Search

There is nothing more or less common more or less wide adhesions connecting the uterus with the walls of the pelvic floor or with adjacent organs. The author investigated the female genital organs of more than 300 subjects who, however, in most cases, belonged to a more mature age, and he came to the conclusion that a healthy uterus, in the sense of the absence of a large or smaller number of adhesions, which are the consequences of former inflammations, is a rarity. almost an exception.

Introduction The clinical presentation of endometriosis is extremely varied. Because endometriosis symptoms may overlap with symptoms caused by gastroenterological disorders, this can lead to misdiagnosis and a considerable delay in arriving at the correct diagnosis. The aim was to evaluate the type and duration of endometriosis-related symptoms and to identify predictors for patterns of involvement depending on symptoms. Material and Method The data of 266 consecutive patients who were operated on in the Endometriosis Center between 1/2016 and 12/2017 after receiving a histologically verified diagnosis of endometriosis were recorded. In addition to recording the clinical parameters, a questionnaire was distributed to the patients, who were asked about their medical history. Infertile patients were grouped together as Group 1 and compared to non-infertile patients (Group 2). Results The response rate for returned questionnaires was 79.47% (182/229). 41.8% of patients reported that they were infertile and 91.8% reported pelvic pain. In more than ⅓ of cases in both groups, more than 10 years passed between the initial symptoms and the final diagnosis (39.4 vs. 37.5%). On average, patients consulted 2.72 (± 1.58) resp. 3.08 (± 1.72) doctors before they presented to a hospital or were referred for laparoscopic diagnostic workup (p = 0.162). Cycle-related diarrhea (odds ratio 2.707; 95% CI: 1.063 – 6.895, p = 0.037) and dysmenorrhea (odds ratio 2.278; 95% CI: 1.193 – 4.348, p = 0.013) were associated with involvement of the pelvic peritoneum, cycle-related dyschezia was associated with rectal involvement by a factor of 4.6 in binary regression analysis (odds ratio 4.659; 95% CI: 1.132 – 19.186; p = 0.033). Conclusion Cycle-related diarrhea and dysmenorrhea increase the risk probability of peritoneal endometriosis. Dyschezia increases the risk probability of rectal endometriosis.

Background: Laparoscopic rectal resection may cause various surgical complications including perineal hernia and adhesive small-bowel obstruction. Pelvic peritoneum reconstruction (PPR) could prevent those complications. The aim of the study is to evaluate the short-term clinical, technical and safety outcomes of PPR using the barbed suture in laparoscopic rectal resection. Methods: This is a retrospective cohort study conducted in Chengdu second’s people hospital. Between January 2014 and December 2019, a total of 402 patients who underwent curative surgery for rectal cancer in Chengdu Second People’s Hospital were enrolled in the study. Among them, 216 patients who underwent laparoscopic rectal resection with PPR were allocated into the experimental group, and 186 patients who underwent laparoscopic rectal resection without PPR were allocated into control group. All the patients received standard preoperative and postoperative treatments. Observational indicators (1) surgical and postoperative conditions; (2) postoperative pathological examination. (3) postoperative complications. The data were represented by X ± s. t-test and X2 test were used for counting data. Results (1) Surgery condition: all patients in the two groups underwent successful surgery without conversion to open surgery. There were no differences between the two groups in terms of surgical approach, resection margin, tumor size, postoperative T-stage, postoperative N-stage, positive lymph nodes, harvest lymph nodes, perineal wound infection, perineal hernia, postoperative pneumonia, postoperative hemorrhage, presacral fluid, or abscess. The operative time, blood loss, the incidence of anastomotic leakage, and small-bowel obstruction showed a significant difference between the two groups. Conclusion We hypothesized that pelvic peritoneum reconstruction with barbed suture could improve the efficiency of intracorporeal closure of the pelvic cavity after in laparoscopic rectal resection, which can significantly reduce postoperative perineal-related complications. Further, we expect that use of the barbed sutures will reduce intra-operative stress on the endoscopic surgeon.

Endometriosis is a common, estrogen-dependent benign tumor that affect 3–10% women of reproductive age, and is characterized by the ectopic growth of endometrial tissue, which is found primarily in the rectovaginal septum, ovaries, and pelvic peritoneum. To date, accumulating evidence suggests that various epigenetic aberrations, including the expression of aberrant microRNAs (miRNAs), play definite roles in the pathogenesis of endometriosis. This review summarizes the recent findings on the aberrantly repressed miRNAs, as well as their potential roles regarding the pathogenesis of endometriosis.

Background: Adenosarcoma arises most commonly in the uterus. Rarely, it may arise from extrauterine sites, such as the pelvic peritoneum and rectovaginal septum. Two cases of extrauterine ...

Endometriosis is a benign gynaecological disease characterized by the presence of endometrial tissue outside the uterine cavity, primarily on the pelvic peritoneum and ovaries. The most common clinical features of endometriosis are dysmenorrhea, chronic pelvic pain, pain during intercourse, and infertility. However, the clinical symptoms do not always correlate with the extent of the disease, and for this reason, the diagnosis of the disease is often delayed between 7 and 10 years.

Objective To demonstrate identification and dissection of the pelvic autonomic nerves in gynecologic surgery. Design Identification on the right and left pelvic pelvises, dissection and preservation of the inferior hypogastric plexus in deep endometriosis, and dissection and preservation of the pelvic autonomic nerves in radical hysterectomy. Setting Academic center. Interventions Robotic excision of the pelvic peritoneum, excision of deep endometriosis in the uterosacral ligaments, and radical hysterectomy. Conclusion Pelvic autonomic nerves are easy to identify with the magnification provided with an endoscopic camera. They should be dissected and preserved whenever possible because of their important function.

Pelvic inflammatory diseases (PID) are on the second place in the structure of gynecological incidence. It has been proven, that PID develops in case of disturbed immune balance and often complicated by pelvic adhesions. Aim - to study in a comparative aspect the features of expression and distribution of proinflammatory cytokines (IL-1, IL-2, IL-6 and TNF-a) in the tissue of intact pelvic peritoneum and adhesions in women of reproductive age with PID, and evaluate the effectiveness of the proposed method of prevention of pelvic adhesions at women of reproductive age. Materials and methods. One hundred patients of reproductive age suffering from tubal and peritoneal form of infertility, who had a history of chronic PID and pelvic adhesions and thirty healthy women in the control group, were included at this study. Results. The presence of macrophages and proinflammatory cytokines IL-1, IL-2, IL-6 and TNF-a in adhesions of the abdominal cavity in patients with PID is the evidence of their internal inflammatory activity. According to the received data, the number of patients without pelvic adhesions was 4.3 times higher in the main group compared to the control group. Сonclusion. The proposed scheme of pelvic adhesions prevention, taking into account the pathogenic role of inflammatory disorders in the adhesiogenesis, allows to reduce the adhesion after the surgical treatment in 4.3 times and the density of the reformed adhesions in 8 times.

Transgender reassignment surgeries have become a major topic of interest within the last decade. Although there are numerous surgical techniques for male-to-female reassignment, a physician must assess each patient's anatomy and past medical history to determine the most suitable technique. Additionally, patient preference is important. The neovaginal constructive technique most commonly used in male-to-female reassignment surgery is penile skin inversion, but various other techniques and tissues can also be used including pelvic peritoneum, buccal mucosa, and bowel. Surgical text descriptions were enhanced by creating new anatomical illustrations. Donor and recipient site anatomies, and the surgical technique leading to creation of the neovagina, are demonstrated in detail with relevant illustrations. A review of the literature concerning the anatomy, procedure development, and outcomes is presented. The pelvic peritoneum was originally used in neovaginal construction for females with vaginal agenesis as a result of MRKH syndrome. The use of this technique to create a neovagina in male-to-female transgender reassignment surgery has become appealing owing to the relative ease of the procedure, low complication rates, and overall high patient satisfaction. This technique offers a potential new choice for transgender male-to-female neovaginal construction, but further studies are needed to confirm its successful use in transgender surgery. Clin. Anat. 31:175-180, 2018. © 2017 Wiley Periodicals, Inc.

Objective To describe the different steps of the Davydov surgical technique for creating a neovagina, emphasizing visualization of the rectovesical cleavage and peritoneal-vaginal anastomosis by laparoscopic and vaginal approaches. Design Production of a step-by-step surgical video tutorial with narrative video footage. Setting Uterovaginal agenesis is a rare congenital defect, observed in 1 case per 4000 to 5000 newborn female infants [1] . Vaginal agenesis treatment can be performed by different nonsurgical and surgical techniques that are based on neocavity creation. The Davydov intervention uses the pelvic peritoneum as “covering” tissue for a neocavity and avoids the use of allogenic or autologous transplants, traction devices, or specialized surgical equipment. It is a minimally invasive technique that provides long-term functionality and anatomically satisfying results [2] . Interventions We treated an 18-year-old patient with Mayer-Rokitansky-Kuster-Hauser syndrome who underwent the Davydov procedure after dissatisfaction with the Franck self-expansion method. We created a neovagina using peritoneal flaps that were obtained after rectovesical cleavage by laparoscopic approach and were then fastened to the introitus by vaginal approach. Finally, the vaginal vault was reconstructed laparoscopically, and an intravaginal dilator was left in place. The result after 1 year showed the transition from a narrow vaginal dimple 2 cm in length to a neovagina 10 cm in length, permeable, well epithelialized, and correctly healed without associated stenosis. Sexual intercourse is satisfying for both partners. Conclusion The Davydov technique is less invasive than other surgical techniques and allows good outcomes [ 3 , 4 ] without the invasive use of sigmoidal grafts, cutaneous flaps, or prostheses. It should be proposed to patients experiencing failure with the Franck nonsurgical method.

In contrast to Snger, the author declares that it is necessary to treat gonorrhea in women vigorously in the acute period of illness, not being limited to one absolute rest of the patient in bed. This treatment should be directed to the inner surface of the uterus, which plays an important role in the perception and spread of the breakthrough infection. From the mass of means suitable for such a treatment, the author chose aluminol, in view of its properties, without destroying tissues, deeply penetrate into their thickness.

Introduction/Background The present study was designed to evaluate the effect of the peritoneal stripping method termed ‘wide resection of the pelvic peritoneum (WRPP)’ on eliminating disseminated tumors in the pelvic peritoneum and whether there is any survival benefit for patients with epithelial ovarian cancer. Methodology From January 2000 to December 2018, 460 patients with epithelial ovarian cancer were treated surgically at Kumamoto University Hospital. The clinical and surgical records of these patients were reviewed retrospectively, and 225 patients with ovarian cancer who underwent standard definitive surgery were included in this study. Eligible patients with ovarian cancer were divided into 3 groups according to surgical approach. Patients in the standard surgery group underwent cytoreduction with standard surgical techniques (n=65). The WRPP group consisted of patients who underwent standard surgery plus WRPP (n=125). The RS group included patients who required standard surgery plus rectosigmoidectomy (RS) (n=35). The primary outcome measure was overall survival. The secondary endpoint was recurrence-free survival. Results Overall survival was significantly longer in the WRPP group than in the standard surgery group for patients with stage III–IV disease (P Conclusion WRPP is an effective procedure that should be a part of the skill set of any gynecological surgeon performing surgical cytoreduction in patients with advanced ovarian cancer. The addition of this surgical technique has the potential to improve patient outcomes. Disclosure Nothing to disclose.

A 60-year-old woman with a history of a ruptured ectopic pregnancy and subsequent salpingo-oophorectomy presented with clinical signs. Pre-operative imaging and intra-operative observations were highly suggestive of acute on chronic cholecystitis. A laparoscopic cholecystectomy was performed. In addition to confirming calculous cholecystitis, final pathology revealed endosalpingiosis on the serosal surface of the gallbladder. Endosalpingiosis is a rare, benign presence of glands lined by tubal-like epithelium, and the few case reports describe it on the surface of the female reproductive organs or seeded on the pelvic peritoneum. We hypothesize that, in this unique case, the endosalpingiosis is due to patient’s ruptured ectopic pregnancy, which allowed tubal epithelial cells to spread to the gallbladder. The only documented cases of endosalpingiosis outside the pelvic and lower abdominal organs have been congenital choristomas. To our knowledge, this is the first documented case of acquired endosalpingiosis of the gallbladder.

Background In laparoscopic extralevator abdominoperineal excision, reconstruction of the pelvic peritoneum helps to prevent the small intestine from adhering to pelvic wall tissues, thus avoiding small-bowel obstruction and perineal complications. However, there are difficulties in pelvic peritoneum closure if the patient has received preoperative radiotherapy and has a rigid pelvis. We report a novel laparoscopic method for pelvic peritoneum reconstruction using the bladder peritoneum flap in laparoscopic extralevator abdominoperineal excision after neoadjuvant radiotherapy. Technique After transection of the rectum, if the patient had a rigid pelvis, we chose to perform the novel technique for the pelvic peritoneum closure in a 3-step approach. The flap has an arch shape with the bottom at the anterior wall of the pelvic cavity entrance. The height of the arched flap is equal to the distance from the bladder to the sacral promontory. The peritoneum was incised with electrocautery at the planned level and peeled off the bladder. The bladder peritoneum flap was then rotated to cover the entrance of the pelvic cavity and sutured to the brim of the pelvis. Results Acceptable postoperative short-term and long-term outcomes (5- to 22-month follow-ups) were achieved in 3 patients who underwent bladder peritoneum flap closure. Conclusions The bladder peritoneum flap appears to be safe and feasible for intracorporeal closure of the pelvic cavity in laparoscopic extralevator abdominoperineal excision after neoadjuvant radiotherapy. The procedure provides a novel option for patients with severe fibrosis of the pelvis when another peritoneum reconstruction method is not feasible.

Highlights • Endometriosis can cause complete bowel obstruction. • Must be considered in the diagnosis of bowel obstruction. • It can present with un typical symptoms of endometriosis. • Surgical resection is the choice in case of complete obstruction. • In case of bowel endometriosis Uterus and ovaries should be inspected., Intoduction Endometriosis is a disease in which endometrial epithelium implanted outside the uterus. Although the endometrial tissue can implant anywhere, the most common places are the ovary and pelvic peritoneum. We present a rare case of recto-sigmoid endometriosis that causes a complete large bowel obstruction in a non-reproductive age woman who came with no specific symptoms of endometriosis and the diagnosis was made after surgical resection. Case presentation A 50 years old female who never been married and admitted to have no sexual experience in her life, presented with symptoms of acute bowel obstruction. She underwent sigmoid colectomy as the primary diagnosis was colonic tumor, but the histopathological reports showed the diagnosis with recto-sigmoidal Endometriosis. At the second laparotomy for closure of colostomy, the uterus was abnormal and she had a hysterectomy with salpingio-oopherectomy to prevent recurrence. The histopathological report revealed cervical, ovarian, and fallopian tube endometriosis. Discussion Unlike our patient, most patients complain of the common symptoms of endometriosis such as dysmenorrhea, dyspareunia, and dyschezia and many of them came with infertility as a main complaint which make them undergo further investigations like laparoscopy, and lead to pre-surgical diagnosis of endometriosis. But in case of complete bowel obstruction, urgent laparotomy is the treatment of choice. Conclusion Although Intestinal endometriosis is rare to cause bowel obstruction physicians and surgeons should always consider it as a differential diagnosis of bowel obstruction even without specific symptoms, to prevent surgery in incomplete obstruction.

Study Objective To compare results of 3 original techniques of laparoscopically assisted colpopoiesis from pelvic peritoneum. Design Level II-1, Canadian Taskforce. Setting Department of Operative Gynecology, National Medical Research Center for Obstetrics, Gynecology and Perinatology of the Ministry of Healthcare of Russia Patients or Participants We recruited 203 patients with utero-vaginal aplasia, gonadal dysgenesis, testicular feminization, congenital adrenogenital disorders, male-to-female transgenders. Interventions Adamyan's technique of laparoscopically assisted colpopoiesis from pelvic peritoneum has been used for more than 30 years. Since 2012, we have used three original methods of laparoscopic neovagina creation from pelvic peritoneum: laparoscopic-perineal technique, total laparoscopic technique and combined laparoscopic-perineal technique with ligatures used for bringing down the peritoneum. Measurements and Main Results Total of 71 patients underwent colpopoesis using a laparoscopic-perineal technique: in 94 cases - total laparoscopic technique of colpopoiesis and in 38 - laparoscopic-perineal technique with ligatures were used. 27 patients had history of unsuccessful attempts for surgical neovagina creation. There were no significant differences between three types of colpopoesis in blood loss, duration of surgery, length of postoperative hospital stay and in use of pain relievers postoperatively. From the standpoint of complications, 1 case of bladder injury, 1 case of rectal injury in patients with previous fibrosis were diagnosed and eliminated during surgery followed by asymptomatic recovery. Postoperative neovaginal stricture was seen in 5 cases and dyspareunia was seen in 11 cases, which improved with vaginal maintenance dilation within 1 month. Conclusion Laparoscopy Involving neovagina creation is an effective and safe operation even in patients with unsuccessful previous neovagina attempts and radiation induced fibrosis.which provides sufficient length of neovagina of 10-12 сm, functional aspects such as lubrication, epithelialization, extensibility and sensibility. However, such interventions especially in complex cases should be provided in the specialized medical centers.

Study Objective Parasitic myomas (PMs), mainly caused by intra-corporeal power morcellation during previous laparoscopic surgery, is gradually increasing in recent years. However, techniques for the surgical treatment of PMs remain largely unestablished because of the diversity of occurrence sites. We focused on safe and consistent strategies for dissecting PMs in various sites. Design Thirteen patients with PMs were treated with laparoscopy at our institution between 2008 and 2020. We will show our operative procedure for dissecting PMs using our four-step technique in three of these cases. Setting Urban general hospital in Japan. Patients or Participants Patients were placed in the lithotomy position. We use a modified diamond trocar placement. Case 1: A 45-year-old woman with PMs occurring under the pelvic peritoneum three years after total laparoscopic hysterectomy for a fibromatous uterus. Case 2: A 42-year-old woman with PMs occurring under the bladder peritoneum two years after total laparoscopic hysterectomy for a fibromatous uterus. Case 3: A 61-year-old woman with PMs of the mesoappendix eight years after total laparoscopic hysterectomy for a fibromatous uterus. Interventions Our four steps for dissecting PMs-identify the positional relationship between the PMs and organs considering organ deviation identify the boundary line between PMs and organs pull PMs with the proper force of traction for separation from organs and surrounding loose connecting tissue 4. identify and coagulate feeding vessels to avoid major bleeding. Measurements and Main Results In all surgeries performed with this technique, PMs were resected successfully and no intra or postoperative complications occurred. Conclusion By following our simple four steps, we were able to customize removal of each PM depending on its location. The four-step technique is safe and effective for successful dissection of PMs occurring in various sites.

Background In some patients with peritoneal carcinomatosis, we could perform the cytoreductive surgery and the HIPEC procedure by a complete laparoscopic approach to avoid morbidity. We consider that using laparoscopic approach for performing peritoneal carcinomatosis cytoreductive surgery and HIPEC with closed CO2 recirculation technique is possible and safe, with equal efficacy to conventional methods and hemodynamic complications. Objective Monitoring the effectiveness of the drug distribution in a laparoscopic ctoreductive and HIPEC surgery group with CO2 recirculation respect to a closed and open HIPEC group Methods Porcine model that included fifteen mini-pigs. Five pigs were operated with laparoscopic approach performing a pelvic and retroperitoneal lymphadenectomy. They later received a total laparoscopic closed HIPEC with CO2 recirculation (G1). Group 2 (G2): five pigs operated by an open cytoreductive surgery and closed HIPEC technique. Group 3 (G3): five animals in which an open cytoreductive surgery and an open HIPEC technique was performed. Blood and peritoneal determinations were realized after recirculation of the drug, at 60 min using chromatographic analysis. Results G1–G2: phrenic right peritoneum, p: 0.46. Phrenic left peritoneum, p: 0.46. Pelvic peritoneum, p: 0.17. Serum paclitaxel: p: 0.01. G1–G3: phrenic right peritoneum, p: 0.34. Phrenic left peritoneum, p: 0.34. Pelvic peritoneum, p: 0.17. Serum paclitaxel G1–G3, p: 0.02. Conclusions A total laparoscopic approach for ctoreductive surgery and closed HIPEC with CO2 recirculation may be safe and feasible. In our experimental model there was no significant difference in tissue drug distribution respect the conventional techniques and there was a less toxicity because the serum drug concentration was significantly lower with laparoscopic approach respect the other groups.

Radical pelvic surgery, including the removal of the uterus, adnexa, and pelvic peritoneum and en bloc resection of the rectosigmoid, should be part of the surgical armamentarium of a gynecologic oncologist because these procedures might be required to achieve a complete tumor cytoreduction in patients with advanced ovarian cancer. Furthermore, a complete pelvic and paraaortic lymphadenectomy is often required when a procedure is performed in patients with gynecologic tumors. In this chapter, we describe a step-by-step approach to performing complex radical pelvic and paraaortic retroperitoneal dissection in the setting of ovarian cancer.

Study Objective To study the outcome of a novel method of laparoscopic neovaginal reconstruction using rudimentary uterine horn serosa and the pelvic peritoneum as a graft. Design Canadian Task Force classification II-1. Setting A university hospital. Patients A retrospective study of 14 patients from 2000 to 2014 of patients with vaginal agenesis who underwent laparoscopic neovagina reconstruction using rudimentary uterine horn serosa and the pelvic peritoneum as a graft. Intervention Patients with vaginal agenesis associated with mullerian agenesis who requested surgery. Tertiary referral center and laparoscopic unit. The creation of a neovagina using rudimentary uterine horn serosa and the pelvic peritoneum as a graft via a combined laparoscopic and vaginal route. Measurements and Main Results Data were collected retrospectively including postoperative vaginal length and width, complications, stenosis or reoperations, dyspareunia, and sexual satisfaction. There were no major complications from the surgery with no rectal perforation or bladder or ureteric injury. The postoperative mean (±SD) vaginal length was 6.0±0.7 cm and a width of 2 fingerbreadths. The mean operation time was 142.7±45.9 min. Median blood loss was 100 ml (range: 10 to 300 mL). The mean duration of the hospital stay was 6.6±1.6 days. The follow-up period ranged from 3 to 84 months with a median follow-up of 11 months. Conclusion Lee's method of neovaginoplasty using rudimentary uterine horn serosa and the pelvic peritoneum as a graft is a good method for neovagina creation with minimal morbidity, fast recovery, and minimal complications. This method results in good anatomic and functional outcome and can be a method that is widely used.

Papillary mesothelioma is a well differentiated neoplasm arising from pelvic peritoneum of females in a wide age range. A typicalmorphological appearance is papillary structures with fibro vascular cores. We present a case of a 46-year-old female with a massin left peritoneal cavity involving the left fallopian tube which was excised and reported as a papillary mesothelioma.

A lipiodol hysterosalpingogram was the routine test for tubal patency as recently as the 1970s. Observational studies, then randomised controlled trials, provided evidence of a fertility enhancing effect of lipiodol. It has been found to improve fertility for women with normal tubal patency, particularly where the woman has a history of endometriosis. Previous successful treatment for infertility with lipiodol is a marker of further successful treatment for infertility in a repeat procedure. Whilst lipiodol is probably effective at flushing debris that could hinder fertility from fallopian tubes, it also exerts immunobiological effects in pelvic peritoneum and on the endometrium that could be responsible for fertility enhancement. Effects of lipiodol on the endometrium that might be important at the time of the implantation window are a reduced expression of osteopontin and an increased number of uterine natural killer cells postlipiodol. The effect of lipiodol uterine bathing for women with endometriosis, repeat in vitro fertilisation (IVF) implantation failure and other reproductive disorders merits further investigation. Lipiodol presents a new, simple, low invasive, inexpensive treatment option for endometriosis-related infertility and might have wider applications.

Desmoplastic small round cell tumor (DSRCT) is a rare and highly aggressive variety of sarcoma arising typically from abdominal or pelvic peritoneum. Diagnosis and treatment approaches of this entity are complex and require a skilled, experienced, multidisciplinary team. Authors report their experience with a case of an intraabdominal DSRCT arising in a 37-year-old young man in order to discuss the clinico-pathological and radiological behavior of this tumor and underline diagnostic and therapeutic difficulties.

Background.Benign cystic mesothelioma (BCM) is a rare tumor that arises from the abdominal peritoneum with a predilection to the pelvic peritoneum. For this reason, it can often mimic gynecologic malignancies.Case.A 47-year-old perimenopausal female presented reporting several weeks of abdominal distention associated with abdominal tenderness and constipation. Computed tomography revealed a 24 cm multiloculated pelvic mass, and tumor markers were notable for an elevated CA-125. The patient was taken to the operating room for an exploratory laparotomy, total abdominal hysterectomy, bilateral salpingoophorectomy, and removal of pelvic mass. Final pathologic evaluation revealed a benign cystic mesothelioma.Conclusion.Classically these tumors present as large multicystic masses with thin-walled septations and on preoperative evaluation BCM can mimic many different disease entities including ovarian malignancies and cystic lymphangioma. Often diagnosis can only be made at time of surgery.

Endometriosis is a common gynaecologic disease involving the ectopic growth of endometrial glands and stroma outside the uterus. The most commonly affected organs are the ovaries and other pelvic s...

Over the past two decades, chronic peritoneal dialysis (PD) has emerged as the first choice pediatric dialysis modality. A recent study visually identified the cause of malfunction of PD catheters at the Red Cross Children's Hospital in Cape Town. The reasons that could be found, lead to changed Tenckhoff insertion-techniques from open to laparoscopic. This included suturing of the tip, omentectomy and ovarian-pexy by laparoscopy. In the present paper we prospectively analyzed, if changed insertion technique lead to an improved outcome.26 Patients required 36 laparoscopic Tenckhoff insertions during the period August of 2003 and July of 2006. Overall a total number of 222.5 catheter-months have been observed. Laparoscopic insertion technique required 3 port placements. The tip of the catheter was sutured to pelvic peritoneum, omentectomy performed through a port site and ovariopexy done when required.The mean lifespan of all Tenckhoff's was 6.4 +/- 6.3 months. The tip of the catheter was sutured 20 times, omentectomy done in 9 cases and 6 patients underwent ovarian pexy. In the group where the tip was sutured to the pelvic peritoneum catheter life was 8.4 months compared to the non-sutured group which was only 4.1. Omentectomy lead to an overall catheter survival of 8.0 months compared to the no omentectomy group, which had a survival of 5.8 months. The complication-rate concerning early problems and malfunctions in the sutured and omentectomy groups was also lower. Patients who underwent both, suturing of the tip and omentectomy had no malfunctions at all.Omentectomy and suturing the tip can lower the complication-rate and prolong catheter survival. Using these procedures could decrease costs and morbidity and prevent patients from having further operations.

Endometriosis is a painful condition characterized by chronic pain that is periodic in nature, and intense perimenstrual symptoms. The pain associated with this condition is believed to be inflammatory in nature, in contrast with the pain due to mass effect caused by other gynecological lesions such as teratomas. The authors of this article aimed to compare pain intensity and pain-related distress among women with either an ovarian teratoma or endometrioma discovered on surgery., BACKGROUND: In recent years, numerous studies have considered endometriosis to be a subclinical, local inflammatory process in the pelvic peritoneum, the main symptom of which is pain. OBJECTIVES: To assess pain intensity and pain-related stress in women with ovarian endometriomas versus teratomas. METHODS: In total, 860 women (18 to 38 years of age) treated laparoscopically for lesions in the adnexa between September 2006 and November 2013 were included in the present study. After an intraoperative review of their histopathological lesions, the patients were divided into two study groups: group E (n=480), with histopathologically confirmed ovarian endometriomas; and group T (n=380), after laparoscopic treatment of ovarian teratomas. A questionnaire was generated for the study and completed by each group. Statistical analysis was performed using the Mann-Whitney U test (P≤0.05). RESULTS: Median pain scores for group E versus group T were as follows: pain during menstruation, 6 versus 3 (P=0.001); pain outside of menstruation (in professional life), 2 versus 2 (P=0.014); and pain during sexual intercourse, 3 versus 1 (P=0.006). Pain-related stress scores were higher in group T versus group E (5 versus 3; P=0.007). CONCLUSION: Ovarian endometriomas caused more pain than ovarian teratomas, likely due to the endometrial tissue component and not a mass effect. The assessment of pain and pain-related stress associated with the pelvis minor showed a high level of pain intensity and lower level of pain-related stress among patients with ovarian endometriomas.

The creation of a neovagina is usually necessary in cases of vaginal agenesia, i.e. Mayer-Rokitansky-Kuster-Hauser syndrome, and in some forms of male pseudohermaphroditism such as androgen insensitivity syndrome. The described technique using pelvic peritoneum can also be applied in cases of transsexualism.

Aim: to present the technique of neo-vagina formation with the use of pelvic peritoneum for the treatment of women with vaginal agenesis; to review the data focusing on the postoperative functional results; and to analyze its potential advantages and limitations. Brief description of the review data: Laparoscopic- assisted peritoneal colpopoesis has proven to be reliable and effective method of neovagina creation associated with minimal morbidity and excellent functional and anatomical results. It can be successfully used in patients with vaginal agenesis with or without rudimentary uteri and in patients with previously unsuccessful treatments. Our original experience since 1992 involves 324 patients who underwent this surgery. Long-term evaluation in patients operated on between 1995 and 2013 identified an 87.8 % satisfaction rate as compared with 76 % satisfaction rate in the control group and indicated a functional vaginal length of 12.46 ± 1.16 cm with anatomical vaginal length of 10.87 ± 1.0 cm, and a minimal complications rate. Clinical Implication: Multiple successful methods of neovagina creation are currently used. The pearls for minimizing complications and providing maximal results for the surgeon employing a laparoscopic-assisted peritoneal colpopoesis technique are described in this chapter. Open issues for further research: While technical and methodological advancements for neo-vagina formation continue to develop, research that further identifies etiologic factors in the development of vaginal agenesis, studies related to concomitant pathology in the patients, and investigations into the use of cellular technologies for the formation of the cervical canal in women with functional uteri with vaginal and cervical aplasia would be of a significant importance. Special considerations related to endometriosis in women with mullerian anomalies need further investigation as well.

The cytologic appearance of endosalpingiosis in peritoneal fluid cytology smears has not been extensively described. We report a case of endosalpingiosis in a 29-year-old pregnant female who presented with peritoneal fluid. Dense papillary epithelial clusters with indistinct ciliated cells were found in the Papanicolaou-stained smears. However, long and delicate cilia were obvious in papillary cluster with scanning electron microscopy. Cell nuclei were oval, with finely dispersed chromatin and uniform nuclear membrane. Peritoneal fluid cytology with these findings may be helpful to suggest the probable preoperative diagnosis of endosalpingiosis or benign glandular inclusions involving the pelvic peritoneum. Diagn. Cytopathol. 2004;30:422–425. © 2004 Wiley-Liss, Inc.