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#July 2017
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Ovarian tissue cryopreservation
The French law on bioethics dated August 6 2004 now states the possibility for any person to benefit from a gamete or a germinal tissue collection as well as its preservation. Collection and preservation are planned when the patient’s management may induce a fertility alteration or when the patient’s fertility may be prematurely altered. Young girls who have not reached the age of puberty and who are about to undergo high-dose chemotherapy and/or major radiation therapy for cancer, can benefit from a cryopreservation of their ovarian tissue. It will allow to preserve fertility when these patients have a wish for pregnancy. Once collected, preserved ovarian cortical strips are systematically sent for frozen section to the pathology department in order to be processed for cryopreservation. Later on, when these young women have been healed and wish to become pregnant, the thawing of preserved ovarian cortical strips and the orthotopic autograft can take place. We suggest to collect the anterior cortex from both ovaries, which allows to preserve the two remaining ovaries. Another technique, which is performed by other teams, involves a unilateral oophorectomy for ovarian tissue preservation. A bilateral hemicortical sampling on both ovaries is well accepted by patients and their parents. Indeed, the video does not present an oophorectomy, which is considered as a definitive procedure, but a bilateral sampling which leaves two ovaries in place. The ovaries are reduced in size but are anatomically and functionally healthy.
F Becmeur
Surgical intervention
1 year ago
916 views
54 likes
0 comments
03:05
Ovarian tissue cryopreservation
The French law on bioethics dated August 6 2004 now states the possibility for any person to benefit from a gamete or a germinal tissue collection as well as its preservation. Collection and preservation are planned when the patient’s management may induce a fertility alteration or when the patient’s fertility may be prematurely altered. Young girls who have not reached the age of puberty and who are about to undergo high-dose chemotherapy and/or major radiation therapy for cancer, can benefit from a cryopreservation of their ovarian tissue. It will allow to preserve fertility when these patients have a wish for pregnancy. Once collected, preserved ovarian cortical strips are systematically sent for frozen section to the pathology department in order to be processed for cryopreservation. Later on, when these young women have been healed and wish to become pregnant, the thawing of preserved ovarian cortical strips and the orthotopic autograft can take place. We suggest to collect the anterior cortex from both ovaries, which allows to preserve the two remaining ovaries. Another technique, which is performed by other teams, involves a unilateral oophorectomy for ovarian tissue preservation. A bilateral hemicortical sampling on both ovaries is well accepted by patients and their parents. Indeed, the video does not present an oophorectomy, which is considered as a definitive procedure, but a bilateral sampling which leaves two ovaries in place. The ovaries are reduced in size but are anatomically and functionally healthy.
Pediatric laparoscopic floppy Nissen fundoplication
Surgical therapy is well-established in children with gastroesophageal reflux disease (GERD). It is known that the laparoscopic approach is safe and effective. We tailored our surgical strategy based on two main studies which we conducted: one observational long-term follow-up and the other one related to the effect of Thal fundoplication on pulmonary affections. Our conclusions are summarized as follows:
- no surgery in the first 12 months,
- indications determined together with the consent of parents,
- a radiological contrast study should always be performed preoperatively,
- history taking and at least two positive objective diagnoses leading to indication,
- for neurologically impaired patients, a Nissen fundoplication is selected,
- first-line treatment: percutaneous endoscopic gastrostomy (PEG) implantation, second step: fundoplication if necessary,
- for neurologically healthy patients without inborn anatomical diseases, a Thal fundoplication is selected,
- postoperative diagnoses in the follow-up period are only performed if necessary.
For this personal experience and in comparison with the established approach in the current literature, we have only poor evidence. It is due to the lack of prospective studies available and to an inadequate number of patients, which is typical in pediatric studies.
S Holland-Cunz
Surgical intervention
1 year ago
1684 views
206 likes
0 comments
03:54
Pediatric laparoscopic floppy Nissen fundoplication
Surgical therapy is well-established in children with gastroesophageal reflux disease (GERD). It is known that the laparoscopic approach is safe and effective. We tailored our surgical strategy based on two main studies which we conducted: one observational long-term follow-up and the other one related to the effect of Thal fundoplication on pulmonary affections. Our conclusions are summarized as follows:
- no surgery in the first 12 months,
- indications determined together with the consent of parents,
- a radiological contrast study should always be performed preoperatively,
- history taking and at least two positive objective diagnoses leading to indication,
- for neurologically impaired patients, a Nissen fundoplication is selected,
- first-line treatment: percutaneous endoscopic gastrostomy (PEG) implantation, second step: fundoplication if necessary,
- for neurologically healthy patients without inborn anatomical diseases, a Thal fundoplication is selected,
- postoperative diagnoses in the follow-up period are only performed if necessary.
For this personal experience and in comparison with the established approach in the current literature, we have only poor evidence. It is due to the lack of prospective studies available and to an inadequate number of patients, which is typical in pediatric studies.