Control-matched surgical evaluation of endometriosis progression after IVF: a retrospective cohort study.
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The aim of this study was to examine the surgical findings at repeated surgeries for endometriosis and to compare disease progression in patients after IVF to those without interval fertility treatments.A retrospective case-control study set at the referral center for gynecologic endoscopy at Stanford University. Women who had two surgeries for treatment of symptomatic endometriosis since 1997 were searched in the database. Twenty-one women were identified who underwent IVF treatment between the two procedures (IVF group), and compared to 36 women who did not receive any fertility treatment (controls). The main outcomes were time to recurrence and surgical findings including rASRM score. The presence and size of endometrioma, rectovaginal and para-rectal spaces location of endometriosis were also compared between the two surgical procedures.Demographics in the two groups were similar. The change in rASRM score between surgeries was not significantly different (P=0.80) between the two groups. There was no difference between the two groups in the size and number of pathology proven endometriomas as well as no difference in the presence of rectovaginal and pararectal endometriosis.No significant difference was found in the two groups, suggesting that IVF treatment does not lead to an accelerated progression of endometriosis in patients with recurrence.Keywords:
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Objective To investigate the clinical efficacy of laparoscopic minimally invasive surgical treatment in patients with endometriosis.Methods Retrospective analysis of hospital from 2009 to 2011 were treated 106 cases of uterine en dometriosis in patients with clinical data.Results All patients with postoperative wound healed,patients were followed up for 3 to 18 months,the symptoms completely disappeared,the wound without obvious symptoms,no recurrence.Conclusion Laparoscopic clear the efficacy of the minimally invasive treatment of uterine endometriosis,fewer side effects,rapid postoperative recovery,and worthy of extensive promotion and application.
Invasive surgery
Clinical efficacy
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Abdominal hysterectomy
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Pelvic endometriosis
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Objective To observe the clinical curative effects of laparoscopic in the treatment of endometriosis. Methods Clinical data of diagnosis and surgery of 240 patients uterine endometriosis was retrospective analyzed. Results The operative time, intraoperative blood loss, hospital stay, postoperative complications and recurrence rate in the laparoscopic group were lower than those in the laparotomy group(P 0.05). Conclusion Laparoscopic treatment of endometriosis is safe and effective. It should be used widely in clinical care.
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The effect of endometriosis on obstetric outcomes is still ambiguous. The aim of our study was to determine the association between endometriosis and adverse obstetric outcomes in a cohort of Chinese women.A retrospective cohort study was undertaken to compare obstetric outcomes between 249 women with endometriosis and 249 women without endometriosis. All women were nulliparous and achieved singleton pregnancies naturally. Women with endometriosis were diagnosed during surgery and confirmed histologically. Odds ratios (ORs) and 95% confidence intervals (CIs) of measures of obstetric outcomes were calculated.Women with endometriosis showed significantly increased risks of preterm labor (adjusted OR, 2.42; 95% CI, 1.05-5.57), placenta previa (adjusted OR, 4.51; 95% CI, 1.23-16.50), and cesarean section (adjusted OR, 1.93; 95% CI, 1.31-2.84). No significant differences were observed in the incidence of pregnancy-induced hypertension, fetal growth restriction, small for gestational age, placental abruption, or luteal support in the first trimester between the two groups.Women with endometriosis are at a higher risk of preterm labor, placenta previa, and cesarean section during pregnancy and need additional care.
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Objective: To evaluate of laparoscopic treatment of endometriosis in surgical techniques and clinical results. Methods: 38 patients with endometriosis of our hospital from January 2008 to January 2010 were randomly divided into observation group of 22 patients (laparoscopic surgery) and control group of 16 patients (abdominal surgery). The therapeutic effect of the two groups were compared.Results:Two groups of bleeding, anal exhaust time, wound healing time, postoperative hospital stay was compared, the differences were significant (P0.05), compared the pregnancy rate between the two groups,the difference was significant (P0.05).Conclusion:Laparoscopic treatment of endometriosis has significant effect,it is worthy of clinical application.
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Incisional hernias develop in up to 11% of surgical abdominal wounds with a possible recurrence following repair of 44%. We describe our experience with a combined fascial and prosthetic mesh repair. Thirty-five patients (16M:19F) have been treated. The original operation was bowel related in 19 cases, gynaecological in 8, hepatopancreaticobiliary in 3 patients, aortic aneurysm repair in 2 and involved a thoraco-laparotomy in 3. The incisions were midline in 26 cases, transverse in 6, paramedian in 2 and rooftop in one patient. The hernias were considered subjectively to be large in 15, medium in 14 and small in 6 of the patients. A proforma was completed for each patient noting intra-operative and post-operative complications, post-operative hospital stay and analgesic requirements. Post-operative complications included seroma formation in 6 patients, deep vein thrombosis in one and a non-fatal pulmonary embolism in another. One patient developed a wound haematoma and one had a superficial wound infection. Post-operative in-hospital stay ranged from 1 to 27 days with a mean of 6.2 days. Of the 35 patients 33 were available for follow-up. Follow-up was for a median of 20.3 months (range 6.0 to 54.1 months). Two of these (6%) patients reported a persistent lump and one (3%) reported persistent pain but none of the remaining 33 was found to have a recurrence. We advocate this technique because it is applicable to all hernias, most of the mesh is behind the rectus sheath and has 2 points of fixation, it is relatively pain-free allowing early mobilisation, has a modest complication rate and a low recurrence rate.
Seroma
Incisional Hernia
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In Brief OBJECTIVE: To estimate and evaluate the demographics, clinical course, and complications of delayed postpartum preeclampsia in patients with and without eclampsia. METHODS: We conducted a retrospective cohort study of patients who were discharged and later readmitted with the diagnosis of delayed postpartum preeclampsia more than 2 days to 6 weeks or less after delivery between January 2003 and August 2009. RESULTS: One hundred fifty-two patients met criteria for the diagnosis of delayed postpartum preeclampsia. Of these, 96 (63.2%) patients had no antecedent diagnosis of hypertensive disease in the current pregnancy, whereas seven (4.6%), 14 (9.2%), 28 (18.4%), and seven (4.6%) patients had gestational hypertension, chronic hypertension, preeclampsia, and preeclampsia superimposed on chronic hypertension, respectively, during the peripartum period. Twenty-two patients (14.5%) developed postpartum eclampsia, and more than 90% of these patients presented within 7 days after discharge from the hospital. The most common presenting symptom was headache in 105 (69.1%) patients. Patients who developed eclampsia were significantly younger than those who did not (mean±standard deviation, 23.2±6.2 compared with 28.3±6.7 years; adjusted odds ratio [OR] 1.13, 95% confidence interval [CI] 1.02–1.26, P=.03), and other demographic variables were no different. A lower readmission hemoglobin was associated with a lower odds of progression to eclampsia (10.7±1.7 compared with 11.6±2.2 g/dL, adjusted OR 0.75, 95% CI 0.57–0.98, P=.04). CONCLUSION: One week after discharge appears to be a critical period for the development of postpartum eclampsia. Education about the possibility of delayed postpartum preeclampsia and eclampsia should occur after delivery, whether or not patients develop hypertensive disease before discharge from the hospital. LEVEL OF EVIDENCE: III The majority of late postpartum eclampsia occurs within 7 days of postpartum hospital discharge, and young maternal age is a risk factor.
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