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Introduction: An ectopic pregnancy occurs when the developing blastocyst implants either outside the uterus i.e fallopian tube (interstitial, ampullary, isthmic, fimbrial), Ovary and abdominal cavity or in an abnormal position within the uterus i.e cornual, cervical. Around 98.3% of ectopic pregnancies occur in the fallopian tubes. Visualization of an intrauterine sac, with or without fetal cardiac activity, is often adequate to exclude ectopic pregnancy. The treatment modality also has evolved from radical surgery, conservative surgery to medical and expectant management. Laparoscopy is now recommended approach in surgical management of ectopic pregnancy. Materials and Methods: This is a prospective observational study conducted in Department of Obstetrics and Gynaecology from 2020 to 2022 where 118 cases were studied. Detailed history was taken for all cases with special reference to risk factors like smoking, PID, abortions, previous ectopic, IUD use, sterilization, D & C, IVF and LSCS followed by clinical examination. Routine and other relevant investigations were done including (UPT, CBC, ICTC, HCV, HbSAg, USG (TVS) and serum ß-HCG and managed according to the condition of patient either medical, surgical or both. Data regarding intraoperative finding confirming site of ectopic pregnancy, ruptured or unruptured, operative techniques including salpingectomy, salpingo ophorectomy, cornual repair or hysterectomy and blood product transfusion were collected. Patients were followed up till discharge or death and the outcome were analysed. Results: Maximum numbers of cases, 45 cases (38.1%) were in the age group between 26 to 30 years. Among all cases, 24 cases (20.3%) had history of previous abortions, 22 cases (18.6%) had history of PID, 14 cases (11.9%) had undergone D & C earlier, 8 cases (6.8%) had earlier tubal ligation, 5 cases (4.2%) had h/o IUCD insertion and 1 case (0.8%) had previous history of ectopic pregnancy. The classical triad of amenorrhea, abdomen pain and abnormal vaginal bleeding was seen in 52 cases (44.0%). The most common site of ectopic pregnancy site was fallopian tube, of which 96 cases (81.3%) were in amupulla, 14 cases (11.9%) were in isthmus and only 3 cases (2.5%) were in infundibulum. Only 2 cases (1.7%) had cornual pregnancy with gestational sac implanted in the non communicating horn of unicornuate uterus. Maximum number of ectopic pregnancy cases underwent surgery, with 98 cases (83.0%) had undergone unilateral salpingectomy as the most common procedure whereas 15 cases (12.7 %) had undergone unilateral salpingophorectomy in cases with unhealthy ovary and ovarian pregnancy out of 113 cases of tubal ectopic pregnancy. Only 2 cases (1.7%) with cornual pregnancy had cornual resection and repair. Hysterectomy was adopted as surgical treatment in 2 cases (1.7%) only. Conclusion: Patients with risk of ectopic pregnancy like PID, IUCD implantation, previous ectopic pregnancy and patients with history of D & C should undergo routine USG in first trimester to locate the site of early pregnancy. We recommend follow up above cases of ectopic pregnancy and analyzing the effect of ectopic pregnancy on future fertility and pregnancy. [ABSTRACT FROM AUTHOR]

Objective: The aim of this study was to estimate the possible differential levels of influence of the applied hysterectomy type on ovarian reserve. Materials and Methods: Our study is a single-center prospective cross-sectional study. We included 82 patients who underwent benign hysterectomies between July 2021 and March 2022. There were two groups, abdominal hysterectomy (n=54) and laparoscopic (L/S) hysterectomy (n=28). Transvaginal ultrasonography and hormone status were evaluated before and after the hysterectomy. Patients with a preoperative anti-Mullerian hormone (AMH) value greater than 0.01 ng/dl and a follicle stimulating hormone (FSH) value less than 15 IU/L were included in the study. Results: There was a significant difference between the groups regarding age, parity, duration, and bleeding. There was no significant difference in the percent decrease in AMH value between abdominal and laparoscopic hysterectomies. There was no difference in the comparison regarding the amount of decrease in ovarian volume and antral follicle count (AFS) parameters. In the analysis of serum estradiol values, an increase in 33 patients and a decrease in 49 patients were observed. While serum estradiol values decreased in 33 of 54 patients who underwent abdominal hysterectomy, this rate was 67.3% among patients with decreased estradiol. The difference in estradiol values was not statistically significant. There was a difference between the two groups in the comparative analysis regarding the amount and rate of increase in FSH parameters (p=0.03). Conclusion: In both groups a decrease in ovarian reserve before and after surgery was observed. No significant difference was observed in the analyses performed between them. The increase in FSH levels was more significantly in favor of L/S. Prospective large-scale studies are needed to investigate the effect of L/S hysterectomy on ovarian reserve compared to abdominal surgery, including investigating inhibin-B levels in ovarian follicles due to electrothermal energy use. [ABSTRACT FROM AUTHOR]

Background: In unicornuate uterus cases, when the rudimentary horn is very close to the uterus and is firmly attached, laparoscopic surgery can be very challenging due to the danger of massive bleeding and the possiblity of damaging the healthy hemiuterus. The aim of study is to verify if the laparoscopic resection of the horn site of hematometra, when solidly attached to the unicornuate uterus, is safe and effective. Materials and Methods: This is a retrospective analysis of prospectively collected data in a tertiary referral centre. From 2005 to 2021, a total of 19 women were diagnosed with unicornuate uterus with cavitated noncommunicating horn (class II B). We reviewed the original documentations of the patients and created a database. The follow-up results were assessed by questionnaires answered by the patients. In all cases, the chosen treatment was: laparoscopic removal of the rudimentary horn together with the ipsilateral salpinx and reconstruction of the myometrium of the hemiuterus. Statistical Package for Social Science (SPSS) version 21.0 was used to perform data analysis. We decided to calculate continuous variables in terms of mean and standard deviation (SD) or as median and interquartile range (IQR), as appropriate. Instead, categorical variables were expressed in terms of percentage. Results: Five patients (12-18 years old) with unicornuate uterus and rudimentary horn with hematometra and broadly connected to the hemiuterus were operated laparoscopically. The surgical procedure was successful in all cases. No major complications were recorded. Postoperative course was uneventful. In the follow-up in all cases dysmenorrhea and pelvic pain disappeared. Three patients sought to become pregnant and have children. They had in total 4 pregnancies with 2 abortions in the 1st trimester and two pregnancies with premature births at the 34th and 36th weeks. No serious gestational complications were recorded and the pregnancies ended with caesarean sections due to breech presentation. Conclusion: Overall, for the rudimentary horn solidly attached to the unicornuate uterus, the laparoscopic resection of the horn site of hematometra seems to be safe and effective. [ABSTRACT FROM AUTHOR]

Methotrexate(MTX) has an essential role in the treatment of ectopic pregnancy, and high success rates have been achieved. MTX acts on rapidly proliferating cells like ovarian germinal cells. The aim was to elucidate whether the administration of MTX has a significantly adverse effect on ovarian reserve. 165 patients were included and divided into 3 groups. 38 patients having MTX treatment(50mg/m2) were group1, 45 patients having surgical treatment (laparoscopy or salpingostomy/salpingectomy by laparotomy) were group2, and 82 patients who admitted to gynecology outpatient clinic were group3, the control group of the study. The patients who had surgery because of rupture following MTX treatment were not included. The patients were investigated for ovarian reserve test 3 months after having negative b-hCG test. Basal levels of hormones FSH, E2 measured, and by transvaginal USG, we counted the number of antral follicles and measured ovarian volume. The average age of all patients was 29.6±3.8; in group1 30.1±3.9, in group2 30±3.6, in group3 29.2±3.9 years. There is no statistical difference between groups(p: 0.31). FSH level was 7±1.7IU/L in group1, 7.4±1.6IU/L in group2, and 7±1.4IU/L in group3. There is no difference between groups(p: 0,77). Estradiol level was 44.5±24.2 pg/mL, 45.8±17.6 pg/mL, 48.5±16.4 pg/mL in groups respectively. There is no statistical difference between groups(p: 0.09). There is also no statistically significant difference between groups for basal antral follicle numbers and ovarian volumes(p: 0.11, p: 0.16, respectively). In unruptured ectopic pregnancies, MTX treatment has advantages for cost-effectivity and morbidity. There is no effect of MTX treatment on ovarian reserve. [ABSTRACT FROM AUTHOR]

After vaginal delivery, opportunistic salpingectomy is more cost effective than bilateral tubal ligation for reducing the risk of ovarian cancer. OBJECTIVE: To compare the cost effectiveness of opportunistic salpingectomy and bilateral tubal ligation for sterilization immediately after vaginal delivery. METHODS: A cost-effectiveness analytic decision model was used to compare opportunistic salpingectomy with bilateral tubal ligation during vaginal delivery admission. Probability and cost inputs were derived from local data and available literature. Salpingectomy was assumed to be performed with a handheld bipolar energy device. The primary outcome was the incremental cost-effectiveness ratio (ICER) in 2019 U.S. dollars per quality-adjusted life-year (QALY) at a cost-effectiveness threshold of $100,000/QALY. Sensitivity analyses were performed to determine the proportion of simulations in which salpingectomy would be cost effective. RESULTS: Opportunistic salpingectomy was more cost effective than bilateral tubal ligation with an ICER of $26,150/QALY. In 10,000 patients desiring sterilization after vaginal delivery, opportunistic salpingectomy would result in 25 fewer ovarian cancer cases, 19 fewer ovarian cancer deaths, and 116 fewer unintended pregnancies than bilateral tubal ligation. In sensitivity analysis, salpingectomy was cost effective in 89.8% of simulations and cost saving in 13% of simulations. CONCLUSION: In patients undergoing sterilization immediately after vaginal deliveries, opportunistic salpingectomy is more cost effective and may be more cost saving than bilateral tubal ligation for reducing ovarian cancer risk. [ABSTRACT FROM AUTHOR]

Background: Trophoblastic tissue reimplantation after laparoscopic salpingectomy is a very rare complication. These cases may present a diagnostic challenge and the majority of patients need a surgical treatment. Case presentation: A 31-year-old patient came to a tertiary referral center for nausea and pain in the upper left abdominal quadrant. Ultrasound and abdominal CT scan showed a 68 × 60 × 87 mm size heterogenic mass below the spleen with arterial extravasation from the lower spleen pole. Recent history of surgery for ectopic pregnancy and serum hCG testing allowed to diagnose extratubal secondary trophoblastic tissue reimplantation below the spleen. Embolization of the bleeding vessel and successful treatment with methotrexate was achieved. Conclusions: In cases of a nondisseminated trophoblastic tissue reimplantation, consider embolization and treatment with methotrexate if the patient is hemodynamically stable; thus, secondary surgical treatment is preventable. [ABSTRACT FROM AUTHOR]

Background: The HOPPSA trial is a multi-center national registry-based randomized controlled trial to test the safety and effectiveness of performing opportunistic salpingectomy at hysterectomy to reduce the risk of epithelial ovarian cancer (EOC). The study protocol was first published in January 2019 and is available at https://trialsjournal.biomedcentral.com/articles/10.1186/s13063-018-3083-8. Here, we report amendments made to the study protocol since commencement of the trial. Changes in methods and analysis: The primary outcomes analyses have been changed. (1) Complications will be analyzed using binomial generalized estimating equation (GEE) with log link function, while the unadjusted analyses according to Miettinen and Nurminen will be performed as a sensitivity analysis. (2) Absolute change in Menopause Rating Scale (MRS) will primarily be analyzed using a mixed effects model, adjusted for baseline MRS and center as a random effect. (3) Time to EOC will be analyzed using the mixed effects Cox regression model with center as random effect, while the unadjusted log-rank test will be performed as a sensitivity analysis. The primary outcome Complications will be based solely on the specific assessment in the GynOp quality registry. The Clavien-Dindo classification will be evaluated as a secondary outcome. Furthermore, MRS is also measured three years postoperatively to better pinpoint the onset of menopausal symptoms. Discussion: The changes to the protocol mainly concern the analyses of data. No changes to recruitment, randomization, intervention, or follow-up of primary outcomes have been made. An interim analysis during 2021 concluded that the study should continue until the target sample size is reached. Trial registration: ClinicalTrials.gov, NCT03045965. Registered 8 February 2017. [ABSTRACT FROM AUTHOR]

Background: There have been no studies concerning the complications or benefits of cholecystectomy in ovarian cancer. In this study, we aimed to evaluate the outcomes of cholecystectomy performed during various time periods of the disease course and suggest a management strategy for cholecystectomy in ovarian cancer. Methods: We retrospectively reviewed the medical records of patients with advanced ovarian cancer who underwent cholecystectomy during the cytoreductive surgery from 2009 to 2020. Cholecystectomy was primarily indicated when the gallbladder and surrounding structures were considered to have metastatic tumor invasion. If the final pathologic results showed free of malignant tumor, patients were placed into the no-infiltration group. Clinical outcomes including the recurrence rate and complications were analyzed. Results: A total of 62 patients underwent cholecystectomy, 48 of whom (77.4%) underwent cholecystectomy during primary or interval debulking surgery, whereas 14 (22.6%) underwent cholecystectomy during the follow-up period (five with benign disease and 9 with disease recurrence). Among the patients, 32 (51.6%) patients were included in the no-infiltration group in the final pathology. There were no complications observed in the no-infiltration group (n = 32). Seven (78%) of the nine patients who received cholecystectomy for disease recurrence had metastatic disease in the porta-hepatis or lesser sac at the time of primary surgery. However, no recurrent lesions were observed around the porta-hepatis in patients who received cholecystectomy during primary treatment. Conclusion: Considering the safety of the procedure, as well as the risk of disease recurrence or cholecystitis, a cholecystectomy can be offered to patients with ovarian cancer who have metastatic lesions around the gallbladder and porta-hepatis at the time of primary surgery. [ABSTRACT FROM AUTHOR]

Simple Summary: The nutria (Myocastor coypus), an invasive alien species widely spread in Europe is considered a pest in many regions. Several containment plans have been proposed and, often, euthanasia is the only available option. An alternative approach, based on surgical reproduction control of nutrias is evaluated in the present study. Laparoscopic salpingectomy and vasectomy make it possible to inhibit fertility with prompt recovery and release of the animals back into nature. This technique could be applied in urban and anthropized areas, where application of other control methods could be hindered by public opinion. The outcome of the developed and evaluated procedures suggests that laparoscopic salpingectomy and vasectomy represent an effective, safe, and versatile tool for the management of invasive alien species. The nutria (Myocastor coypus), an invasive alien species, is widely spread in Europe. Pursuant to regulation (EU) no. 1143/2014, the nutria is subject to management programs to reduce its spread. Surgical fertility control is considered an acceptable method, particularly in urban circumstances, avoiding euthanasia. To maintain the hormonal patterns and the social and behavioral dynamics, surgical infertilization preserving the gonads (i.e., salpingectomy and vasectomy) is recommended. Mini-invasive surgery is an eligible choice when dealing with wildlife, allowing reduced captivation time. For these reasons, 77 free-ranging nutrias, captured in urban nuclei in Italy, underwent infertilization under general anesthesia; laparoscopic salpingectomy and vasectomy were performed on 32 animals and traditional surgery on the remainder, leaving the gonads in place. A three-port technique was used, with two paramedian trocars (5 mm) for the instruments and a median one for the telescope. Ablation was obtained through Onemytis® plasma device, allowing a rapid surgical time with no need to place visceral sutures; the skin was surgically closed. After recovery, the animals were released, and no overt complications were noted. No modification of the behavioral patterns was noted, and the population decreased during the following months. [ABSTRACT FROM AUTHOR]

The oral anti-angiogenic therapy nintedanib prolongs progression-free survival (PFS) when combined with chemotherapy after primary surgery for advanced epithelial ovarian cancer. The randomized phase II CHIVA trial evaluated the impact of combining nintedanib with neoadjuvant chemotherapy (NACT) for epithelial ovarian cancer. Patients with newly diagnosed unresectable FIGO stage IIIC–IV epithelial ovarian cancer received 3–4 cycles of carboplatin plus paclitaxel every 3 weeks as NACT before interval debulking surgery (IDS), followed by 2–3 post-operative cycles. Patients were randomized 2:1 to receive either nintedanib 200 mg twice daily or placebo on days 2–21 every 3 weeks during NACT (omitting peri-operative cycles), and then as maintenance therapy for up to 2 years. The primary endpoint was PFS. Between January 2013 and May 2015, 188 patients were randomized (124 to nintedanib, 64 to placebo). PFS was significantly inferior with nintedanib (median 14.4 versus 16.8 months with placebo; hazard ratio 1.50, p = 0.02). Overall survival (OS) was also inferior (median 37.7 versus 44.1 months, respectively; hazard ratio 1.54, p = 0.054). Nintedanib was associated with increased toxicity (grade 3/4 adverse events: 92% versus 69%, predominantly hematologic and gastrointestinal), lower response rate by RECIST (35% versus 56% before IDS), and lower IDS feasibility (58% versus 77%) versus placebo. Adding nintedanib to chemotherapy and in maintenance as part of NACT for advanced epithelial ovarian cancer cannot be recommended as it increases toxicity and compromises chemotherapy efficacy (IDS, PFS, OS). ClinicalTrials.gov registration: NCT01583322. • CHIVA assessed nintedanib integrated into a neoadjuvant strategy for ovarian cancer. • Nintedanib was associated with worse progression-free survival (primary endpoint). • Nintedanib was associated with an increase in typical chemotherapy adverse effects but not surgical complications. • Nintedanib is not recommended as part of neoadjuvant therapy for ovarian cancer. [ABSTRACT FROM AUTHOR]

The aim of this study was to evaluate the indications and management of grade III-IV postoperative complications in patients requiring vacuum-assisted open abdomen after debulking surgery for ovarian carcinomatosis. Retrospective study of prospectively collected data from patients who underwent a cytoreductive surgery by laparotomy for an epithelial ovarian cancer that required postoperative management of an open abdomen. An abdominal vacuum-assisted wound closure (VAWC) was applied in cases of abdominal compartmental syndrome (ACS) or intra-abdominal hypertension, to prevent ACS. The fascia was closed with a suture or a biologic mesh. The primary aim was to achieve primary fascial closure. Secondary outcomes considered included complications of cytoreductive surgery (CRS) and open abdominal wounds (hernia, fistula). Two percent of patients who underwent CRS required VAWC during the study's patient inclusion period. VAWC indications included: (i) seven cases of gastro-intestinal perforation, (ii) three necrotic enterocolitis, (iii) two intestinal ischemia, (iv) three anastomotic leakages and (v) four intra-abdominal hemorrhages. VAWC was used to treat indications (i) to (iv) (which represented 73.7% of cases), to prevent compartmental syndrome. Primary fascia closure was achieved in 100% of cases, in four cases (21.0%) a biologic mesh was used. Median hospital stay was 65 days (range: 18–153). Four patients died during hospitalization, three of these within 30 days of VAWC completion. VAWC for managing open abdominal wounds is a reliable technique to treat surgical post-CRS complications in advanced ovarian cancer and reduces the early post-operative mortality in cases presenting with severe complications. • Vacuum-assisted open abdomen enables the management of grade III-IV postoperative complications after ovarian cytoreduction. • Vacuum-assisted wound closure was applied in cases of abdominal compartmental syndrome. • Primary fascia closure was achieved in 100% of cases after open abdomen using vacuum-assisted wound closure. [ABSTRACT FROM AUTHOR]

Management options for ovarian endometriomas include expectant management, medical treatment, surgical treatment, in vitro fertilization (IVF), or a combination of the above. The choice of management depends on many clinical parameters that should be taken into consideration, the first of which is the main presenting symptom. Most patients are today referred to medical therapy as a first option in the case of associated pain, and to IVF in the case of associated infertility. When both symptoms are present, usually surgery is the preferred approach. Recently, however, surgical excision of an ovarian endometrioma has been associated with a postoperative reduction in the ovarian reserve, and recent guidelines suggest that the clinician should caution the patient as to the possible damage to the ovarian reserve in the case of surgery. However, evidence has been published as to a possible detrimental effect of the ovarian endometrioma on the ovarian reserve even if expectant management is followed. In this review, the current evidence on the conservative management of ovarian endometriomas, with particular focus on the issue of the ovarian reserve, is evaluated, and the different surgical techniques for the treatment of ovarian endometriomas are discussed. [ABSTRACT FROM AUTHOR]

Objective: To study obstetric outcomes of a second pregnancy among women with a first ectopic pregnancy (EP) treated with methotrexate compared with laparoscopic salpingectomy. Methods: A retrospective cohort study including all women with a first EP and a following pregnancy that concluded by delivery at ≥24 weeks of gestation between March 2011 and April 2021. Second pregnancy outcomes were compared between women treated with methotrexate and those treated with salpingectomy in their first pregnancy. Results: Overall, 125 women were included, of which 64 (51.2%) were treated with methotrexate and 61 (48.8%) were treated with salpingectomy. In women treated with salpingectomy, the proportion of women conceiving by in vitro fertilization and those with measured gestational sac diameter or β‐subunit human chorionic gonadotropin was higher. The proportion of women conceiving by in vitro fertilization in their second pregnancy was higher in the salpingectomy group (55.2% versus 18.0%, P < 0.001). All maternal and neonatal outcomes were similar in both groups. The rate of low birth weight < 2500 g was 7.8% in the methotrexate group versus 18% in the salpingectomy group (P = 0.111). Conclusion: Maternal and neonatal outcomes of a second pregnancy among women treated for EP in their first pregnancy are similar in women treated by methotrexate and those treated by salpingectomy. Synopsis: The method of treatment for a first ectopic pregnancy is not associated with maternal and neonatal outcome in the following delivery. [ABSTRACT FROM AUTHOR]

Introduction: Opportunistic salpingectomy (OS) refers to additional removal of the fallopian tubes during abdominal surgery performed for another medical indication, as prevention for ovarian cancer. As OS has been inconsistently implemented, its clinical practice varies worldwide. To reduce this variation, insight is required into current clinical practice and its determinants. Therefore, the study aim was to determine the implementation of counseling and performance of OS between 2015 and 2018, and its patient, surgical, physician, and hospital characteristics. Material and methods: Retrospective study using electronic medical records from six different Dutch hospitals: two academic, two large teaching, and two non‐teaching hospitals. Patients were considered eligible for OS if they underwent elective non‐obstetric abdominal surgery for a gynecological indication from January 2015 through December 2018. Primary outcomes were uptake of counseling and performance of OS. Multilevel multivariable logistic regression analyses were conducted to identify characteristics associated with OS. Results: A total of 3214 patients underwent elective non‐obstetric abdominal surgery for a gynecological indication and were eligible for OS. Counseling on OS increased significantly from 2.9% in 2015 to 29.4% in 2018. In this period, 440 patients were counseled on OS, of which 95.9% chose OS. Performance of OS increased significantly from 6.9% in 2015 to 44.5% in 2018. Counseling for and performance of OS were more likely in patients who had surgery by laparoscopic approach, were counseled by a gynecological resident, or had more than three contact moments before surgery. Additionally, OS was less likely in patients who had vaginal surgery. Conclusions: Although the uptake of OS increased from 2015 to 2018, the majority of patients who were eligible for OS were not counseled and did not undergo OS. Its clinical practice varies on patient, surgery, and physician characteristics. Therefore, an implementation strategy tailored to associated determinants is recommended. [ABSTRACT FROM AUTHOR]

Ectopic pregnancy (EP) occurs in around 1–2% of all pregnancies, and is associated with significant morbidity and mortality. Identifying those most at risk of harm relies on effective information sharing between primary and secondary care, and between secondary care services including early pregnancy assessments units. There is a need to improve the recognition of symptoms of ectopic pregnancy and to ensure that women are given appropriate advice while awaiting further assessment. The mainstay of diagnosis of EP is by transvaginal ultrasound supported by serial serum human chorionic gonadotrophin (hCG) measurements. Surgery is the main treatment in women who become acutely unwell, and in those where medical management is not likely to work or is no longer working. Otherwise, tubal EP may be managed with medical management (methotrexate) and in selected cases, expectant management. There is a lack of good quality evidence on the management of non-tubal EP and these are best managed on an individual basis. [ABSTRACT FROM AUTHOR]

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path_ BRCA 1/2 increases a woman's lifetime risk of breast and ovarian cancer. Interventions can be offered which manage cancer risk; annual breast screening from age 30, chemoprevention and, once a woman's family is complete, risk-reducing surgery. The latter is the most effective method of reducing cancer in path_ BRCA carriers; salpingo-oophorectomy reduces breast and ovarian cancer, respectively, by up to 50% and 95%. Factors affecting a woman's decision to undergo risk-reducing surgery are complex; dominant factors include risks of surgery, effect on cancer outcomes and menopausal sequelae. Specific information relating to hormone replacement and non-hormonal alternatives are an important consideration for women but, are often overlooked. Informative counselling is required to enable satisfaction with the chosen intervention whilst improving survival outcomes. This review paper outlines the current data pertaining to these decision-making factors and provides a proforma to enable effective counselling. [ABSTRACT FROM AUTHOR]

Ectopic pregnancy remains one of the most common causes of pregnancy-related death in the first trimester. 2.4% of ectopic pregnancies occur in the interstitial part of the fallopian tube. As the symptoms of this condition are non-specific and the localization is associated with a higher risk of bleeding, early diagnosis of interstitial pregnancies is important, based not only on clinical symptoms, but also on additional diagnostic methods. Early diagnosis leads to better treatment-related outcomes. We report a 32-year-old female patient who came to the emergency department because of pain in the lower abdomen and right iliac region and bloody vaginal discharge. During palpation of the abdomen, the pain was localized in the lower part of the abdomen. Human chorionic gonadotropin (hCG) was significantly increased in biochemical tests. Transvaginal ultrasound examination of internal genital organs, abdominal and pelvic computer tomography (CT) were per-formed. An ectopic pregnancy was suspected. Thus, the patient was hospitalized in the gynecology department for surgical treatment. A laparoscopy was performed and an ectopic pregnancy was diagnosed in the interstitial part of the right fallopian tube and in the right uterine corner, which led to right salpingectomy and right uterine angle resection. Thus, interstitial pregnancy is a rare and life-threatening gynecological condition due to the higher risk of bleeding compared to other ectopic pregnancies. However, appropriate diagnosis based on clinical signs, transvaginal ultrasound findings and hCG levels in the blood ensures early diagnosis of interstitial pregnancy, which leads to the choice of medical treatment with methotrexate or minimally invasive surgical techniques.

Tubal stump ectopic pregnancy is rare but a potentially life-threatening condition. A high index of suspicion is required for early diagnosis and effective treatment, thereby minimising morbidity associated with this type of abnormal pregnancy. The aim of this report was to document a rare case of repeat ectopic pregnancy in the tubal stump following previous salpingectomy. We report a 35-year-old para 1+1 with one living child who had one previous right salpingectomy for ruptured right ectopic pregnancy. She presented with complaint of abdominal pain of one-day duration following a five-week history of absent menstruation. On presentation, she was in shock and there were features of intra-abdominal fluid (blood) collection. Abdominopelvic ultrasound scan demonstrated intraperitoneal fluid collection with floating loops of bowel. She was resuscitated, had salpingectomy for ruptured tubal stump ectopic pregnancy, and remained stable on follow-up. In conclusion, tubal stump ectopic pregnancy is a rare but possible complication of a previous salpingectomy. A high index of suspicion is required for early diagnosis and effective management.

The patient was a 32-year-old woman, gravida three, para one with one prior cesarean section. She became pregnant spontaneously, but the pregnancy implanted in the isthmus of the right fallopian tube, and therefore, she underwent laparoscopic right salpingectomy. Eight months later, another spontaneous pregnancy occurred. the patient experienced abdominal pain and an ultrasound examination revealed a hematoma around the right cornual region. A wedge-shaped incision was made in the cornual pregnancy using monopolar cauterization, and the myometrium was sutured with a single nodule suture. We report a case of spontaneous cornual pregnancy after ipsilateral salpingectomy for an isthmic pregnancy.

ObjectiveTo understand women's preferences for permanent contraception by salpingectomy or tubal occlusion following standardized counseling and evaluate the practicality of a future randomized trial.Study designWe invited pregnant and non-pregnant women planning permanent contraception at the University of California, Davis (UCD) and University of Tennessee (UT) Obstetrics and Gynecology clinics to participate. We enrolled women when they received routine counseling and signed procedure consent. Participants received standardized information sheets reviewing permanent contraception options based on pregnancy status then completed an anonymous survey with questions about demographics, method preference, and willingness to participate in a hypothetical randomized trial comparing salpingectomy and tubal occlusion. We evaluated predictors for salpingectomy preference using multivariable analysis.ResultsFrom July 2015 to October 2016, we enrolled 75 women at UCD and 63 women at UT. Overall, respondents preferred salpingectomy (63.0%); among the 47 women not currently pregnant at both sites, 40 (85.1%) preferred salpingectomy, most commonly because of higher efficacy. Although population characteristics differed significantly between the sites, only UCD site (aOR 4.2; 95% CI 1.9, 9.4) and non-pregnancy status (aOR 4.2; 95% CI 1.6, 10.8) predicted preference for salpingectomy in the multivariable model. Most participants (n=84, 60.9%) would not be willing to be randomized to a theoretical trial comparing salpingectomy and tubal occlusion procedures.ConclusionAmong a diverse group of women from two different areas in the U.S. given a choice of permanent contraception methods, salpingectomy is preferred over tubal occlusion. Most women planning a permanent contraceptive procedure would not agree to a randomized comparison of these methods.Implications statementSalpingectomy, which offers theoretically higher efficacy and potentially greater ovarian cancer protection compared to tubal occlusion, is preferred by the majority of patients and should be offered to all women seeking permanent contraception. Differences in method choices less likely reflect the patient population and more likely the counseling provided.

Lei Zhang, Jun Zhao, Yun Bai, Xiuping Liu Department of Obstetrics and Gynecology, the Third Hospital of Hebei Medical University, Shijiazhuang City, 050051, People’s Republic of ChinaCorrespondence: Lei Zhang, Department of Obstetrics and Gynecology, the third hospital of Hebei Medical University, No. 139 of Ziqiang Road, Qiaoxi District, Shijiazhuang City, Hebei Province, 050051, People’s Republic of China, Tel +86-0311-88602058, Email leizhang1442@163.comObjective: This study aimed to compare fertility outcomes in patients who underwent different laparoscopic surgeries and to determine the most beneficial surgical treatment for tubal ectopic pregnancy (EP) patients who wished to become pregnant in the future.Methods: In this retrospective study, patients aged 18– 36 years, who had been diagnosed with a tubal EP in our hospital, were enrolled. Based on the treatment methods, the patients were divided into three groups, ie a salpingectomy group, a salpingotomy with suturing group and a salpingotomy without suturing group. The follow-up time for the enrolled patients was more than three years. Serum beta (β)-human chorionic gonadotropin (β-HCG) levels were monitored after surgery. The intrauterine pregnancy (IUP) rate at 12, 24 and 36 months postoperatively, and recurrent EP rate were compared.Results: The median time for β-HCG level returning to normal in the salpingectomy group was much shorter than in the salpingotomy with suturing or salpingotomy without suturing groups (P < 0.001). The 12, 24 and 36-month IUP rates among the three groups were not significantly different. A recurrent EP was found in only one patient in the salpingotomy with suturing group and two patients in the salpingotomy without suturing group.Conclusion: In this study, we found that salpingectomy and salpingotomy with or without suturing methods reflected no significant differences in fertility outcomes for tubal EP patients.Keywords: ectopic pregnancy, salpingectomy, salpingotomy, intrauterine pregnancy, fertility

Objectives: To know the demographic profile, different clinical presentations and different modes of management of ectopic pregnancy at our tertiary care centre. Material and methods: It was a prospective observational study for 2 years. All types of ectopic pregnancies and who were willing to participate in the study were included. According to history, findings and investigations as per protocol the expectant, medical or surgical management was done. Results: The magnitude of ectopic pregnancy was 3.95 per 1000 pregnancies. The classical triad of ectopic pregnancy was present in 45.38 % of patients. (89.24%) were managed by surgical methods, by exploratory laparotomy (112) and laparoscopy (6). In surgical management, 64.40% of cases were managed with unilateral salpingectomy, 19.49% cases with bilateral salpingectomy, and 4.23% cases with salpingo-oophorectomy. In 83.90 % of cases, the most common site of ectopic was in the ampullary region. Conclusion: Surgical management was the mainstay of treatment. The most common site was an ampullary tubal ectopic pregnancy. Concern was no etiological risk factor could be found in almost one-third of cases.

This article, titled "Editorial Comment on Anatomical outcomes and complications of sacrocolpopexy using surelift uplift mesh: A multicentric observational study," discusses the use of abdominal sacrocolpopexy (ASC) as a treatment for vault prolapse. The study examines the outcomes of 325 laparoscopic sacrocolpopexy (LSC) procedures using a lightweight macroporous mesh. The results show excellent anatomical and subjective success rates, low recurrence rates, and a low need for re-treatment. The study confirms that ASC is an effective choice for severe prolapses, but it should be performed by experienced surgeons in high-volume centers to avoid complications. The article also discusses the use of concomitant procedures and the impact of hysterectomy on outcomes. [Extracted from the article]

Objective: Quality surveillance of gynecologic cancer surgery is crucial to ensure safety and enhance outcomes in patients with advanced ovarian cancer. We investigated the effect of our quality control (QC) program on the surgical strategy, completeness, and clinical outcomes in advanced ovarian cancer. Methods: We retrospectively reviewed medical records of advanced ovarian cancer patients undergoing surgery at our institution from January 2005 to December 2019. Cases were divided into group 1(2005-2013) and group 2 (2014-2019), representing periods before and after QC program implementation based on the operation date. We performed a comprehensive analysis, comparing clinicopathologic variables, operative details, recurrence, and survival outcomes between the 2 groups. Results: The analysis involved 132 advanced ovarian cancer patients: 86 in group 1, 46 in group 2. Group 2 showed a decreased rate of primary debulking surgery (PDS) and an increased rate of interval debulking surgery (IDS) compared to group 1(86.0% vs. 60.9% in PDS; 12.8% vs. 34.8% in IDS; p=0.003). However, the optimal resection rate was increased after the application of the QC program in PDS (51.4% vs. 75.0%, p=0.031) and maintained highly in both groups during IDS (81.8% vs. 81.3%, p>0.999). The cooperation rate with other surgical divisions in group 2 significantly increased during IDS (27.3% vs 68.8%, p=0.034). After the QC program implementation, the median recurrence-free survival was increased from 19.90 to 25.51 months, although statistical significance was not reached (p=0.704). Conclusion: After the application of QC program, treatment strategies and outcomes were improved in advanced ovarian cancer. Systematic QC monitoring should be considered as routine surveillance for better surgical outcomes. [ABSTRACT FROM AUTHOR]

This narrative review aims to clarify the role of breast and gynecological risk-reduction surgery in BRCA mutation carriers. We examine the indications, contraindications, complications, technical aspects, timing, economic impact, ethical issues, and prognostic benefits of the most common prophylactic surgical options from the perspectives of a breast surgeon and a gynecologist. A comprehensive literature review was conducted using the PubMed/Medline, Scopus, and EMBASE databases. The databases were explored from their inceptions to August 2022. Three independent reviewers screened the items and selected those most relevant to this review's scope. BRCA1/2 mutation carriers are significantly more likely to develop breast, ovarian, and serous endometrial cancer. Because of the Angelina effect, there has been a significant increase in bilateral risk-reducing mastectomy (BRRM) since 2013. BRRM and risk-reducing salpingo-oophorectomy (RRSO) significantly reduce the risk of developing breast and ovarian cancer. RRSO has significant side effects, including an impact on fertility and early menopause (i.e., vasomotor symptoms, cardiovascular disease, osteoporosis, cognitive impairment, and sexual dysfunction). Hormonal therapy can help with these symptoms. Because of the lower risk of developing breast cancer in the residual mammary gland tissue after BRRM, estrogen-only treatments have an advantage over an estrogen/progesterone combined treatment. Risk-reducing hysterectomy allows for estrogen-only treatments and lowers the risk of endometrial cancer. Although prophylactic surgery reduces the cancer risk, it has disadvantages associated with early menopause. A multidisciplinary team must carefully inform the woman who chooses this path of the broad spectrum of implications, from cancer risk reduction to hormonal therapies. [ABSTRACT FROM AUTHOR]

We present a case of chemotherapy refractory spindle cell rhabdomyosarcoma of the lower urinary tract in a 15-month-old female that ultimately required consolidative surgery with cystectomy, urethrectomy, ovarian-sparing hysterectomy, bilateral salpingectomy, anterior vaginal wall resection, and bilateral pelvic lymph node dissection. Genitourinary reconstruction was performed by ileal conduit creation and vaginoplasty. After completion of her maintenance postoperative chemotherapy regimen, the patient has remained disease-free for approximately 27 months. [ABSTRACT FROM AUTHOR]

Hydrosalpinx is rare in childhood, and its pathogenesis may differ from that in reproductive‐aged women. Herein, we report a case of hydrosalpinx in a premenarcheal 14‐year‐old girl, which might be caused by thickening of the smooth muscle of the fallopian tube. The patient had recurrent right lower abdominal pain and was referred to our hospital with a suspected adnexal tumor. Laparoscopy revealed a hydrosalpinx with complete obstruction of the fimbria and scar‐like stenosis of the proximal ampulla. Right salpingectomy was performed because of a severe hydrosalpinx. As the patient was a virgin and a vaginal culture showed normal flora, ascending infection to the fallopian tube was not considered to be the cause of the hydrosalpinx. Histopathological examination revealed that the resected fallopian tube had a markedly dilated lumen with no inflammatory cell infiltration. Immunohistochemically, estrogen‐ and progesterone‐positive smooth muscle proliferation was found at the isthmus of the fallopian tube. [ABSTRACT FROM AUTHOR]

Investigate outcomes for advanced stage epithelial ovarian cancer (EOC) patients based on facility-level utilization of neoadjuvant chemotherapy (NACT). Stage III-IV EOC patients diagnosed between 2010 and 2016 were identified in the National Cancer Database. Percentage of patients managed with NACT was calculated for facilities, reporting ≥120 patients. Facilities with lowest and highest quartile of NACT rate comprised the low and high-utilizing groups. Clinico-pathological characteristics were collected, and appropriate statistical analysis performed. High- and low-utilizing facilities managed on average 54.1% and 25.4% of patients with NACT respectively. Patients managed at high-utilizing facilities were significantly more likely to be >65 (p = 0.029), have stage IV disease (p < 0.001) and comorbidities (p < 0.001). Patients managed with primary debulking surgery (PDS) at low-utilizing facilities were significantly more likely to be >65, have stage IV disease, and have comorbidities (all, p < 0.001). Patients undergoing PDS at low-utilizing facilities were significantly less likely to achieve complete gross resection (p < 0.001), and were significantly more likely to experience 90-day mortality (p < 0.001), and unplanned 30-day readmission (p < 0.001). After controlling for age, comorbidities, race, insurance status, stage, grade and histology, high-utilizing facilities trended towards better overall survival (OS) (HR: 0.92, 95% CI: 0.85–0.99). Overall, patients undergoing PDS had better OS compared to those who had NACT (median 42 vs 27 months, p < 0.001). Despite treating an EOC population with more advanced disease and comorbidities, high-utilizing facilities have lower surgical morbidity and mortality with no detrimental impact on long-term survival. Careful patient selection to minimize the morbidity and mortality associated with PDS is pivotal. • Adoption of neoadjuvant chemotherapy among high-volume facilities varies. • Patients managed at low-adopting facilities experience higher surgical morbidity. • Inappropriate selection of patients for primary cytoreductive surgery is associated with worse oncologic outcomes. [ABSTRACT FROM AUTHOR]

Anti-müllerian hormone levels decline similarly in patients who have hysterectomy with conservation of one or both ovaries when compared with patients undergoing natural menopause. OBJECTIVE: To evaluate the relationship between hysterectomy with and without ovarian conservation and the onset of ovarian failure using anti-müllerian hormone (AMH) levels and imputed final menstrual period (FMP). METHODS: A total of 1,428 women with an observed FMP and 232 women who underwent hysterectomy (159 with bilateral salpingo-oophorectomy [BSO], 13 with one ovary conserved, and 60 with both ovaries conserved) and who had serial AMH measurements were included from SWAN (The Study of Women's Health Across the Nation), a multi-ethnic, multi-site, community-based study. Anti-müllerian hormone levels were sampled annually with at least one presurgery or pre-FMP measurement at least one postsurgery or post-FMP measurement. Surgery-related differences in patterns of AMH levels with respect to surgery date or FMP were estimated using piecewise linear mixed modeling; differences in age at first undetectable AMH level were estimated using survival analyses. RESULTS: Patients with conservation of one or both ovaries or natural menopause demonstrated similar patterns of decline in AMH levels when anchored to surgery or FMP. Patients with hysterectomy (all types) had a later counterfactual FMP (52.9±0.2 SEM) compared with the observed FMP in those with natural menopause (52.1±0.1 years, P =.002). Those undergoing BSO had an immediate reduction in AMH level to undetectable after surgery. CONCLUSION: Hysterectomy does not lead to a more rapid decline in AMH levels postoperatively compared with natural menopause. Patients undergoing BSO have a rapid loss of AMH, consistent with complete removal of the ovaries. These data suggest that hysterectomy as currently performed does not compromise ovarian reserve. [ABSTRACT FROM AUTHOR]

Germline pathogenic variants mutations) in the BRCA1 and BRCA2 genes cause an increased risk of breast cancer and ovarian cancer. Mainstream cancer genetic testing (MCG) was introduced for breast cancer patients in our unit in 2013. Non-geneticist clinicians have been trained to offer genetic testing during initial treatment planning. We assessed the impact of timely test results on surgical decision-making. Women who had undergone mainstream genetic testing for breast cancer between September 2013 and September 2018 were identified from a prospective database. Surgical data were collected retrospectively. 580 eligible women had mainstream genetic testing. For 474 this was their first breast cancer diagnosis. The median age was 46 years (interquartile range (IQR) 38–57). The indications were: age ≤45 years for 233 (49%); triple negative disease for 192 women (40.5%); bilateral breast cancer age <60 for 39 (8%) and other for 72 (14%) women. The median time for test initiation to result was 18 days (IQR 15-21). 302 (64% received results before surgery. 88% of those found to have a BRCA mutation before surgery opted for bilateral mastectomy (compared to 5% with BRCA wild type). An additional 106 patients had a new diagnosis on a background of previous treatment. Of these all with a pathogenic variant chose bilateral mastectomy. Timely BRCA gene testing influences surgeons' and patients' choice of surgery. It reassures women with a negative result and allows those with a positive result to take an active decision about the management of their future risk. • Early access to rapid genetic testing for high risk women allows results to contribute to surgical decision-making. • Median time to receiving results was 29 calendar days9% had a pathogenic mutation. • Women with mutations were more likely to have bilateral mastectomy as their primary surgery if results were available before surgery. Those for whom results were available after surgery often chose additional risk-reducing surgery. • Only 4% of women without a mutation had bilateral mastectomy. [ABSTRACT FROM AUTHOR]

Simple Summary: In this observational study, we aimed to describe the cardiorespiratory variations during laparoscopic abdominal surgery in baboons (Papio hamadryas) anesthetized via a laryngeal mask. Animals were immobilized with a combination of tiletamine/zolazepam and medetomidine. A laryngeal mask was inserted to allow for the delivery of oxygen and isoflurane. Cardiovascular variables showed no alterations, while the respiratory parameters indicated a rise in respiratory rate and end-tidal carbon dioxide concentration during the pneumoperitoneum. Hypercapnia was mild, even with the animal in spontaneous breathing, and it was solved rapidly after the discontinuation of the pneumoperitoneum. The results of this study suggest that laparoscopy can be performed safely in spontaneously breathing baboons. Furthermore, adequate ventilation and gas exchange can be achieved using a laryngeal mask without the need for endotracheal intubation. The study aims to describe the anesthetic and airway management of baboons (Papio hamadryas) undergoing laparoscopic salpingectomy with a laryngeal mask airway (LMA) device. Eleven baboons received tiletamine-zolazepam and medetomidine; anesthesia was induced with propofol. An LMA was positioned for oxygen and isoflurane administration in spontaneous respiration. Heart rate (HR), mean arterial pressure (MAP), respiratory rate (RR), end tidal carbon dioxide (EtCO2), minute volume (MV), and peripheral hemoglobin oxygen saturation (SpO2) were recorded before (PREPP) and immediately after abdomen insufflation (PP1), at 10 (PP2), 20 (PP3), and 30 (PP4) minutes during pneumoperitoneum, and after (POSTPP) pneumoperitoneum. The respiratory rate was significantly higher at all times compared to PREPP. The end tidal carbon dioxide concentration was significantly higher at PP2, PP3, PP4, and POSTPP, compared to the previous times. The higher values for RR and EtCO2 were registered at PP4: 22.7 (95% CI 17.6–27.8) breaths/min and 57.9 (95% CI 51.9–63.8) mmHg, respectively. The minute volume was significantly higher at PP4 and POSTPP compared to the other times. The higher value for MV was registered at POSTPP (269.1 (95% CI 206.1–331.8) mL/kg/min). This protocol is suitable for baboons undergoing laparoscopic salpingectomy. The LMA was easy to insert and allowed for good ventilation, gas exchange, and delivery of the anesthetic in spontaneous breathing baboons. [ABSTRACT FROM AUTHOR]

Introduction: Ectopic pregnancy is the most common cause of maternal mortality in the first trimester.1 Bilateral tubal pregnancy is the rarest subset with an estimated incidence of one in 725 to 1,580 ectopic pregnancies.2 Of the cases of bilateral tubal pregnancy reported in the literature, most were associated with the use of assisted reproductive techniques.3 Here we present the case of a patient, without a prior history of reproductive technology use, who underwent treatment for a tubal pregnancy and was subsequently found to have a second, contralateral tubal pregnancy 11 days later. Case Report: A 35-year-old female gravida eight para two with a history of left tubal pregnancy and salpingectomy 11 days prior, presented to the emergency department (ED) with two days of left lower and upper quadrant abdominal pain. The patient's last menstrual period had been several months prior. A physical examination revealed left lower quadrant abdominal tenderness, rebound, guarding, and left adnexal tenderness. Her vital signs were unremarkable, and her laboratory studies revealed normal white blood cell and hemoglobin values. Her human chorionic gonadotropin had tripled from her last presentation 11 days prior. Transvaginal ultrasound showed a possible ectopic pregnancy adjacent to the right ovary. She promptly underwent a right salpingectomy. Pathology findings confirmed a tubal pregnancy, and the patient's postoperative course was uneventful. Conclusion: This case highlights the importance of maintaining a high index of suspicion for ectopic pregnancy in all biologically female patients of reproductive age who present to the ED with abdominal pain. [ABSTRACT FROM AUTHOR]

Hereditary women's syndromes due to inherited mutations result in an elevated risk of developing gynecological cancers over the lifetime of affected carriers. The BRCA 1 and 2 mutations, Lynch syndrome (LS), and mutations in rare hereditary syndromes increase this risk and require more effective management of these patients based on surveillance and prophylactic surgery. Patients need counseling regarding risk-reducing surgery (RRS) and the time required to perform it, considering the adverse effects of premenopausal surgery and the hormonal effect on quality of life, bone density, sexual activity, and cardiological and vascular diseases. Risk-reducing salpingo-oophorectomy (RRSO) is the gold standard for BRCA-mutated patients. An open question is that of endometrial cancer (EC) risk in patients with BRCA1/2 mutation to justify prophylactic hysterectomy during RRSO surgical procedures. RRS provides a 90–95% risk reduction for ovarian and breast cancer in women who are mutation carriers, but the role of prophylactic hysterectomy is underinvestigated in this setting of patients. In this review, we evaluate the management of the most common hereditary syndromes and the benefits of risk-reducing surgery, particularly exploring the role of prophylactic hysterectomy. [ABSTRACT FROM AUTHOR]

Background and Objective: The simultaneous occurrence of ectopic pregnancy in both fallopian tubes and a live intrauterine fetus is very rare. The increase in the use of reproductive technology methods has caused an increase in the prevalence of this type of pregnancy. The aim of this study is to report a case of simultaneous occurrence of ectopic pregnancy in both fallopian tubes and live intrauterine fetus following the use of ovulation induction medications. Case Report: The patient was a 29-year-old pregnant woman in her 7th week of pregnancy with a one-year history of infertility and the use of ovulation induction medications, with a transvaginal ultrasound report a week ago, live intrauterine pregnancy (6th week) and normal fallopian tubes, and complaints of vaginal bleeding. In repeated ultrasound, a live fetus was seen in the uterus (7 weeks and three days) and a live fetus in the left adnexa (7 weeks and three days), and the right adnexa was normal. The patient underwent laparoscopy. An incidental finding during surgery was the presence of ectopic pregnancy in both tubes. Left salpingectomy and right salpingostomy were performed and progesterone suppositories were prescribed to maintain intrauterine pregnancy. One week after the surgery, the fetus was observed without a heartbeat in the control ultrasound. Conclusion: Based on the results of this report, the correct use of assisted reproductive methods, control of infertile patients under the supervision of infertility centers, and accurate ultrasounds due to the possibility of heterotopic pregnancy in high-risk patients are necessary. [ABSTRACT FROM AUTHOR]

The presence of macroscopic residual disease after primary cytoreductive surgery (PCS) is an important factor influencing survival for patients with high-grade serous ovarian cancer (HGSC). More research is needed to identify factors associated with having macroscopic residual disease. We analyzed 12 lifestyle and personal exposures known to be related to ovarian cancer risk or inflammation to identify those associated with having residual disease after surgery. This analysis used data on 2054 patients with advanced stage HGSC from the Ovarian Cancer Association Consortium. The exposures were body mass index, breastfeeding, oral contraceptive use, depot-medroxyprogesterone acetate use, endometriosis, first-degree family history of ovarian cancer, incomplete pregnancy, menopausal hormone therapy use, menopausal status, parity, smoking, and tubal ligation. Logistic regression models were fit to assess the association between these exposures and having residual disease following PCS. Menopausal estrogen-only therapy (ET) use was associated with 33% lower odds of having macroscopic residual disease compared to never use (OR = 0.67, 95%CI 0.46–0.97, p = 0.033). Compared to nulliparous women, parous women who did not breastfeed had 36% lower odds of having residual disease (OR = 0.64, 95%CI 0.43–0.94, p = 0.022), while there was no association among parous women who breastfed (OR = 0.90, 95%CI 0.65–1.25, p = 0.53). The association between ET and having no macroscopic residual disease is plausible given a strong underlying biologic hypothesis between this exposure and diagnosis with HGSC. If this or the parity finding is replicated, these factors could be included in risk stratification models to determine whether HGSC patients should receive PCS or neoadjuvant chemotherapy. • Menopausal estrogen-only therapy use was associated with 33% lower odds of having macroscopic residual disease following PCS. • Being a current smoker may be associated with higher odds of having macroscopic residual disease following PCS. • These factors could be included in models to determine if patients should receive PCS or neoadjuvant chemotherapy. [ABSTRACT FROM AUTHOR]

Recent findings suggest that high-grade serous ovarian cancer can originate in the fallopian tube. Not only has that made the identification of precursor lesions pivotal in early detection and prevention of these cancers, prophylactic salpingectomy alongside hysterectomy for benign indications has been increasingly proposed as well. The present prospective single-center study included 273 women who underwent opportunistic salpingectomy alongside laparoscopic supracervical hysterectomy. Uterine and tubal histopathological results as well as intra- and postoperative complications were evaluated. The complication rate was 3.3%, of which none were caused by salpingectomy. Uterine histopathology diagnosed 181 patients (66.8%) with uterine myomas, 60 patients (22.1%) with adenomyosis, 29 patients (10.7%) with adenomyomatosis, and, 1 patient (0.4%) without pathological abnormality. p53 signatures were detected in 221 right fallopian tubes (80.9%) and in 229 left tubes (83.9%). In total, 8 patients showed bilateral STIL (2.9%), whereas in 1 patient (0.4%) STIL was detected in the left tube only. No STIC were detected. Laparoscopic opportunistic salpingectomy is demonstrated to be both safe and feasible. It appears to be promising to reduce the risk for ovarian cancer, yet more studies are needed to undoubtedly confirm this. [ABSTRACT FROM AUTHOR]

Background: Ectopic pregnancy (EP) is a major reason of maternal mortality and morbidity, affecting 1% to 2% of pregnancies. Whether medically with methotrexate (MTX) or surgically with salpingectomy, managing EP could seriously affect female sexuality and reproductive health. The impact of medication and surgical treatment for EP on future fertility is currently unknown and has not been well explored. Objective: This study examines the future reproductive effects of medication and surgical management for EP. Patients and methods: In this prospective study, 50 EP subjects were involved and randomly subdivided into two groups: (MTX) (Group A, n: 25) and salpingectomy (Group B, n: 25). Anti-Mullerian hormone (AMH), beta-human chorionic gonadotropin (ß-HCG), liver enzyme levels, and platelet count were evaluated before and after the treatment protocol. Hysterosalpingography (HSG) has also been conducted three months after therapy for Group A to examine tubal patency. Results: Three months following therapy, the AMH levels significantly decreased in Group A compared with Group B (p=0.04). Also, in Group A, AMH levels after 3 months showed a statistically significant decline contrasted with those at the time of therapy. Conclusion: AMH levels prior to and after medication with a single dose of systemic MTX and unilateral salpingectomy for EP were positive signs. Present medical and surgical therapy methods have no detectable detrimental impact on ovarian reserve. [ABSTRACT FROM AUTHOR]

To analyze quality of life(QoL) and symptom resolution after surgical removal of Essure devices. Single-center cohort study which included patients with Essure removal between February 2017 and March 2018. Surgery was performed in 65 patients by laparoscopy (Salpingectomy only or Hysterectomy). Questionnaires were used to assess QoL(SF-36), emotional disorders(HAD) and symptoms preoperatively, at 3 months and 4 years postoperatively. 4(6,1%) and 16(24,6%) patients were lost of follow-up at three months and 4 years postoperatively respectively. Four(6,1%) intraoperative surgical complications occurred. During the three-months postoperative period, 3(4,6%) complications occurred: five Clavien Dindo Grade 1 complications (umbilical hematoma) and one Grade 2 complication (hyperthermia and digestive disorder requiring antibiotic therapy). Preoperative QoL scores were lower than those of general population. Scores were significantly improved at 3 months and 4 years postoperatively. At 4 years postoperatively, 17/49(34,7%) had a complete regression of symptoms, 21/49(42,8%) partial resolution and 11/49(22,4%) no improvement. 27/49(55,1%) patients made the connection between symptoms and ESSURE device after media coverage. 22/49(44,89 %) were influenced by media coverage in their decision of surgery. There was a higher percentage of patients with anxiety disorder before Essure removal than 4 years after [22/44 (50 %) versus 11/44 (25 %); p = 0.0045]. Essure removal has a restorative role in terms of QoL in short and long-term. Patients should be informed about possibility of no improvement after surgery and surgical morbidity. Larger prospective cohort is needed to make a well-considered decision about risks of surgery compared with expected benefits. [ABSTRACT FROM AUTHOR]

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Copyright of Universidad Médica Pinareña is the property of Editorial Ciencias Medicas and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Aim: To investigate the effect of of adding oophorectomy on patients who underwent abdominal hysterectomy in the perimenopausal period on menopause, sexual function and mental status. Materials and Methods: The study was designed prospectively. Women who underwent total abdominal hysterectomy and bilateral salpingectomy (TAH+BS) and total abdominal hysterectomy and bilateral salpingo-ophorectomy (TAH+BSO) in the perimenopausal period for benign indications were included in the study. Three months after surgery, menopausal symptoms (such as vasomotor symptoms, vaginal dryness and/or dyspareunia, memory and sleep problems) were investigated. Beck Anxiety Inventory (BAI) scores were investigated one day before the operation and three months after the operation. Results: 51 patients with TAH+BS and 55 patients with TAH+BSO included in study. Vasomotor symptoms and postoperative BAI scores were significantly higher in the oophorectomy group (p<0.001 and p=0.009, respectively). Vaginal dryness and/or dyspareunia, which adversely affect sexual function, were significantly higher in the oophorectomy group (p=0.005). Memory and sleep problems were higher in the oophorectomy group (p=0.009 and p<0.001, respectively). Postoperative BAI scores were found to be correlated with postmenopausal symptoms (vasomotor symptoms, vaginal dryness and/or dyspareunia, memory problems, sleeping disorders) in the TAH+BSO group. Conclusion: Vasomotor symptoms, vaginal dryness and/or dyspareunia, memory and sleeping problems, and anxiety levels were significantly higher in patients who underwent bilateral salpingo-ophorectomy with hysterectomy compared to patients who underwent only hysterectomy and bilateral salpingectomy. It seems useful to inform the patients who are planned for the operation regarding these effects before the decision of oophorectomy. [ABSTRACT FROM AUTHOR]

Purpose: To investigate the association between different treatments of tubal ectopic pregnancy (EP) —expectant management, methotrexate (MTX), selected or recommended laparoscopic surgery—and the subsequent reproductive outcomes. Methods: We conducted a retrospective cohort study including 228 EPs. The patients were divided into four treatment groups: 28 (12.3%) with expectant management successfully, 60 (26.3%) with MTX successfully, 140 patients with laparoscopic salpingectomy, of which 47 (20.6%) were assigned to selected surgery group because they opted for surgical treatment versus MTX, 93 (40.8%) were assigned to recommended surgery group as recommended by the attending physician. Results: The recommended surgery group had the lowest rate of intrauterine pregnancy (IUP) (77.42%) and live birth (LB) (72.04%), while the incidence of recurrent EP (REP) (20.43%) was the highest, but the statistical differences were not significant. We did not observe significant differences of the EP-IUP time interval, rates of LB and miscarriage (MIS) between the four groups. Compared to the MTX group, recommended surgery was negatively associated with IUP (adjusted OR, 95%CI: 0.34, 0.11–1.03) and LB (0.35, 0.14–0.92), while it had higher risk for REP (3.48, 1.03–11.74) in the subsequent pregnancy. Further, compared to selective surgery group, recommended surgery was negatively associated with IUP (0.15, 0.03–0.68) and LB (0.23, 0.07–0.74), while it had higher risk for REP (6.83, 1.43–32.67) in the subsequent pregnancy. Expectant treatment was negatively associated with assisted reproductive technology (ART) (0.08, 0.02–0.40) compared with MTX. Of the185 patients who had LBs, all adverse outcomes were not statistically different between the four groups. Conclusion: Patients with recommended laparoscopic salpingectomy had worse reproductive outcomes than the other treatment groups. The disease status of EP may play an important role in the association rather than the surgery alone. [ABSTRACT FROM AUTHOR]

Background: Excision of multi-compartment deep infiltrating endometriosis with visceral involvement is challenging. We illustrate an interdisciplinary approach to complete minimally invasive excision in a single surgery. Case: We present a case of deep infiltrating endometriosis with visceral involvement in the anterior, middle, and posterior compartments. A collaborative surgical approach was taken with gynecologic, colorectal, and urologic surgeons to perform a robot-assisted total laparoscopic hysterectomy, bilateral salpingectomy, ovarian cystectomy, and unilateral oophorectomy with concurrent segmental resection of rectosigmoid and excision of transmural bladder and vaginal nodules. Conclusion: Thorough preoperative evaluation and an interdisciplinary approach to surgical planning involving radiology, gynecology, colorectal surgery, and urology allowed for complete simultaneous resection of bladder, rectosigmoid, and pelvic deep infiltrating endometriosis without complications via a minimally invasive route. [ABSTRACT FROM AUTHOR]

To study the extent of hormone replacement therapy (HRT) dispensing in premenopausal women after being treated with bilateral salpingo-oophorectomy (BSOE) for ovarian cancer (OC). Nationwide population- and register-based cohort study including women 18–50 years old, registered in The Swedish Quality Register for Gynecological Cancer (SQRGC), where BSOE was performed due to epithelial (EOC) and non-epithelial ovarian cancers (NEOC) or borderline ovarian tumor (BOT) between 2008 and 2014. Data on HRT dispensing was obtained from the National Prescribed Drug Register analyzed at semi-annual intervals from surgery until end of follow-up December 2015, including a logistic regression analysis. A cohort of 664 women were identified with OC, whereas 396 women had an EOC, 61 a NEOC and 207 a BOT. At surgery 49% of the women were ≤44 years. HRT dispensed to the total cohort varied between 32% and 41% the first five years after surgery. During follow-up at first 0.5–1 year 51% of the women <40 years were dispensed HRT compared to 25% of women ≥40 years. Of women with EOC, 21% dispensed HRT at first 0.5–1 year. In the multivariable regression analysis; age <40 (OR6.17, p < 0.001) and age 40–44 (OR2.95, p < 0.001) as well as BOT histology (OR3.84, p < 0.001) were found significant variables for dispensing of HRT. A majority of premenopausal women undergoing BSOE for OC did not use HRT postoperatively. Our study shows that there is a need to address HRT use after OC treatment in young women to prevent from morbidity and a poorer quality of life. • HRT prescription pick-up is low in women with premature menopause and ovarian cancer. • <50% of premenopausal women with ovarian cancer were dispensed HRT after surgical menopause. • Young age and borderline ovarian tumors were factors that led to a significant dispensing of HRT. [ABSTRACT FROM AUTHOR]

To describe breast and ovarian cancer risk reduction strategies in the clinical management of women who test positive for non- BRCA hereditary breast and ovarian cancer (HBOC) pathogenic variants compared to those who test positive for pathogenic BRCA variants or have negative germline panel testing. Examination of imaging and preventive surgeries in women undergoing HBOC genetic testing from 1/1/2015 to 12/31/2018, with follow up to 03/31/2020 in Kaiser Permanente Northern California. A total of 13,271 tests which included HBOC genes were identified. Rate of bilateral salpingo-oophorectomy after genetic testing were similar for BRCA and the non- BRCA moderate risk ovarian pathogenic variants (PVs) (47.4% vs 54%, p = 0.25). Rates were lower for low risk or unknownrisk non- BRCA PVs (12.8%, p < 0.001, 5.3% (p < 0.001). Rates of surveillance for ovarian cancer with ultrasound and CA 125 in the first year was 63.3% and 64.7% for BRCA PV, 37.5% and 27.1%, for non- BRCA moderate risk PVs and 13.7% and 4.6%, for low-risk PVs. Bilateral mastectomy rates were 19.7% for BRCA PV, 10.1% (p = 0.028) for non- BRCA breast high risk PVs, for moderate risk PVs 7.7% (p < 0.001) and for unknown risk 0.4% (p < 0.001). MRI surveillance rates in the first year similarly were 47.4% for non- BRCA BRCA PV, 43% for breast high risk PV, 39.4% for moderate risk and 4.9% for unknown risk PV. Surgical and surveillance strategies are underutilized for HBOC PV, however there is concordance of uptake of preventive strategies with specific risk associated with non- BRCA PVs. • Preventive surgical and surveillance strategies are underutilized for all HBOC PV including BRCA and non-BRCA PV. • There is stratification of preventive and surveillance management uptake commensurate with specific risks of each HBOC PVs. • The gap in uptake of prevention strategies is especially low in those with Lynch PVs. [ABSTRACT FROM AUTHOR]

Objective: Venous thromboembolism (VTE) is a life-threatening complication that may exacerbate cancer prognosis. Whilst some studies indicate an increased risk of VTE in cancer patients undergoing chemotherapy, the prevalence estimates on the pooled prevalence of VTE in cancer patients undergoing chemotherapy are not known. This study aims to calculate the pooled prevalence of VTE in chemotherapy-treated cancer patients. Methods: Studies on VTE occurrence in cancer patients undergoing chemotherapy were retrieved after database search. The terms used included "cancer", "chemotherapy", and "venous thromboembolism". A random-effects meta-analysis was conducted to obtain a pooled estimate of VTE prevalence in cancer patients undergoing chemotherapy. Results: A total of 102 eligible studies involving 30,671 patients (1773 with VTE, 28,898 without) were included in the meta-analysis. The pooled estimate of VTE prevalence was found to be 6%, ranging from 6% to 7% (ES 6%; 95% CI 6–7%; z = 18.53; p < 0.001). Conclusions: The estimated pooled prevalence rate of VTEs was 6% in cancer patients undergoing CRT, which was higher than the overall crude prevalence rate (5.78%). Comprehensive cancer care should consider stratified VTE risk assessment based on cancer phenotype, given that certain phenotypes of cancer such as bladder, gastric and ovarian posing particularly high risks of VTE. [ABSTRACT FROM AUTHOR]

Background: Opportunistic salpingectomy (OS) is an attractive method for primary prevention of ovarian cancer. Although OS has not been associated with a higher complication rate, it may be associated with earlier onset of menopause.Objective: To provide a systematic review and meta-analysis of the effect of OS on both age at menopause and ovarian reserve.Methods: A search was conducted in the Cochrane Library, Embase and MEDLINE databases from inception until March 2022. We included randomized clinical trials and cohort studies investigating the effect of OS on onset of menopause and/or ovarian reserve through change in anti-Müllerian hormone (AMH), antral follicle count (AFC), estradiol (E2), follicle stimulating hormone (FSH) and luteinizing hormone (LH). Data was extracted independently by two researchers. Random-effects meta-analyses were conducted to estimate the pooled effect of OS on ovarian reserve.Results: The initial search yielded 1047 studies. No studies were found investigating the effect of OS on age of menopause. Fifteen studies were included in the meta-analysis on ovarian reserve. Meta-analyses did not result in statistically significant differences in mean change in AMH (MD -0.07 ng/ml, 95%CI -0.18;0.05), AFC (MD 0.20 n, 95 % CI -4.91;5.30), E2 (MD 3.97 pg/ml, 95%CI -0.92;8.86), FSH (MD 0.33mIU/ml, 95%CI -0.15;0.81) and LH (MD 0.03mIU/ml; 95%CI -0.47;0.53).Conclusion: Our study shows that OS does not result in a significant reduction of ovarian reserve in the short term. Further research is essential to confirm the absence of major effects of OS on menopausal onset since clear evidence on this subject is lacking. Registration number PROSPERO CRD42021260966. [ABSTRACT FROM AUTHOR]