of bowel through the hiatus of the pelvic diaphragm seen on pelvic videofluoroscopy or physical examination. Of these 196 patients, 44 per cent had pelvic hiatal hernia repair (PHHR), 27 per cent had total abdominal colectomy and ileorectal anastomosis for colonic inertia, and 29 per cent had surgery for both colonic inertia and pelvic hiatal hernia. Of the 144 patients undergoing PHHR, 95 had Gore-Tex patch (W. L. Gore and Associates, Inc., Phoenix, AZ) sacral colpopexy. PHHR for pelvic hiatal hernia without colonic inertia included sigmoid resection, rectopexy, and Gore-Tex patch sacral colpopexy. Mean duration of follow-up was 20 months. Symptoms noted preoperatively included abdominal pain (84%), straining at stool (90%), incomplete rectal emptying (85%), painful bowel movements (74%), pelvic pain (69%), vaginal bulge (55%), digital assistance with evacuation (35%), and incontinence of stool (38%). Outcome assessed by symptom relief was successful in 89.1 per cent of patients. 8.6 per cent of patient conditions were unchanged, and 2.3 per cent were unsatisfied with the outcome. There were no postoperative deaths. The complication rate was 6.1 per cent (small bowel obstruction, 7; anastomotic leak, 2; ureteral stenosis, 2; and patch erosion, 1). In our experience, severe surgical constipation can be due to colonic inertia, pelvic hiatal hernia, or both. Careful preoperative evaluation identifies these disorders, and surgical therapy aimed at correction of anatomic and physiologic defects results in high patient satisfaction and improvement in bowel function.
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PMID:Operative management of severe constipation. 1059 57

Ultrasound has become a valuable primary imaging tool in the assessment of acute pelvic pain in women, both for diagnosis and for assessment of complications. Although ultrasound is an established imaging tool for gynecologic diseases, it is also a useful modality for assessing nongynecologic disorders that cause acute pelvic pain, such as diverticulitis and urinary tract calculi. These are important differential diagnoses in women with acute pelvic pain, and sonologists are not always expert in their diagnosis. This article reviews the gamut of conditions that can cause acute pelvic pain in women. The usual gynecologic causes are included, such as ectopic pregnancy, but also considered are conditions such as diverticulitis, appendicitis, and incarcerated hernia, which are important differential considerations.
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PMID:Acute female pelvic pain: ultrasound evaluation. 1068 69

Gender-, age- and race-related generalised joint hypermobility (GJH) is elucidated, based on publications that have used validated criteria for GJH. Furthermore, we analysed the connection between GJH and the clinical criteria for benign joint hypermobility syndrome (BJHS), and we looked for literature on the treatment of BJHS. There seems to be evidence in support of an increased prevalence of hypermobility among children, females and certain races when the diagnosis of hypermobility is based on the Carter and Wilkinson criteria (> or =3 positive tests out of 5) and/or Beighton's tests (> or =4 positive tests out of 9). However, there are no unequivocal statements that hypermobility predisposes to the various clinical situations used as major or minor criteria for BJHS, e.g., arthralgia, low back and pelvic pain, joint luxation, soft tissue rheumatism, abnormal cutis or genitourinary prolapse, varicose veins and hernia. There have been no randomised controlled studies of the effect of treatment.
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PMID:[Generalised joint hypermobility and benign joint hypermobility syndrome. II: epidemiology and clinical criteria]. 1630 62

Obturator hernia is a rare variety of pelvic hernia. Preoperative diagnosis is still uncommon and influences treatment and prognosis. Clinical suspicion and tomography are fundamental for establishing a preoperative diagnosis. Subsequently, elective treatment via the total extraperitoneal laparoscopic approach seems to offer the best results for both the patient and the hospital. This management might reduce the high rates of associated morbidity and mortality. We present the case of a patient with chronic pelvic pain after hernia surgery in whom tomography confirmed the existence of a bilateral obturator hernia. Details are given of diagnostic and therapeutic management using ambulatory total extraperitoneal laparoscopy. We recommend ruling out obturator hernia as a possible cause of chronic pain after hernia repair.
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PMID:Obturator hernia as a cause of chronic pain after inguinal hernioplasty: elective management using tomography and ambulatory total extraperitoneal laparoscopy. 1655 84

We present a 33-year-old woman with a history of radical hysterectomy and pelvic radiation who developed a nonreducible high anterior vaginal wall bulge, postoperative pelvic pain, and dyspareunia. Dynamic MRI revealed herniation of the omentum into the vesico-vaginal space. The incarcerated hernia was repaired transvaginally, and the patient's symptoms improved.
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PMID:Incarcerated vaginal herniation of the omentum mimicking vaginal prolapse. 1734 17

There is a wide variety of uncommon and unusual gastrointestinal causes of acute abdominal and pelvic pain that may be prospectively diagnosed on computed tomography. We demonstrate 10 such diagnoses and briefly review the current computed tomography and clinical literature on intussusception occurring beyond early childhood, small bowel obstruction from internal hernia, cecal volvulus, intramural small bowel hemorrhage, Boerhaave's syndrome, gastrointestinal luminal foreign bodies, small bowel diverticulitis, hemoperitoneum secondary to abdominal tumor; gallstone ileus, and gallbladder torsion. Radiologists and clinicians need to be aware of these disorders, particularly with the widespread utilization of computed tomography (CT) in the management of patients with acute abdominal pain.
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PMID:Uncommon and unusual gastrointestinal causes of the acute abdomen: computed tomographic diagnosis. 1885 44


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