The rate of an adnexal mass detected during pregnancy increased after the routine use of ultrasonography. There is no consensus on the approach to adnexal masses in pregnancy, which requires treatment in a wide spectrum from a conservative approach to complicated operations. These masses, which are frequently asymptomatic, are mostly benign and resolve spontaneously during the later weeks of pregnancy, especially in the second trimester, but persistent masses can be difficult to follow up and treat. Therefore, we examined the diagnosis, follow-up and treatment of adnexal masses during pregnancy, based on our patient who had a 15x13.5 cm well-defined cystic mass in the right adnexal area, which was detected incidentally at the first antenatal visit to our clinic, and who presented with acute abdomen during the follow-up and underwent an emergency operation.
BACKGROUND: An important step in laparoscopic surgery is abdominal access. Several abdominal access techniques have been described to reduce complications. We compare our novel abdominal access technique (MESAD) with other abdominal access techniques, particularly to reduce complications in obese patients. OBJECTIVE: Compare the MESAD method and other methods we use for abdominal access in gynecologic laparoscopic surgery of obese patients DESIGN: Retrospective SETTING: Gynecology department in university hospital PATIENTS AND METHODS: Patients who underwent abdominal access by the MESAD technique, the Veress needle technique, and the Hasson technique were included in our study. In addition to demographic data, minor and major complications, number of unsuccessful attempts, conversion to another technique, and abdominal access times were collected from all patient files. MAIN OUTCOME MEASURES: Clinical data and complications SAMPLE SIZE: 66 patients, 26 by MESAD technique, 24 by the Veress needle technique, and 16 by the Hasson technique. RESULTS: There were two major complications (one in the Veress group and one in the Hasson technique group) and 7 minor complications. No significant difference was found between the groups in terms of complications ( P =.477, P =.476, respectively). The fastest technique for abdominal access was in the MESAD technique whereas the slowest was in the Hasson ( P <.001). The failure of abdominal access and subsequent conversion to another technique was most common in the Veress group. However, no significant difference was found between the groups ( P =.092). CONCLUSIONS: The MESAD technique is an easy method to both learn and teach. We think that the low major-minor complication rates in the MESAD technique will allow surgeons to reduce their anxiety at the first entry and to perform a more comfortable operation. LIMITATIONS: Retrospective CONFLICT OF INTEREST: None.
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