Cobellis G

Comparison of intramural myomectomy scar after laparotomy or laparoscopy

Optimal uterine repair after myomectomy is important to avoid menstrual disturbances and allow for successful subsequent pregnancies. Apart from patients’ individual characteristics, different surgical approaches might be accountable for different healing processes. The objective of this study was to compare the morphology of scars resulting from laparoscopic and laparotomic myomectomy. Fifteen patients (age range, 22–35 years) who underwent cesarean delivery because of a previous myomectomy were included. In all patients myomectomy had been performed for a single intramural nodule located in the anterior, posterior, or fundal uterine wall. The surgical approach was either laparotomic myomectomy (ns10) or laparoscopic myomectomy (ns5). The postoperative course was uncomplicated in all patients. The laparotomic myomectomies were performed by the same surgeon whereas the laparoscopic myomectomies were performed by two different surgeons. The surgical technique for optimal uterine repair following laparotomic myomectomy was similar to that previously described for myomectomy dur-

Hemostatic technique for myomectomy during cesarean section

Myomectomy during cesarean section is usually avoided because of the high risk of intraand post-operative complications, such as uterus atony and hemorrhagew1–3x. Some authors, however, demonstrate that by taking into consideration several factors such as uterine contractility, anatomic side, number and size of myomas, myomectomy performed during cesarean section could be considered a safe procedure w4–6x. The results of a retrospective analysis of 322 consecutive patients, collected over a period of 18 years, submitted to myomectomy during cesarean section are presented, emphasizing an accurate case selection and a correct surgical technique which permitted good results to be obtained. The average age of patients was 33.5 years, the gestational age ranged between 35.3 and 42.2 weeks, and 65% were nulliparas. Cesarean section indications were: anomalous(breech or shoulder ) presentation (33%), previous cesarean section (26%), prolonged labor or cardiotocography anomalies (15%), hypertensive disorders (12%), fetopelvic disproportion(11%), and others(3%). Subserosal myomas with a diameter F4 cm represented the more common type of fibroids removed(71%); the other locations were: subse-

Electro-cautery of myomas during caesarean section--two case reports.

Myomectomy is a surgical procedure not usually performed during caesarean section because associated with high risk of haemorrhage and other complications. The goal of our study is to evaluate the feasibility of myomectomy during caesarean section, the outcome, and try to establish the favourable conditions to perform a myomectomy during the same surgical event. Electro-cautery of intramural-subserous myomas was performed on two different patients. Only the myomas of little or middle size were treated. Both patients had multiple fibroids, a firm contraindication for myomectomy during caesarean section. After 10 and 13 months since myoma electro-cautery, all uterine fibroids treated were completely reabsorbed. These preliminary results regard the fibroids of middle size. It could be interesting evaluating the electro-cautery on bigger fibroids.

Ovarian hyperstimulation syndrome : Distinction between local and systemic disease

The ovarian hyperstimulation syndrome (OHSS) is an iatrogenic ,unpredictable and potentially life-threatening complication in patients submitted to pharmacological ovarian stimulation. Information on risk factors ,etiopathogenetic mechanisms ,prevention strategies and therapeutic management is continuously updated. The present study retrospectively analyzed 123 women affected by different grades of OHSS as a result of pharmacological ovulation induction. Hospital admission was suggested in 14 patients with severe OHSS ,whereas patients with moderate or mild OHSS were followed in the out-patient section of our department. The results confirmed the efficacy of the therapeutic scheme adopted. The syndrome is localized to the ovaries at the time that the condition is triggered; when organs different from the ovaries become involved ,OHSS assumes systemic aspects. The different clinical signs are the basis of a proposal of a local and systemic classification.