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Lucie SCHWARTZ

Centre médico-chirurgical et Obstétrique (CMCO)
Strasbourg, France
MD
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Anterior and posterior laparoscopic mesh removal due to pelvic pain, subtotal hysterectomy, mesh replacement, and Burch procedure
This is the case of a 69-year-old woman presenting with pelvic pain after laparoscopic sacrocolpopexy. The patient has a history of one vaginal birth, laparoscopic sacrocolpopexy with uterine preservation combined with a transobturator tape (TOT) sling procedure performed in 2013.
The following symptoms appeared after surgery: invalidating pelvic pain, especially in an upright position, severe terminal constipation, worsening of a previously mild stress urinary incontinence.
On clinical examination, a high rectocele (grade 2/3), a cystocele, and elective pain at the level of the TOT sling were observed. MRI revealed a perineal inflammation between the anterior aspect of the vagina and the urethra, at the level of the lower third of the urethra. A fibrotic area can be noted at the level of the rectovaginal space.
Her TOT sling was partially resected in January 2014.
Cystoscopy ruled out the presence of mesh erosion. Hysteroscopy was normal.
Endometrial biopsy demonstrated an atrophic endometrium.
In this surgery, the anterior and posterior meshes are removed. A subtotal hysterectomy combined with the replacement of meshes were performed, followed by a Burch procedure.
Surgical intervention
4 years ago
1839 views
65 likes
0 comments
33:56
Anterior and posterior laparoscopic mesh removal due to pelvic pain, subtotal hysterectomy, mesh replacement, and Burch procedure
This is the case of a 69-year-old woman presenting with pelvic pain after laparoscopic sacrocolpopexy. The patient has a history of one vaginal birth, laparoscopic sacrocolpopexy with uterine preservation combined with a transobturator tape (TOT) sling procedure performed in 2013.
The following symptoms appeared after surgery: invalidating pelvic pain, especially in an upright position, severe terminal constipation, worsening of a previously mild stress urinary incontinence.
On clinical examination, a high rectocele (grade 2/3), a cystocele, and elective pain at the level of the TOT sling were observed. MRI revealed a perineal inflammation between the anterior aspect of the vagina and the urethra, at the level of the lower third of the urethra. A fibrotic area can be noted at the level of the rectovaginal space.
Her TOT sling was partially resected in January 2014.
Cystoscopy ruled out the presence of mesh erosion. Hysteroscopy was normal.
Endometrial biopsy demonstrated an atrophic endometrium.
In this surgery, the anterior and posterior meshes are removed. A subtotal hysterectomy combined with the replacement of meshes were performed, followed by a Burch procedure.
Laparoscopic tubo-cornual anastomosis for reversal of sterilization
This video shows a case of tubo-cornual anastomosis for reversal after tubal sterilization. A 43-year-old patient has requested a reversal of sterilization. She already had 4 deliveries. On the hysterosalpingography, one can see that Hulka clips are really near the uterine horns.
The video demonstrates the removal of Hulka clips, the dissection of the interstitial part of the tube, the catheterization of a guide through the ostium in the proximal, then distal part of the tube hysteroscopically, and finally a tubo-cornual anastomosis. In our opinion, the quality of the anastomosis directly depends on the complete congruence of the two tubal stumps. Different prognostic factors have been discussed in previous studies (e.g., age, type of sterilization (clips or coagulation), length of remaining tube, and site of anastomosis). According to the literature, the best anastomotic site, in terms of successful pregnancy, would be the isthmic-isthmic position. In our experience, the use of a tubal hysteroscopic guide seems the best aid to obtain a luminal alignment and it is more comfortable for the suture.
Surgical intervention
4 years ago
2832 views
108 likes
0 comments
08:01
Laparoscopic tubo-cornual anastomosis for reversal of sterilization
This video shows a case of tubo-cornual anastomosis for reversal after tubal sterilization. A 43-year-old patient has requested a reversal of sterilization. She already had 4 deliveries. On the hysterosalpingography, one can see that Hulka clips are really near the uterine horns.
The video demonstrates the removal of Hulka clips, the dissection of the interstitial part of the tube, the catheterization of a guide through the ostium in the proximal, then distal part of the tube hysteroscopically, and finally a tubo-cornual anastomosis. In our opinion, the quality of the anastomosis directly depends on the complete congruence of the two tubal stumps. Different prognostic factors have been discussed in previous studies (e.g., age, type of sterilization (clips or coagulation), length of remaining tube, and site of anastomosis). According to the literature, the best anastomotic site, in terms of successful pregnancy, would be the isthmic-isthmic position. In our experience, the use of a tubal hysteroscopic guide seems the best aid to obtain a luminal alignment and it is more comfortable for the suture.