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Gynécologie Cochin Paris : chirurgie, PMA et cancers
Gynécologie Cochin Paris : chirurgie, PMA et cancers

Publications

1991

Publication

[Surgical celioscopy in gynecology].

• 11/1991

458. Presse Med. 1991 Nov 30;20(41):2081-3. [Surgical celioscopy in gynecology]. Bruhat MA, Mage G, Chapron C, Pouly JL, Manhes H, Canis M, Wattiez A.

Publication

Laparoscopic treatment of ectopic pregnancies: a one hundred cases study.

Chapron C, Querleu D, Crépin G
• 10/1991

From June 1987 to December 1989, 100 ectopic pregnancies (93 patients) were operated on by laparoscopy. The different techniques included salpingostomy, salpingectomy and tubal expression. There were no intra-operative complications or unwanted laparotomy. Only one patient (1%), on the fourth post-operative day, underwent a laparotomy due to an occlusive syndrome. Six failures (9.5%), in cases of conservative treatment were observed including three (16.6%) after tubal expression. The length of operation and hospitalization is similar with regard to the different endoscopic procedures, and shorter than those observed after treatment by laparotomy. These results confirm that laparoscopic treatment of ectopic pregnancies is not only reliable but also significantly less expensive than treatment by means of classical surgery.

DOI
Publication

Multifactorial analysis of fertility after conservative laparoscopic treatment of ectopic pregnancy in a series of 223 patients.

Pouly JL, Chapron C, Manhes H, Canis M, Wattiez A, Bruhat MA
• 09/1991

OBJECTIVES: To lay down the criteria to clearly define whether conservative or radical laparoscopic treatment should be adopted in cases of ectopic pregnancies (EP). DESIGN: Retrospective, noncomparative. SETTING: At the University Hospital of Clermont Ferrand and the La Pergola Clinic at Vichy from July 1974 to December 1987. PATIENTS: This study was carried out in 223 patients who had been treated laparoscopically for EP and who desired future childbearing and who were not lost to follow-up. MAIN OUTCOME MEASURES: The measures chosen to achieve the objective included age, parity, size of hematosalpinx, volume of hemoperitoneum, tubal rupture, location, intrauterine device, ipsilateral and contralateral adhesions, and patient's previous history of salpingitis, EP, solitary tube, and tubal infertility. RESULTS: The general intrauterine pregnancy rate was 67% (149 patients) and the recurrence rate 12% (27 patients). The results according to the studied factors demonstrated that age, parity, and the type of the EP have no influence on the postectopic fertility. The history of the patient, ipsilateral adhesions, or contralateral tubal status significantly reduce the future fertility prognosis and risk of recurrence. CONCLUSIONS: From a multivariable analysis, the authors propose a scoring system to choose the most suitable treatment to preserve fertility and to reduce the risk of recurrence ranging from laparoscopic conservative treatment to laparoscopic salpingectomy with contralateral sterilization.

DOI
Publication

Present day endoscopic surgery in gynecology.

Bruhat MA, Mage G, Chapron C, Pouly JL, Canis M, Wattiez A
• 08/1991

The last ten years have been characterized by a tremendous change in laparoscopy. Initially used exclusively for diagnosis, laparoscopy is now a surgical method in its own right and plays a strategic role. Long-term evaluation of results for various pathologies (such as ectopic pregnancy and tubo-peritoneal sterility) means that just one laparoscopic procedure can be used for diagnosis, selection of the best therapeutic approach and also for treatment in those cases where laparoscopy is the optimum choice. Other more recent indications (including hysterectomy, lymphadenectomy etc.) which are now possible thanks to recent technological developments (such as clips and mechanical sutures) need long-term analysis of their results.

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Publication

Advanced heterotopic pregnancy after in-vitro fertilization and embryo transfer, with survival of both the babies and the mother.

Bassil S, Pouly JL, Canis M, Janny L, Vye P, Chapron C, Bruhat MA
• 08/1991

A combination of an extra-uterine and an intra-uterine pregnancy is defined as heterotopic pregnancy. An infertile patient, pregnant at her fourth in-vitro fertilization/embryo transfer attempt, was diagnosed at 21 weeks' gestation as having simultaneous abdominal and intra-uterine pregnancy. Expectant management under strict hospitalization was proposed and accepted by the couple, fetal assessment was by serial ultrasound evaluation of growth and amniotic fluid volume and by non-stress tests. Planned operative delivery was accomplished at 34 weeks' gestation. Both the mother and infants are alive and well.

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Publication

Subsequent fertility for patients presenting with an ectopic pregnancy and having an intra-uterine device in situ.

Pouly JL, Chapron C, Canis M, Mage G, Wattiez A, Manhes H, Bruhat MA
• 08/1991

Of 503 ectopic pregnancies (EP) dealt with surgically using conservative laparoscopic techniques, 153 (30.4%) occurred in patients with an intra-uterine device (IUD) in situ. Examination of the characteristics of the EP revealed that the fimbrial location was more frequent among patients with an IUD whereas a significantly higher proportion were located in the isthmus in the group of patients without an IUD. Whereas the condition of the tubal wall did not differ according to the presence or absence of an IUD, adhesions and obstructed or non-existent contralateral tubes were significantly less frequent among patients with an IUD in situ. Two hundred and twenty three patients desired pregnancy, 30 of whom had an IUD in situ when the EP was diagnosed. The subsequent fertility for these 30 patients with an IUD was shown by rates for intrauterine pregnancy (IUP), recurrent EP and infertility of 96.7, 3.3 and 0% respectively. These results were significantly better than those for women who had no IUD, the figures for this group being 59, 13.4 and 27.4%, respectively. The favourable prognosis was due solely to the fact that women with an IUD had far fewer negative antecedents and that the EP probably occurred due to impaired ciliary action which is reversible when the IUD is removed.

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Publication

Treatment of tubal pregnancy.

• 08/1991

463. Fertil Steril. 1991 Aug;56(2):374-5. doi: 10.1016/s0015-0282(16)54507-5. Treatment of tubal pregnancy. Chapron C, Pouly JL, Manhes H, Mage G, Canis M, Wattiez A, Bruhat MA.

DOI
Publication

[Fertility after ectopic pregnancy. III. The prognostic role of antecedents].

• 06/1991

467. Contracept Fertil Sex (Paris). 1991 Jun;19(6):453-9. [Fertility after ectopic pregnancy. III. The prognostic role of antecedents]. Pouly JL, Chapron C, Mage G, Canis M, Wattiez A, Manhes H, Bruhat MA. PIP: Fertility after conservative laparoscopic treatment for ectopic pregnancy (EP) was studies in 223 patients based on the existence of either past EP, salpingitis, having a single tube, or sterility. These factors impact significantly on fertility rate. The global fertility rate is statistically much higher for patients who do not fit into any of these categories (group a-101 patients) compared to patients with 1 or more criteria (group B-122 patients). For each group, the compared intrauterine pregnancy rate is 90% (91 cases) for group A and 42.6% (52 cases) for group B (p001). The compared ectopic recurrence rate is 5% (5 cases) in group A and 18% (22 cases) in group B (0.001p0.01). The rate of sterility was only 5% (5 cases) in group A as compared to 39.4% (48 cases) in group b (p0.001). Moreover, the fertility rate for patients with 1 or more of the above mentioned criteria is significantly much lower that that of patients without any of the factors examined. This is a significant difference when intrauterine rate, ectopic recurrence rate, and sterility rate are each examined separately. A positive past history for these criteria also affects cumulative intrauterine pregnancy (IUP) rate. For all patients, cumulative IUP rate is 54.60% at 2 years. For patients in group A, this rate increased up to 75.70%. For patients with 1 of these factors, the cumulative IUP rate is only between 12.90% and 25.50%. Finally, these factors delay the onset of subsequent intrauterine pregnancy. Globally, 70% of all IUP occurred with 2 years after the conservative laparoscopic treatment for EP. This rate is 83.20% for patients without any of these factors and 50% for those with at least 1 factor. (author's modified)

Publication

[Fertility after ectopic pregnancy. IV. Proposition for a therapeutic score and a strategy for surgical treatment for ectopic pregnancy].

• 06/1991

466. Contracept Fertil Sex (Paris). 1991 Jun;19(6):461-7. [Fertility after ectopic pregnancy. IV. Proposition for a therapeutic score and a strategy for surgical treatment for ectopic pregnancy]. Pouly JL, Chapron C, Mage G, Canis M, Wattiez A, Manhes H, Bruhat MA. PIP: A series to extrauterine pregnancies treated with conservative laparoscopic techniques was the basis for an evaluation of the subsequent fertility of 223 women. Treatment for extrauterine pregnancy should be based on a proven and reproducible technique that does not expose the patient to a significant risk f complications or failure in the hands of a well trained surgeon. The treatment should preserve the fertility of patients desiring later pregnancy if possible while controlling the risk of recurrence. No operative complications justifying laparotomy were observed in the author's series of 321 cases, and their failure rate of 4.8% was not significantly different from that reported after conservative treatment by laparotomy. Subsequent fertility, explored in terms of intrauterine pregnancy, recurrence of ectopic pregnancy and sterility, or in cumulative intrauterine pregnancy rates, was comparable or superior to that of the principle series treated by laparotomy, whether radical or conservative and using or not using microsurgical techniques. In appears that, in the absence of the few rare contraindications, the most satisfactory surgical treatment of extrauterine pregnancy at present is laparoscopic. The possibility of intrauterine pregnancy should be kept in mind in choosing between radical and conservative laparoscopic treatment. The authors found in their series of 223 patients desiring subsequent pregnancy that factors significantly affecting the fertility prognosis included the presence of adhesions on the tube, the condition of the contralateral tube, and a history of salpingitis. Neither age, parity, nor the characteristics of the extrauterine pregnancy significantly affected the possibility of pregnancy. A treatment score was created based on the results of a multiple regression analysis that assessed the fertility impact of 8 risk factors. A coefficient of 2 was assigned to a history of ectopic pregnancy or tubal microsurgery or to presence of a single tube. A coefficient of 1 was assigned to each additional ectopic pregnancy after the 1st, to a history of laparoscopic adhesiolysis, to homolateral and contralateral adhesions, and to a history of salpingitis. A score of 6 or over indicated that the patient's hopes of subsequent pregnancy would be maximized by radical laparoscopic treatment and sterilization of the contralateral tube to avoid recurrence, and attempts at in vitro fertilization. Patients with a score of 5 had approximately equal chances of recurrence or intrauterine pregnancy after conservative laparoscopic treatment. But radical treatment would greatly reduce chances of recurrence and increase chances of normal pregnancy. Patients with a score of 4 or less had much greater chances of normal pregnancy than of recurrence after conservative laparoscopic treatment. Women desiring pregnancy who failed to conceive within 2 years should be referred for in vitro fertilization.