Type of publication:
Conference abstract

Author(s):
*Oates S.

Citation:
BJOG: An International Journal of Obstetrics and Gynaecology, June 2016, vol./is. 123/(24)

Abstract:
Introduction Paediatric and Adolescent care is now more structured within the gynaecology department and will often be undertaken by only one or two individuals. It would be useful to know the outcome after uncommon procedures to provide advice and reassurance to both the girls and their parents. Haematocolpos is a simple adolescent surgical intervention although the underlying pathology can be variable. Methods This was a retrospective study of 23 cases of haematocolpos identified using ICD codes, theatre records and theatre diaries at the Shrewsbury and Telford Hospitals trust over a 20 year period. More than half of the cases had been managed by the author. Results The age range of the girls was 11-17 years and those presenting with delayed menarche were aged 16 or 17 years at diagnosis. The commonest symptom was pain in 17 (74%) and then delayed menarche in 3 (13%) and urinary retention or difficult micturition in 3 (13%). There were three cases of Uterus Didelyphys and in these cases the girls had had menarche 1, 2 or 3 years before. Two cases of Transverse Vaginal Septum were identified and these girls required more extensive and repeated surgery to correct their problem following referral to a tertiary centre. The follow-up period for these patients is between 6 months to 20 years. Of the 23 cases identified 4 patients were lost to follow-up but all the others remain local. Five (22%) have gone on to successful pregnancies without difficulty. A further two cases have tried for pregnancies but one lady is awaiting a kidney transplant due to chronic renal failure and the other has a partner with sperm dysfunction and her BMI precludes her from infertility treatment at present. The remaining 12 do not appear to have any contact with maternity services yet or have a referral for infertility issues. There is no evidence that any of these women have endometriosis although two have had further surgery to open up their tight hymen and two have had vaginal dilators to stretch the hymen. Conclusion The management of heamatocolpos is relatively simple but follow-up of the cases highlights the variable out comes.

Link to more details or full-text: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&CSC=Y&NEWS=N&PAGE=fulltext&AN=00134415-201606002-00037&LSLINK=80&D=ovft

Type of publication:
Journal article

Author(s):
*Moores K.L., *Bentick B.

Citation:
Gynecological Surgery, May 2016, vol./is. 13/2(125-130)

Abstract:
Worldwide, increasingly complex surgery is being performed laparoscopically; thus, laparoscopic complication rates may be increasing. Reported risks from all complications of laparoscopic surgery are between 1 and 12.5/1000 cases and serious complications in 1/1000 cases. Accurate complication rates of surgery are difficult to obtain as most data are from retrospective studies and may be incomplete. This paper is a 10-year retrospective review of gynaecological laparoscopic complications from 1 January 2003 to 31 December 2012. Data sources are SEMAHELIX Hospital Database, Gynaecology Complications Register, Clinical Governance Records, Complaints and Legal Cases. Recorded complications were classified as diagnostic, sterilisations and therapeutic laparoscopies. Further classifications are as follows: major complications and type of injury (bowel, urological, vascular, other), minor complications and failed sterilisations. Twenty-nine complications were identified from 5128 laparoscopies; total complication rate is 5.7/1000 procedures. Major complication rates are as follows: diagnostic, 2.2/1000; sterilisations, 3.3/1000; and therapeutic, 3.1/1000, subcategorised into bowel 1.4/1000, urological 0.2/1000 and vascular 1.2/1000. Our total complication rate lies within published national rates. Compared to published standards of major complications, diagnostic laparoscopy and laparoscopic sterilisation rates were comparable. Conversely, our therapeutic laparoscopy complication rate was much lower. The highest complication rate was in the failed sterilisation group; however, this rate is within published sterilisation failure rates. Bowel and vascular complications were comparable; minor complication rates were low in all groups.

Type of publication:
Journal article

Author(s):
*Papoutsis D., *Panikkar J., *Gornall A., *Blundell S.

Citation:
Journal of Obstetrics and Gynaecology, February 2016, vol./is. 36/2(251-256)

Abstract:
The objective of our study was to determine whether removing multiple pieces of cervical tissue during large loop excision of the transformation zone (LLETZ) reduced the margin positivity of excision and cytology recurrence rates at follow-up. We conducted an observational cohort study and identified 462 women having had a single LLETZ treatment for cervical intraepithelial neoplasia (CIN) over a two-year period. Women with previous cervical treatment, cervical cancer on the excised tissue or missing follow-up data were excluded. Multiple regression analysis showed that removal of cervical tissue in multiple pieces did not offer any benefit in removing more disease and less recurrence rates. When multiple pieces were taken there was a four-fold increased risk for inconclusive excision margins as reported by the histopathologist. Removal of multiple pieces led to significantly more tissue being removed which may expose the patient to an increased risk of preterm delivery in a future pregnancy.