Comparison of the complications between minimally invasive surgery and open surgical treatments for early-stage cervical cancer: A systematic review and meta-analysis

Background This meta-analysis comprehensively compared intraoperative and postoperative complications between minimally invasive surgery (MIS) and laparotomy in the management of cervical cancer. Even though the advantages of laparotomy over MIS in disease-free survival and overall survival for management of gynecological diseases have been cited in the literature, there is a lack of substantial evidence of the advantage of one surgical modality over another, and it is uncertain whether MIS is justifiable in terms of safety and efficacy. Methods In this meta-analysis, the studies were abstracted that the outcomes of complications to compare MIS (laparoscopic or robot-assisted) and open radical hysterectomy in patients with early-stage (International Federation of Gynecology and Obstetrics classification stage IA1-IIB) cervical cancer. The primary outcomes were intraoperative overall complications, as well as postoperative aggregate complications. Secondary outcomes included the individual complications. Two investigators independently performed the screening and data extraction. All articles that met the eligibility criteria were included in this meta-analysis. Results The meta-analysis finally included 39 non-randomized studies and 1 randomized controlled trial (8 studies were conducted on robotic radical hysterectomy (RRH) vs open radical hysterectomy (ORH), 27 studies were conducted on laparoscopic radical hysterectomy (LRH) vs ORH, and 5 studies were conducted on all three approaches). Pooled analyses showed that MIS was associated with higher risk of intraoperative overall complications (OR = 1.41, 95% CI = 1.07–1.86, P<0.05) in comparison with ORH. However, compared to ORH, MIS was associated with significantly lower risk of postoperative aggregate complications (OR = 0.40, 95% CI = 0.34–0.48, P = 0.0143). In terms of individual complications, MIS appeared to have a positive effect in decreasing the complications of transfusion, wound infection, pelvic infection and abscess, lymphedema, intestinal obstruction, pulmonary embolism, deep vein thrombosis, and urinary tract infection. Furthermore, MIS had a negative effect in increasing the complications of cystotomy, bowel injury, subcutaneous emphysema, and fistula. Conclusions Our meta-analysis demonstrates that MIS is superior to laparotomy, with fewer postoperative overall complications (wound infection, pelvic infection and abscess, lymphedema, intestinal obstruction, pulmonary embolism, and urinary tract infection). However, MIS is associated with a higher risk of intraoperative aggregate complications (cystotomy, bowel injury, and subcutaneous emphysema) and postoperative fistula complications.

Four cases of heterotopia of an intrauterine device embedded in the bladder muscular layer causing cystolithiasis: case report and review of the literature

Family planning is a basic national policy in China. An intrauterine device (IUD) is an important method of achieving family planning owing to its high safety, low cost, and convenient use. The indwelling birth control ring has no obvious adverse effects on the sexual life of women after the operation, and the process is reversible. This ring can be removed for women who want to have children again. There are approximately 100 million women with IUDs worldwide, with approximately 80 million in China. This finding accounts for approximately 40% of women of childbearing age in China. Although an IUD is safe, the invasive operation inevitably leads to complications, such as pelvic infection, abnormal menstruation, and damage to adjacent organs. Among them, ectopic bladder stone formation is a rare complication, but several related cases have been reported. We report four cases of heterotopia of an IUD and cystolithiasis, with diagnosis based on the medical history, clinical manifestations, imaging, and cystoscopic findings. The four patients with ectopic IUDs were treated with cystoscopy combined with laparoscopy (or hysteroscopy). We describe the process of diagnosis and treatment of our patients, and the related literature on an ectopic IUD is reviewed.

Effect of Hysterosalpingography (HSG) on Biochemical Pregnancy Rate in Women with Primary and Secondary Infertility

Background: Hysterosalpingography (HSG) is a common diagnostic method that has therapeutic effects on fertility success. Objectives: The purpose of this study was to investigate the effect of HSG on the biochemical pregnancy rate of women with primary and secondary infertility in patients referring to Ali-ibn Abitalib Hospital in Zahedan. Methods: A descriptive-analytical study was performed on 100 women with primary and secondary infertility referred to Ali-ibn Abitalib Hospital of Zahedan for performing HSG. Following performing the examinations, initial tests, and procedures, as well as ruling out acute pelvic infection by the expert gynecologist, the patients were referred to the radiologist for HSG. All patients in the study underwent HSG. Data were analyzed by SPSS version 21 software. Results: The mean age of patients in the study was 30.36 ± 5.25 years, and the mean duration of infertility was 4.81 ± 2.31 years. There was no significant relationship between the type of pregnancy and the outcome of pregnancy. There was no statistical relationship between age, abdominal surgery history, and HSG in both groups of women with spontaneous pregnancy or ovulation induction. There was a significant relationship between the mean duration of infertility and spontaneous pregnancy. Conclusions: The use of HSG as a therapeutic approach is not effective, but it could have therapeutic effects as a diagnostic method in women with early infertility.

Risk factors associated with ectopic pregnancy in our sociodemographic setup

Background: Ectopic pregnancy (EP) is assuming greater importance because of its increasing incidence and its impact on woman’s fertility.Aim: To assess the frequency and to determine an association between the studied risk factors and ectopic pregnancy.Methods: A retrospective study was conducted for the role of several risk factors in the occurrence of EP in department of obstetrics and Gynaecology, SMGS Hospital. A total of 110 cases and 110 controls were compared for socio demographic characteristics, cigarette smoking, obstetrical and gynaecological history, PID, past exposure to Chlamydia, surgical histories, the presence of assisted conception and contraceptive usage.Results: The main risk factors for ectopic pregnancy were history of tuberculosis (TB) (odds ratio (OR)=12.11), history of infertility (p=0.001), abortions (p=0.01) and a history of prior ectopic pregnancy (OR=8.549). Other risk factors found to be associated with an increased risk for ectopic pregnancy were Pelvic inflammatory disease (PID)/Chlamydia infection (OR=5.63), endometriosis (5.40), induced conception cycle (OR=3.063), intrauterine device usage (OR=3.55), prior caesarean section (OR=2.83) and appendectomy (OR=2.25). On the contrary, barrier methods (OR=0.28) and oral contraceptive use (OR=0.28) were protective from ectopic pregnancy.Conclusion: Pelvic infection particularly TB was found to be a major etiological factor for EP in our setup. Furthermore, other factors found to be associated with ectopic pregnancy, such as prior ectopic pregnancy and infertility history may be the result of a previous pelvic infection that caused tubal sequele. Thus, these factors are potential targets for intervention and modification. Further, patients with previous abortions, pelvic surgeries, induced conception cycle and intrauterine contraceptive device (IUCD) users should be counselled about the possible risk when they conceive.

The use of NAAT- PCR to determine asymptomatic chlamydia and gonorrhoea infections in infertile patients undergoing hysterosalpingogram at the federal medical centre, Yenagoa, South-South Nigeria

Background: The roles of Chlamydia trachomatis and Neisseria gonorrhoeae in the aetiology of infertility due to tubal occlusion have been established by various studies. These organisms may lead to pelvic infection by ascending into the upper genital tract through any instrumentation like hysterosalpingography. The objectives were to determine the prevalence of asymptomatic chlamydial and gonorrhoeal infections of the genital tract among women being investigated for infertility referred for hysterosalpingography; the relationship of these infections with tubal pathologies; and if routine endo-cervical screening and prophylactic antibiotics be recommended for these patients.Methods: This was a descriptive cross-sectional study. The study population consisted of consecutive 220 infertile women that met the inclusion criteria for this study. Consent was obtained. Endo-cervical swab was taken for NAAT-PCR for Chlamydia trachomatis and Neisseria gonorrhoeae. Hysterosalpingography was carried out. Data was analyzed using SPSS (version 22).Results: Amongst the 220 women, 9 (4.1%) had asymptomatic chlamydia infection. None had gonorrhoea infection and 211 (95.9%) had none of these two organisms. Forty-eight (21.9%) of the 220 women had bilateral tubal blockage and 9 (18.8%) out of these 48 women had asymptomatic infection with Chlamydia trachomatis.Conclusions: There is a statistically significant association between tubal blockage and chlamydia infection (p = 0.00) [RR 4.31 (3.37-5.50)]. There was no evidence to recommend routine screening/antibiotics considering the low prevalence of microbes and the absence of post-HSG pelvic infection. Results from a multicenter randomized controlled trial will be more representative.

A tubo-ovarian abscess mimicking an appendiceal abscess: a rare presentation of Streptococcus agalactiae

A tubo-ovarian abscess (TOA) is a relatively rare medical complication that results from an untreated/unrecognized ascending pelvic infection of the female genital tract. In a right-sided TOA, this clinical entity may mimic appendicitis on computed tomography (CT). In addition, both disease processes can present with pelvic pain, leukocytosis and fever. We present the case of a 47-year-old female with mid right-sided abdominal pain that was diagnosed on CT scan with an appendiceal abscess. She underwent CT-guided percutaneous drainage with interventional radiology. On Day 8, a CT limited study involving a contrast injection was performed to evaluate for abscess resolution. The contrast within the drain filled the fallopian tube, endometrial cavity and contralateral fallopian tube. These findings demonstrated that the initial diagnosis actually represented a TOA. To the authors’ knowledge, this is the only reported case involving a TOA secondary to Streptococcus agalactiae (GBS) mimicking an appendicitis with abscess formation.

Isthmocele: A Review of Management Options for This Novel Entity

The incidence of cesarean section is on rise all over the world and so are the complications associated with the procedure. Isthmocele as a complication of cesarean section is becoming a well documented entity all over the world in medical literature. It presents with symptoms like prolonged post menstrual bleeding, chronic pelvic infection and infertility. A pregnancy can get lodged in this area and can have disastrous consequences for the patient. The present article is an attempt to review to various presenting complaints, diagnosis and management of Isthmocele.International Journal of Human and Health Sciences Vol. 03 No. 03 July’19. Page: 127-133