Publications

History of infertility.

Infertility has always been a constant preoccupation. The problems it raises today on medical, social, ethical, political and religious levels bear witness to this emphasis, but also to how complicated infertility is to deal with and understand. This study not only examines the history of infertility and the treatments applied but also the repercussions for infertile women socially. As we look through history, we find that the attitudes of physicians have often reflected the role of the woman and her image in society.

Complications of gynecologic laparoscopic surgery.

The growing impact of laparoscopic surgery must not make us underestimate the existence of complications, some of them severe, with medical-legal implications. Several surveys and case reports of complications following modern gynecologic laparoscopic surgery, some reporting laparoscopic management of visceral injuries, have been published recently. The complication rate depends on the complexity of the surgical procedure; serious complications still arise during performance of laparoscopy. Patients must be informed of the hazards of so-called 'minimally' invasive surgery.

Uterine rupture during pregnancy after laparoscopic myomectomy.

A 31 year old patient presenting with primary infertility underwent an operative laparoscopy for the treatment of bilateral hydrosalpinges, during which a myomectomy was also performed. The uterus was repaired using interrupted sutures. At follow-up laparoscopy seven weeks later, a uterine fistula was diagnosed and was oversewn using a single 'figure of eight' suture. One year later the patient became pregnant through in-vitro fertilization. At 34 weeks gestation, she required an emergency laparotomy for acute abdominal pain and the presence of fetal bradycardia. The operative findings revealed a uterine rupture at the site of the previous myomectomy scar. This was then enlarged with a scalpel and a live baby was delivered. The uterus was repaired in two layers. The postoperative period for both mother and baby was satisfactory. This complication raises the problem of the quality of uterine repair following laparoscopic myomectomy, together with the question of how to prevent this type of life-threatening situation.

Sterilization reversal: fertility results.

Fertility outcome following sterilization reversal by laparotomy was evaluated. We studied all sterilization reversals performed between January 1978 and December 1991; a total of 226 women were treated. Tubal anastomosis was performed according to the rules for microsurgery. The microsurgical technique comprised two main phases: preparation of the healthy tube segments and the anastomosis carried out on two layers. It was possible to study the subsequent fertility of 206 patients in all, as 20 patients were lost to follow-up (8.8%). Cumulative pregnancy rates were evaluated by life-table analysis. The overall intrauterine pregnancy rate, including births and miscarriages, was 69.9% (144 patients) after 2 years. The cumulative intrauterine pregnancy rate was 62% at 18 months. Analysis of the fertility results demonstrated that age was the most significant predictive factor. The cumulative intrauterine pregnancy rate at 2 years was 83.5% (61 cases) for patients < or = 33 years, 70% (35 cases) for patients aged 34-36 years, 62.5% (30 cases) for patients aged 37-39 years, and 51.4% (18 cases) for patients aged > or = 40 years. Even for patients aged approximately 40 years, microsurgical repermeabilization can be retained as the first choice rather than in-vitro fertilization. PIP: At Cochin-Port Royal Hospital in Paris, France, gynecologic surgeons used laparotomy to perform microsurgical sterilization reversal on 226 patients aged 6-41 during January 1978-December 1991. 20 women were lost to follow-up. The researchers used life-table analysis to examine cumulative pregnancy rates. The mean interval between sterilization and sterilization reversal was 6.15 years. The surgeons first prepared the healthy tube segments and then performed anastomosis on two layers. At 18 months and 2 years post-reversal, the overall intrauterine pregnancy rates (births and miscarriages) stood at 62% and 69.9%, respectively. The average time between sterilization reversal and intrauterine pregnancy was 9.6 months. At 2 years, there were 4 ectopic pregnancies (2%). Even though women who had undergone bilateral sterilization reversal were more likely to become pregnant and to become pregnant more quickly than those who had undergone unilateral sterilization (73% vs. 56.4% and 8.8 vs. 12.2 months), the differences were insignificant. The type of anastomosis (e.g., isthmic-isthmic or isthmic-ampullary) had no bearing on fertility, as long as the tubes were at least 3 cm in length. The intrauterine pregnancy rates decreased with age (p = 0.01) (at 2 years post-reversal: 83.5% for age 33 or younger; 70% for age 34-36; 62.5% for age 37-39; and 51.4% for age 40 or older). Age was the most significant predictive factor of return to fertility. The findings show that microsurgical repermeabilization can remain the first choice rather than in-vitro fertilization for sterilized women wishing to bear a child, even women around age 40.

Laparoscopic hysterectomy.

421. Lancet. 1995 Mar 4;345(8949):593. Laparoscopic hysterectomy. Chapron C, Dubuisson JB.

[Trophoblast graft on the omentum. Failure of conservative celioscopic treatment of extra-uterine pregnancy].

422. Presse Med. 1995 Feb 11;24(6):327. [Trophoblast graft on the omentum. Failure of conservative celioscopic treatment of extra-uterine pregnancy]. Chapron C, Decoret E, Morice P, Capella S, Dubuisson JB.

[Laparoscopic salpingostomies: analysis of results].

One hundred and twenty three infertile women were treated by laparoscopic salpingostomy. The intra-uterine pregnancy rate is 30.4%. The mucosal status seems to be the principal prognostic factor.

Laparoscopic management of asymmetric Mayer-Rokitansky-Kuster-Hauser syndrome.

Mayer-Rokitansky-Kuster-Hauser (MRKH) syndrome is a partial or complete absence (agenesis) of the uterus with an absent or hypoplastic vagina. Until now, the recommended treatment, when resection of a rudimentary horn was indicated, was laparotomy. We report a case of MRKH syndrome in which the patient benefited from laparoscopic surgery for bilateral resection of rudimentary horns. Laparoscopy is not only useful for diagnosis of uterine malformations but can also be valuable for any treatment required for this type of malformation, this being carried out during the same operative procedure, thus avoiding laparotomy for the patient. The creation of an artificial vagina is performed during a second operation.

Bladder injuries during total laparoscopic hysterectomy: diagnosis, management, and prevention.

Based on a series of 150 total hysterectomies carried out via laparoscopy between January 1993 and December 1994, we observed 2 bladder complications: 1 bladder injury and 1 vesicovaginal fistula. These two accidents form the basis of discussion on the risk factors for these complications, their diagnosis, treatment, and prevention.

Classification of endometriosis. The need for modification.