Uterine leiomyomas are the most common benign tumors affecting reproductive age women. The symptomatic spectrum varies from large asymptomatic fibroids to smaller ones causing all sorts of menstrual problems. With the advent of minimally invasive surgery, laparoscopic myomectomy is the preferred approach to many of these myomas depending on the size, site and number as recommended by the standard bodies. Aims and objectives To describe one of the largest myoma operated laparoscopically using conventional technique. Background The size and type of myoma represent the best predictors of surgical difficulties and possible intraoperative complications. Intramural myomas > 8 cm and subserosal myomas > 12 cm are considered challenging to operate laparoscopically. Till date, to the best of our knowledge the largest myoma operated laparoscopically is around 30 cm. Case Report Authors report a case of 29 years old unmarried girl who presented with abdominal distention and on examination had a abdominopelvic mass of 34 weeks gravid uterus size. Ultrasound revealed a very large intramural fibroid arising from the left wall close to the fundus with a large submucosal component. An uneventful laparoscopic myomectomy was done. Conclusion Laparoscopic myomectomy is surely a safe and attractive alternative to treat large myomas with less postoperative pain, shorter hospital stay and equivalent pregnancy outcomes. The authors believe that with required skills, experience, and improved technologies for tissue retrieval, the size may not be a limiting factor for laparoscopic myomectomies. How to cite this article Yadav G, Manchanda R, Pathak C. Laparoscopic Myomectomy of a 34 Weeks Size Myoma: ‘Exhausting but Satisfying’. J South Asian Feder Obst Gynae 2016;8(1):69-70.
Aim:To discuss the incidence of various hysteroscopic findings in patients of infertility, abnormal uterine bleeding (AUB), and postmenopausal bleeding and to compare the prevalence of various uterine pathologies in patients of primary and secondary infertility. Materials and methods:This is a retrospective observational study, which evaluated 296 patients who underwent diagnostic hysteroscopy for evaluation of primary or secondary infertility, AUB, and postmenopausal bleeding over a period of 18 months in a Gynae-endoscopy Unit. Detailed hysteroscopic evaluation of the endocervical canal and uterine cavity in all recruited cases was done by the same surgeon and the data were collected by reviewing the case records.Results: Among the 296 cases analyzed, 157 cases were of primary infertility, 81 cases were of secondary infertility, 45 cases were of AUB, and 13 cases presented with postmenopausal bleeding. Among the primary infertility patients, 58.6% had abnormal findings on hysteroscopy, while among the secondary infertility patients, hysteroscopy revealed abnormalities in as high as 72.5% cases. In the present study, uterine synechiae was the most common abnormality detected among the infertile patients. Endometrial polyps were the most common pathology detected among patients with AUB and postmenopausal bleeding. Conclusion:Hysteroscopy is a minimally invasive and highly safe technique to directly visualize the endocervical canal, uterine cavity, and tubal ostia. It has an added advantage of treating the pathology in the same sitting, thus improving the clinical outcomes. Based on our findings, we conclude that uterine pathologies are a major contributor in causing infertility and menstrual irregularities, which are missed on blind modalities like hysterosalpingography and dilatation and curettage.Clinical significance: This article stresses on the use of hysteroscopy as a primary diagnostic modality in evaluating patients of infertility, AUB, and postmenopausal bleeding in order to increase the detection rates of uterine pathologies.
Study objective:The aim of this study is to analyze the findings in females on whom laparoscopy was performed for the evaluation and management of infertility.Design: Retrospective study in a Multispecialty Hospital.Participants: Two hundred patients who underwent diagnostic and Operative Laparoscopy for evaluation and management of infertility in the age group 20-49 years were selected. Materials and methods:In this retrospective observational study we evaluated 200 patients on whom laparoscopy was performed for evaluation of primary or secondary infertility, and simultaneous management of the cause was done in a gynae-endoscopy unit in Delhi. The study included 120 females of primary Infertility and 80 women with secondary Infertility for 18 months. Laparoscopic findings, patient's age, nature of pathology and their distribution, the most common factor involved in infertility, chromopertubation, and results were analyzed from the data collected from these available case records.Results: Total 200 women on whom laparoscopy was performed for evaluation of infertility, it was observed that there were 120 cases were of primary infertility, Out of 120, 8 cases had no abnormal finding. A most common finding was endometriosis in 6/120 (57.5%) cases including endometrioma in 38 (31.7%) cases. Tubal factor 24 cases (20%), ovarian factor 14 cases (11.7%), bowel and Omental adhesions28 cases (23.33%), PCOD 32 cases (26.7%), and myoma 34 cases (28.33%), similarly Out of 80 cases of secondary infertility in 11 cases no abnormal finding was there. Strangely, even in cases of secondary infertility, we found endometriosis to be the most common cause in about 53/80 (66.3%) cases which is a significant number. This may be the possible reason for adhesions (Bowel, mental and other) also which account to42 cases (52.5%). Tubal factor 13 cases (16.25), ovarian factor 9 cases (11.25%), endometriosis 24 cases (30%), PCOD 4 cases (5%), Myoma17 cases (21.25%).In both primary and secondary infertility, filmy dense adhesions were seen distorting the normal anatomy. These findings were not significant according to age groups 20-30 years and >30 years. Conclusion:In this study, endometriosis was found to be the most significant factor contributing to both primary and secondary infertility and also giving an explanation to increased finding Bowel/Omental and pelvic adhesions. Sometimes, more than one factor is present in overlapping fashion making management more difficult. Laparoscopy has a key role in delineating and managing such cases. It is the minimally invasive method, reaching new horizons with better technique. Simultaneous chromopertubation can be done for evaluation of tubal patency. Now in this era, it is impossible to consider workup for infertility without the aid of laparoscopy.Clinical significance: This study demonstrates the benefits of laparoscopy in the evaluation of infertility patients and the advantages of the minimally invasive technique. Statistical analysis:Fischer's exact test for calculation of p value. A p value...
Introduction The incidence of congenital uterine malformations is as high as 3 to 4% with septate uterus being one of the most common forms of congenital malformation. Structurally anomalous uterus has been recognized as a cause of infertility, and obstetric complications. Of all known uterine anomalies, septate uterus is the most common and is associated with poorest reproductive outcome, with fetal survival rates between 6 to 28%. Also, it carries high rate of spontaneous miscarriage exceeding > 60% but, on the bright side, it is one of the uterine anomaly that is most amenable via simple hysteroscopic management. Aims and objectives To describe a case series (comprising two cases) septate uterus managed successfully using hysteroscopy. Background Septate uterus results from incomplete resorption of paramesonephric mullerian ducts during the first trimester of pregnancy. Depending on the size of septum, it can be incomplete septum or complete septum dividing the uterine cavity into two separate components including two cervix and vaginal septum. Congenital malformations may be associated with recurrent pregnancy loss, preterm labor, abnormal fetal presentation, intrauterine growth restriction (IUGR) and infertility. Hysteroscopy is considered the gold standard for the assessment and treatment of intrauterine anomalies. Cases Authors report two cases of septate uterus managed hysteroscopically. • A case of complete septate uterus and another case of complete septate uterus with two cervices, managed hysteroscopically both subjects conceived successfully after treatment. Conclusion Operative hysteroscopy is an effective and safe minimally invasive technique to manage complete uterine septum, associated with quicker recovery. Additionally, there is no scar formation which promotes improved reproductive outcome. It has enabled more liberalized approach to treatment, i.e. now being extended to include patients with recurrent pregnancy loss and premature labor. Also, this intervention can be used successfully in patients diagnosed with infertility secondary to uterine septations, especially if in vitro fertilization (IVF) is being contemplated. How to cite this article Pathak C, Manchanda R, Yadav G. Hysteroscopy in Uterine Anomalies: A Boon! J South Asian Feder Obst Gynae 2016;8(1):74-76.
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