An Adhesion Barrier May Induce Peritonitis and Abscess after Laparoscopy-Assisted Myomectomy with Vaginal Extraction: Report of a Case

Ko, Mei–Lan; Huang, Lee-Wen; Chang, Jier-Zen; Hwang, Jian-Loung; Pan, Hun-Shan

doi:10.1159/000261789

Cited by 6 publications

(4 citation statements)

References 24 publications

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“…Consistent with our results, most previous studies have reported that postoperative infections were not related to posterior colpotomy and transvaginal extraction [ 14 – 16 ]. Conversely, the complication of vaginal abscess has been reported after transvaginal NOSE procedure following laparoscopic myomectomy [ 17 , 18 ]. However, the authors explained that the abscess could be attributed to the adhesion barrier used during surgery.…”

Section: Discussionmentioning

confidence: 99%

Cosmesis and feasibility of transvaginal natural orifice Specimen extraction (NOSE) for large organ specimen: a prospective pilot study

2022

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Background This study aimed to evaluate cosmetic outcomes and feasibility of transvaginal natural orifice specimen extraction (NOSE) in patients who underwent laparoscopic or robotic surgery for the treatment of benign or malignant diseases of the kidney, liver, stomach, adrenal gland, and bladder. Methods This prospective study was conducted at a tertiary hospital between March 2015 and May 2020. The main outcome was cosmetic outcomes of scars assessed using the Patient and Observer Scar Assessment Scale (POSAS) 1 and 8 weeks after surgery. The secondary outcomes were postoperative pain, operating time, and complications. Sexual function was assessed using the Female Sexual Function Index (FSFI) questionnaire 6 months after surgery in 17 patients who were sexually active at the time of surgery. Results A total of 38 transvaginal NOSE procedures were performed for the extraction of 33 kidneys, 2 livers, 1 stomach, 1 adrenal gland, and 1 bladder. Observers rated pigmentation and relief scores as most deviant from normal skin (2.9 ± 1.7, 3.0 ± 2.1 at postoperative 1 week; 3.6 ± 1.9, 3.5 ± 2.2 at postoperative 8 weeks, respectively), but the overall scores of each item were low. The patients’ overall satisfaction with postoperative scars was high, and the mean scores for pain and itching were low, with significant improvement from the first week to the eighth week (P = 0.014 and P = 0.006, respectively). Patients also reported low scores on vaginal assessment items, indicating better symptoms, and bleeding improved significantly between the two time points (P = 0.001). Postoperative pain was reduced from moderate during the first 24 h after surgery to mild after 24 h. The mean operative time of the transvaginal NOSE procedure was 28.3 ± 13.3 min. No postoperative complications were associated with the procedure. The mean FSFI total score was 21.2 ± 8.7 (cutoff score for dysfunction is 21), with higher scores indicating better sexual functioning. Conclusion Transvaginal NOSE seems to be a feasible procedure with promising cosmetic benefits, for patients who undergo minimally invasive surgery for large organs including the kidney, liver, stomach, adrenal gland, and bladder. A prospective randomized clinical trial is needed to provide solid evidence to support transvaginal NOSE. Trial registration: This trial is registered at ClinicalTrials.gov (NCT05113134).

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Section: Discussionmentioning

confidence: 99%

Cosmesis and feasibility of transvaginal natural orifice Specimen extraction (NOSE) for large organ specimen: a prospective pilot study

2022

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“…Prevention of adhesion formation after peritonitis seems the ultimate challenge for proving the effectiveness of an anti-adhesion barrier. It also is crucial that the barrier does not promote infection or abscess formation [17,18].…”

mentioning

confidence: 99%

Polyvinyl Alcohol Hydrogel Decreases Formation of Adhesions in a Rat Model of Peritonitis

Deerenberg

Mulder

Ditzel

et al. 2012

Surgical Infections

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“…Moreover, the authors concluded that the risk of pelvic infection was not an adequate reason to avoid a colpotomy for pelvic mass retrieval . Two case reports demonstrated that vaginal abscesses developed following laparoscopic myomectomies with TV retrievals . The authors indicated that these complications could be attributed to the adhesive barrier that was used in both operations.…”

Section: Discussionmentioning

confidence: 99%

Transabdominal versus transvaginal specimen extraction in mini‐laparoscopic surgery

Soyman¹,

Kelekçi

Aydoğmuş

et al. 2019

J of Obstet and Gynaecol

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Aim: The objective of this study was to present our experiences of tissue extraction via the transvaginal (TV) route after a mini-laparoscopic gynecological surgery and compare them with our transabdominal (TA) specimen extraction experiences. Methods: This prospective randomized controlled study was conducted in a tertiary care center between July 2014 and February 2016. Fifty-eight women who were undergoing mini-laparoscopy for adnexal mass removal were randomized into two groups according to the surgical specimen removal by the TV route (n = 28) or the TA route (n = 30). The main outcome measures were the postoperative incisional pain, cosmetic outcomes and overall satisfaction rate. The secondary outcome measures were additional blood loss, additional operation duration and the need for morcellation. Results: The TV group had significantly lower visual analog scale scores than the TA group at 6 and 24 h postoperatively. The morcellation needs were lower in the TV group than in the TA group. Three months after the surgery, the participants scored a higher rate of overall satisfaction in the cosmetic outcomes in the TV group than in the TA group. Conclusion: Tissue extraction through a posterior colpotomy after mini-laparoscopic surgery may be a feasible technique for improving cosmetic results, decreasing postoperative pain and decreasing the need for morcellation when compared to TA specimen retrieval.

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An Adhesion Barrier May Induce Peritonitis and Abscess after Laparoscopy-Assisted Myomectomy with Vaginal Extraction: Report of a Case

Cited by 6 publications

References 24 publications

Cosmesis and feasibility of transvaginal natural orifice Specimen extraction (NOSE) for large organ specimen: a prospective pilot study

Cosmesis and feasibility of transvaginal natural orifice Specimen extraction (NOSE) for large organ specimen: a prospective pilot study

Polyvinyl Alcohol Hydrogel Decreases Formation of Adhesions in a Rat Model of Peritonitis

Transabdominal versus transvaginal specimen extraction in mini‐laparoscopic surgery

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