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Pouch Dysfunction in Colitis
Published in Peter Sagar, Andrew G. Hill, Charles H. Knowles, Stefan Post, Willem A. Bemelman, Patricia L. Roberts, Susan Galandiuk, John R.T. Monson, Michael R.B. Keighley, Norman S. Williams, Keighley & Williams’ Surgery of the Anus, Rectum and Colon, 2019
Mariangela Allocca, Silvio Danese, Tom Øresland, Michael R.B. Keighley
Most authors report good outcomes after redo pouch procedures. However, one should not give the patient false expectations. The best strategy is to have an agreement that the surgeon should do what appears to be most sensible procedure at the time whilst avoiding risk, as this is a matter of improving function and not a life-saving operation. If it is not possible to do a redo pouch, one should have an agreement on the alternatives, which might include a continent reservoir ileostomy or a conventional permanent ileostomy (see Chapter 69 on continent ileostomy). The specific risks involve those of dissecting in a frozen pelvis where it may not be possible to identify nerves or to avoid damage to other structures, such as loops of small bowel, bladder, ureter, vascular strictures and the female genital tract.
Benign conditions of the ovary and pelvis
Published in Helen Bickerstaff, Louise C Kenny, Gynaecology, 2017
Endometriotic tissue responds to cyclical hormonal changes and therefore undergoes cyclical bleeding and local inflammatory reactions. These regularly repeated episodes of bleeding and healing lead to fibrosis and adhesion formation between pelvic organs, causing pain and infertility. In extreme cases a ‘frozen pelvis’ results, where extensive adhesions tether the pelvic organs and obliterate normal pelvic anatomy.
Colorectal Surgery for Deep Endometriosis Infiltrating the Bowel
Published in Nazar N. Amso, Saikat Banerjee, Endometriosis, 2022
Hanan Alsalem, Jean-Jacques Tuech, Damien Forestier, Benjamin Merlot, Myriam Noailles, Horace Roman
Rectogenital disease is described by the LSD component of the classification. L is length of stricture, S is the percentage of (%) stricture and D is distance of stricture to anal verge. For the LSD/MURO classification, the severity of the pathology is given a numeric evaluation (i.e., 0, 1, 2, or 3). Rectogenital disease is described by the LSD component, which identifies and quantifies pathology from the anal verge to the lower sigmoid. The following information can be gleaned from VC in the rectogenital area. L equals the length of stricture (0 = no stricture or rectogenital nodule with no bowel involvement, 1 = a stricture length of <3 cm, 2 = stricture length 3–5 cm, and 3 = stricture >5 cm and/or nondistensibility). Nondistensibility was further defined as the inability to achieve normal distention of bowel by gas insufflation. This signifies a frozen pelvis, or a diffusely infiltrated bowel wall, and it predicts an intensive surgical intervention. The stricture S is calculated by measuring the smallest stricture diameter and comparing it with the closest normal bowel lumen diameter (0 = no stricture, 1 = <30% stricture, 2 = >30%–60% stricture, and 3 = >60% stricture). This measurement is important in preoperatively determining the surgical intervention: That is, a short stricture <3 cm and strictures of <30% may only require a discoid excision rather than a segmental resection. Likewise, strictures above 30% may require segmental resection. D is the distance from the anal verge (0 = bowel involvement, 1 = >15 cm, 2 = 8–15 cm, and 3 = <8 cm). The score increases as the pathology gets closer to the anal verge because of the surgical complexity and associated complications such as fistula formation, anal sphincter and/or bladder dysfunction, which are more likely to occur at this distal location. This information is critical for patient counseling when ileostomy or colostomy is to be considered.
Hysterectomy via vaginal Natural Orifice Transluminal Endoscopic Surgery in virgin patients: a first feasibility study
Published in Journal of Obstetrics and Gynaecology, 2022
Katrien Nulens, Ralph Kempenaers, Jan Baekelandt
Vaginal NOTES is a promising and relatively novel minimally invasive technique in the field of gynaecologic surgery. Instead of skin incisions in the abdominal wall, vNOTES gains access to the peritoneal cavity through a colpotomy. Obviously, conditions that interfere with this access route (e.g. obliteration of the pouch op Douglas, frozen pelvis, rectovaginal endometriosis, prior rectal surgery and active lower genital tract infection) are contraindications for vNOTES procedures (Baekelandt et al. 2018; Baekelandt et al. 2019). Furthermore, although not considered as contraindications, nulliparity, absence of uterine descent, obesity and large uterine volume may compromise technical feasibility (Doucette et al. 2001; Lee et al. 2014; Wang et al. 2015; Baekelandt 2015; Baekelandt et al. 2016). Likewise, due to a narrow vagina and introitus in combination with the absence of uterine descent, virginity may reduce vaginal accessibility and thus complicate the feasibility of vaginal surgery. Therefore, virgo status has until now been contraindicated for vNOTES (Baekelandt 2015; Baekelandt et al. 2019). All previous reports of vNOTES hysterectomies did not include virgo patients.
Adnexal torsion in symptomatic women: a single-centre retrospective study of diagnosis and management
Published in Journal of Obstetrics and Gynaecology, 2019
Padmasree Resapu, Sirisha Rao Gundabattula, Vijaya Bharathi Bayyarapu, Manjula Pochiraju, Kameswari Surampudi, Shashikala Dasari
On analysing the false negatives and false positives, it was found that seven of the 17 missed diagnoses occurred in pregnant women, possibly due to technical difficulty posed by the gravid uterus and reluctance to diagnose torsion, unless absolutely certain for fear of an unnecessary surgery during pregnancy. Apart from non-torsed cysts (n = 5), the other false positives turned out to be a tubal pregnancy (n = 2) and a normal adnexa (n = 1); the last-mentioned patient had a frozen pelvis, presumably secondary to the adhesions caused by previous unilateral adnexectomy for a large mucinous ovarian tumour, and the displaced ovary (suspected to have torted) was normal and adherent to the pelvic side wall. The treating physician later admitted to having been biased in favour of surgery to prevent the possible loss of function in the remaining ovary.
Successful management of ureteric endometriosis by laparoscopic ureterolysis – A review and report of three further cases
Published in Arab Journal of Urology, 2018
Deepa Talreja, Vivek Salunke, Shinjini Pande, Chirag Gupta
A 28-year old nulliparous female with complaints of severe dysmenorrhoea, dyspareunia and primary infertility with no urinary complaints, was taken for diagnostic hysterolaparoscopy at another institution. Laparoscopy revealed frozen pelvis due to extensive endometriosis with bilateral severe ureteric involvements. No operative intervention was done at that time. During further evaluation, renal US showed bilateral renal cortical thinning. A confirmatory CT revealed similar bilateral hydroureter and hydronephrosis with obstruction of bilateral ureters (Fig. 3a). After complete urological evaluation and bilateral ureteric stenting, she was reposted for ureterolysis and excision/anastomoses if needed.