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Endometriosis Centers of Excellence, Past, Present and Future: The Challenges of Introducing New Technologies
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
In 2018, over 1700 cases of pararectal dissection were recorded on the BSGE database. The number of cases performed within each center and the number of gynecological laparoscopic surgeons involved, however, varied markedly. In 2019 (pre-COVID-19), 34 centers declared only one gynecological endometriosis surgeon, and 22 centers performed under 20 cases per year with only ten centers performing more than 40 cases per year. In 2019, the BSGE reconsidered its role in overseas units and ceased to accredit these centers, even though they had adopted the standards set by the BSGE (Pearl 5).
Adult Autopsy
Published in Cristoforo Pomara, Vittorio Fineschi, Forensic and Clinical Forensic Autopsy, 2020
Cristoforo Pomara, Monica Salerno, Vittorio Fineschi
The inferior half of the pelvic rectum is retroperitoneal and is loosely covered with the so-called rectal band. Pull the rectum forward in such a way that the two pararectal recesses can be visualized. Then, incise the peritoneum and the underlying rectosacral ligaments sagittally, from the top to the bottom, taking care to isolate and detach the rectum from the sacral wall (Figures 2.97 and 2.98).
Unexplained Fever in the Pediatric Age Group
Published in Benedict Isaac, Serge Kernbaum, Michael Burke, Unexplained Fever, 2019
A multitude of abscesses which can remain undiagnosed for variable periods of time (pararectal, pelvic, perinephric, intra-abdominal, subdiaphragmatic, and liver abscesses). Osteomyelitis can occasionally present as a low-grade infection without localizing signs, such as in infections of the pelvis, spine, scapula. Salmonella infections of bone and joints, mainly with salmonella typhi, are not as rare as previously considered and can produce fever without localizing signs. Chronic mastoiditis can be at the origin of prolonged fever in infants with immune deficiencies and chronic otorrhea. Infants and small children up to 3 years of age, who have repeated bouts of acute otitis media during the winter season, may present with temperature elevations in the morning, which have been attributed to infections of hypertrophic adenoids. There are no controlled studies documenting the relationship between upper respiratory infections (URTI) and unexplained fever. Their presence in a certain group of infants with frequent URTI during the cold season, and the improvement noted after aggressive antibiotic treatment, strengthens the supposition that these are bacterial infections of the upper respiratory lymphatic tissue.
Diagnosis and treatment of pudendal and inferior cluneal nerve entrapment syndrome: a narrative review
Published in Acta Chirurgica Belgica, 2022
Katleen Jottard, Pierre Bonnet, Viviane Thill, Stephane Ploteau, Stefan de Wachter
In 2018, Beco et al. described an endoscopic transperineal pudendal decompression technique in which the perineal pararectal approach was combined with sectioning of the sacrospinous ligament and transposition of the PN [29]. The use of the pudendoscope made it possible to better visualize the anatomical structures, however, as stated by the authors themselves, the main disadvantage of operative pudendoscopy is the difficulty of operating with a single endoscopic ‘dissecting hand’. Furthermore, to avoid vessel or nerve damage, it is mandatory to perfectly visualize all anatomical structures implicated. The study, in which different inclusion criteria than the Nantes criteria were used, found a 50% pain reduction in 41.6% of patients in the long term. However, it is unclear how many of those patients reported pelviperineal pain as their primary symptom.
Sacrospinous Ligament Fixation Under Local Anesthesia in Elderly Patients at High Risk of General Anesthesia
Published in Journal of Investigative Surgery, 2020
Mehmet Baki Senturk, Ozan Doğan
The algesia of visceral and parietal peritoneum and the visceral organs are conducted by group C nerve fibers. Peritoneal tension of these organs causes severe pain. When classical surgery is preferred without using The Pelvic Floor Repair Tissue Fixing Anchor system, retractors have been used (Breisky speculum) to visualize the pararectal fossa, and when the visceral peritoneum is pulled while using retractors, severe pain occurs. However, pulling on the rectum also causes severe pain and is technically hard to control with infiltrative anesthesia. Therefore, using the specific instruments, without expanding the pararectal fossa, suturing can be made without peritoneum tension. With the use of The Pelvic Floor Repair Tissue Fixing Anchor for SSLF, there was no need for retractors and so severe pain did not occur from the pulling of the peritoneum or rectum and surgery was performed comfortably with local anesthesia.
Do Pelvic Organ Prolapse Quantification Examination Ba and D Guide the Selection of Operation for Severe Pelvic Organ Prolapse?
Published in Journal of Investigative Surgery, 2020
Chunbo Li, Huimin Shu, Zhiyuan Dai
Vaginal SSLF was performed unilaterally to the right sacrospinous ligament. In brief, to expose the recto-vaginal and pararectal space, a longitudinal incision in the posterior vaginal wall was made. Blunt dissection was done until the right ischial spines exposly. Two permanent sutures were placed under direct vision through the sacrospinous ligament at least 2 cm from the ischial spine. The sutures were also placed through the uterosacral ligament and the uterus was redressed. For the patients with hysterectomy, after the vaginal cuff was sutured and closed, it was fixed to sacrospinous ligament with nonabsorbable sutures. Neurovascular bundle injuries should be avoided during the operation. At last, the posterior vaginal wall was closed with absorbable sutures.