The authors describe a new technique for the subcutaneous heterotopic transplantation of the ovary before pelvic irradiation to treat Hodgkin's disease. Creation of a cavity to receive the transplant and the use of two surgical teams and the surgical microscope during the operation ensured its successful outcome. The transplanted ovary was followed up clinically and by ultrasound monitoring: ovarian cycles remained regular despite radiotherapy, and follicle growth occurred normally. In comparison to other types of oophoropexy described in the literature, the advantages of this technique included total protection of the ovary from irradiation, and conservation of ovarian function and fertility. One year after the procedure, puncture of the ovarian compartment produced a mature oocyte specimen.
In a trained center, mesh removal was found to be a quick and safe procedure. Mesh-related complications may frequently occur more than 2 years after the primary operation. Recurrence was mostly associated with SUI and less with genital prolapse.
: In addition to recommendations within the report, the committee reaffirms that in planning surgery, the individual patient's risk for surgery, risk of recurrence, previous treatments, and surgical goals are all considered in deciding on obliterative versus reconstructive procedures, and in deciding whether the vaginal or the abdominal approach will be used for reconstructive repairs.
Case reportA 49 year old woman underwent abdominal hysterectomy indicated by metrorrhagia and a very large fibroid uterus. A bladder injury occurred during the dissection and was sutured immediately. Postoperatively the patient developed a vesico-vaginal fistula between the vaginal apex suture and the upper third of the bladder, as demonstrated by cystogram and intravenous pyelogram. Cystoscopy revealed a fistula five millimeter in diameter located posterior and superior to the trigone. The fistula was too high to be reached by a finger. Continuous drainage via a Foley catheter for three weeks failed to allow closure. A vaginal approach was not appropriate because of the location of the fistula. We proposed a laparoscopic approach, following the same principles as laparotomy. The woman was aware that conversion to laparotomy might be required.Four months after hysterectomy, we performed laparoscopy, as follows. A video-laparoscope was inserted through a 10 mm trocar at the umbilicus, and two 12 mm trocars were set in the lower abdomen to insert grasping forceps, scissor, suctionirrigator probe and staplers. Inspection of the pelvic and abdominal cavity revealed a few pelvic adhesions, easily lysed. The bladder was dissected away from the vagina, with a vaginal tampon exposing the vaginal cul-de-sac to orient the dissection. The fistula was excised and the bladder wall repaired with one layer of a continuous suture (Endostitch Polysorb zero). Closure of the vagina was not necessary. An omental J flap was then dissected, based on the gastrointestinal vessels, with five cartridges of Endo-GIA 30 staples (Fig. 1) and inserted between vagina and bladder to enhance blood supply, protect suture lines, and close dead space2. This flap was stapled to
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