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Abis P, Madeddu C, Magro Malosso G, Sole G, Mereu A, Locci G, Macciò A. Complicated enterocele: timely resolution with bowel resection via a vaginal approach: case report. Front Surg 2023; 10:1228981. [PMID: 37520150 PMCID: PMC10372482 DOI: 10.3389/fsurg.2023.1228981] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 06/28/2023] [Indexed: 08/01/2023] Open
Abstract
Background Enterocele is an uncommon, serious condition that requires accurate and early diagnosis to prevent complications such as intestinal obstruction, incarceration, and strangulation, with consequent intestinal ischemia, necrosis, and evisceration. We report a rare case of a patient with a voluminous enterocele and initial signs of intestinal ischemia who underwent urgent vaginal surgery. Case description An 80-year-old woman presented with a voluminous mass protruding from the vagina, associated abdominopelvic pain, a 10-day history of bowel sub-occlusion, and numerous episodes of profuse vaginal bleeding. She was diagnosed with an enterocele with early signs of complications. Owing to her advanced clinical condition and comorbidities, we opted for an urgent vaginal procedure. Intestinal loops with initial signs of ischemia were resected via a transvaginal approach, leading to good clinical outcomes. She was discharged on postoperative day 5. Conclusions This rare case highlights a surgical emergency that was managed with transvaginal resection of the intestine. Early identification of the initial signs of complications allowed for this less invasive approach, resulting in reduced morbidity and length of hospital stay.
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Affiliation(s)
- Paola Abis
- Department of Obstetrics and Gynecology, ARNAS G. Brotzu, Cagliari, Italy
| | - Clelia Madeddu
- Department of Medical Sciences and Public Health, University of Cagliari, Cagliari, Italy
| | | | - Gabriele Sole
- Department of Obstetrics and Gynecology, ARNAS G. Brotzu, Cagliari, Italy
| | - Alessia Mereu
- Department of Obstetrics and Gynecology, ARNAS G. Brotzu, Cagliari, Italy
| | - Giorgia Locci
- Unit of Anatomic Pathology, ARNAS G. Brotzu, Cagliari, Italy
| | - Antonio Macciò
- Department of Obstetrics and Gynecology, ARNAS G. Brotzu, Cagliari, Italy
- Department of Surgical Sciences, University of Cagliari, Cagliari, Italy
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Kim SM, Baek JM, Song JY, Lee SJ, Park EK, Kim CJ, Lee YS. The use of barbed sutures for vaginal cuff closure during laparoscopic hysterectomy. Arch Gynecol Obstet 2017; 297:691-697. [PMID: 29289989 DOI: 10.1007/s00404-017-4637-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2017] [Accepted: 12/18/2017] [Indexed: 12/13/2022]
Abstract
PURPOSE To compare surgical outcomes and complications of 334 women who underwent total laparoscopic hysterectomy with or without the use of barbed sutures for vaginal cuff closure. METHODS A retrospective study was conducted on a cohort of women who underwent total laparoscopic hysterectomy for benign gynecologic diseases at Dae-Jeon St. Mary's Hospital, between May 2009 and May 2016. Surgical outcomes and complications were compared between the two groups. RESULTS A total of 334 women were included: 212 cases of vaginal cuff suture performed with traditional suture material and 122 cases of vaginal cuff suture performed with the barbed suture. No difference in major complications including vaginal bleeding and vaginal cuff dehiscence was found between the two groups, with a significant reduction in operative times for the barbed suture group (P = 0.002). Underlying clinical variables including diabetes, pelvic adhesion, and obesity showed no significant differences in complication rate. CONCLUSION Vaginal cuff suture performed with barbed suture material is a safe and well-tolerated procedure and reduces operative times. We did not find any meaningful decrease in postoperative vaginal complications including vaginal cuff dehiscence based on the suture material.
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Affiliation(s)
- Su Mi Kim
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jong Min Baek
- Department of General Surgery, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Jae Yen Song
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Sung Jong Lee
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Eun Kyung Park
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Chan Joo Kim
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea
| | - Yong Seok Lee
- Department of Obstetrics and Gynecology, College of Medicine, The Catholic University of Korea, 222, Banpo-daero, Seocho-gu, Seoul, 06591, Republic of Korea.
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Matsuhashi T, Nakanishi K, Hamano E, Kamoi S, Takeshita T. Laparoscopic Repair of Vaginal Evisceration after Abdominal Hysterectomy for Uterine Corpus Cancer: A Case Report and Literature Review. J NIPPON MED SCH 2017; 84:90-95. [DOI: 10.1272/jnms.84.90] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Affiliation(s)
- Tomohiko Matsuhashi
- Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokusoh Hospital
| | - Kazuho Nakanishi
- Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokusoh Hospital
| | - Eri Hamano
- Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokusoh Hospital
| | - Seiryu Kamoi
- Department of Obstetrics and Gynecology, Nippon Medical School Chiba Hokusoh Hospital
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Thomopoulos T, Zufferey G. Totally laparoscopic treatment of vaginal cuff dehiscence: A case report and systematic literature review. Int J Surg Case Rep 2016; 25:79-82. [PMID: 27337703 PMCID: PMC4919793 DOI: 10.1016/j.ijscr.2016.06.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2016] [Accepted: 06/11/2016] [Indexed: 11/28/2022] Open
Abstract
Minimal invasive approaches to hysterectomy, such as total laparoscopic or robotic, can lead to higher incidence of vaginal cuff dehiscence. Vaginal evisceration is a rare but life-threatening complication if it is misdiagnosed. Even if several approaches for the management of the vaginal herniation have been describe in the literature, the entirely laparoscopic treatment seems to be safe and effective, demanding nevertheless a high surgical experience.
Introduction To highlight the laparoscopic management as a feasible treatment option for vaginal cuff dehiscence with intestinal evisceration after hysterectomy. Presentation of case We report a rare case of a 49-year-old postmenopausal woman who was admitted to the emergency department with vaginal herniation of approximately 40 cm of small bowel 3 months after total laparoscopic hysterectomy, treated laparoscopically exclusively. Discussion The patient underwent a laparoscopic reduction of the protruded mass, inspection of the entire small bowel and closure of the vaginal dehiscence. She was discharged home in a good health and the postoperative course remains uneventful 6 months later. Our systematic review of the literature found 116 cases of vaginal evisceration, which were described as early as 1864. There is no consensus on the ideal method of surgical repair. To our knowledge, only 2% (3 cases) were treated totally laparoscopically and 10% by a combined approach (laparoscopic and vaginal). Although the current evidence does not suggest that one approach is preferred to the others, the laparoscopic approach seems to be the new trend for the management of this surgical emergency. Conclusion Totally laparoscopic repair in experience hands seems to be a safe approach to cure vaginal evisceration after pelvic surgery.
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Affiliation(s)
- T Thomopoulos
- Oesogastroduodenal and Bariatric Unit, Department of Abdominal Surgery and Transplantation, Cliniques Universitaires Saint-Luc, 10 Avenue Hippocrate, 1200 Brussels, Belgium.
| | - G Zufferey
- Department of General Surgery, Hospital of Nyon (GHOL), Nyon, Switzerland
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Veciana Colillas M, Vicedo Madrazo E, Iglesias Ferreiro S, Monje Beltran M, Marqueta Sanchez J. Evisceración vaginal con antecedente de cirugía pélvica: 2 casos. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2014. [DOI: 10.1016/j.gine.2013.06.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Arachchi A, Lie F, Davidson A, Saranasuriya C, Vasudevan A. Gut on the floor: vaginal evisceration. ANZ J Surg 2014; 85:690-1. [PMID: 24456200 DOI: 10.1111/ans.12512] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Asiri Arachchi
- Department of General Surgery, Maroondah Hospital, Melbourne, Victoria, Australia
| | - Fanny Lie
- Department of General Surgery, Maroondah Hospital, Melbourne, Victoria, Australia
| | - Adee Davidson
- Department of General Surgery, Maroondah Hospital, Melbourne, Victoria, Australia
| | - Cham Saranasuriya
- Department of General Surgery, Maroondah Hospital, Melbourne, Victoria, Australia
| | - Abinav Vasudevan
- Department of General Surgery, Maroondah Hospital, Melbourne, Victoria, Australia
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Nikolopoulos I, Khan H, Janakan G, Kerwat R. Laparoscopically assisted repair of vaginal evisceration after hysterectomy. BMJ Case Rep 2013; 2013:bcr-2013-009897. [PMID: 23667228 DOI: 10.1136/bcr-2013-009897] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Vaginal evisceration is a rare condition most commonly associated with previous vaginal surgery. It usually presents with vaginal bleeding, lower abdominal pain and a protruding mass, and requires immediate assessment and surgical management to salvage the prolapsed bowel. Any delay in the treatment may result in bowel ischaemia and perforation which is associated with higher morbidity and mortality. We report a case of spontaneous vaginal evisceration during defaecation in a 56-year-old postmenopausal women 11 months post hysterectomy. This case highlights the benefits of a combined laparoscopic and transvaginal approach in the successful management of this surgical emergency.
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8
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Abstract
It is suggested that a laparoscopic approach may simplify repair of vaginal evisceration in patients with intact pelvic organs and limited vaginal exposure. Vaginal evisceration following hysterectomy occurs predominately in postmenopausal patients. Laparotomic repair is most common. This case of a 17-year-old patient with postcoital vaginal evisceration represents the first reported laparoscopic repair in a premenopausal patient with intact pelvic organs.
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Blikkendaal MD, Twijnstra ARH, Pacquee SCL, Rhemrev JPT, Smeets MJGH, de Kroon CD, Jansen FW. Vaginal cuff dehiscence in laparoscopic hysterectomy: influence of various suturing methods of the vaginal vault. ACTA ACUST UNITED AC 2012; 9:393-400. [PMID: 23144640 PMCID: PMC3491192 DOI: 10.1007/s10397-012-0745-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2012] [Accepted: 04/06/2012] [Indexed: 11/26/2022]
Abstract
Vaginal cuff dehiscence (VCD) is a severe adverse event and occurs more frequently after total laparoscopic hysterectomy (TLH) compared with abdominal and vaginal hysterectomy. The aim of this study is to compare the incidence of VCD after various suturing methods to close the vaginal vault. We conducted a retrospective cohort study. Patients who underwent TLH between January 2004 and May 2011 were enrolled. We compared the incidence of VCD after closure with transvaginal interrupted sutures versus laparoscopic interrupted sutures versus a laparoscopic single-layer running suture. The latter was either bidirectional barbed or a running vicryl suture with clips placed at each end commonly used in transanal endoscopic microsurgery. Three hundred thirty-one TLHs were included. In 75 (22.7 %), the vaginal vault was closed by transvaginal approach; in 90 (27.2 %), by laparoscopic interrupted sutures; and in 166 (50.2 %), by a laparoscopic running suture. Eight VCDs occurred: one (1.3 %) after transvaginal interrupted closure, three (3.3 %) after laparoscopic interrupted suturing and four (2.4 %) after a laparoscopic running suture was used (p = .707). With regard to the incidence of VCD, based on our data, neither a superiority of single-layer laparoscopic closure of the vaginal cuff with an unknotted running suture nor of the transvaginal and the laparoscopic interrupted suturing techniques could be demonstrated. We hypothesise that besides the suturing technique, other causes, such as the type and amount of coagulation used for colpotomy, may play a role in the increased risk of VCD after TLH.
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Affiliation(s)
- M. D. Blikkendaal
- Department of Gynaecology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - A. R. H. Twijnstra
- Department of Gynaecology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - S. C. L. Pacquee
- Department of Gynaecology, Bronovo Hospital, PO Box 96900, 2509 JH The Hague, the Netherlands
| | - J. P. T. Rhemrev
- Department of Gynaecology, Bronovo Hospital, PO Box 96900, 2509 JH The Hague, the Netherlands
| | - M. J. G. H. Smeets
- Department of Gynaecology, Bronovo Hospital, PO Box 96900, 2509 JH The Hague, the Netherlands
| | - C. D. de Kroon
- Department of Gynaecology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands
| | - F. W. Jansen
- Department of Gynaecology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, the Netherlands
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Vaginal cuff dehiscence: risk factors and management. Am J Obstet Gynecol 2012; 206:284-8. [PMID: 21974989 DOI: 10.1016/j.ajog.2011.08.026] [Citation(s) in RCA: 86] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2011] [Revised: 08/17/2011] [Accepted: 08/23/2011] [Indexed: 11/24/2022]
Abstract
Vaginal cuff dehiscence and evisceration are rare but serious complications of pelvic surgery, specifically hysterectomy. The data on risks of vaginal cuff dehiscence are variable, and there is no consensus on how to manage this complication. In our review, we present a summary of the risk factors, with symptoms, precipitating events, and treatment options for patients with vaginal cuff dehiscence after pelvic surgery. In addition, we provide a review of the current literature on this important surgical outcome and suggestions for future research on the incidence and prevention of vaginal cuff dehiscence.
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Halwani Y, Nicolau-Toulouse V, Oakes J, Leipsic J, Geoffrion R, Wiseman SM. Transvaginal strangulated small intestinal hernia after abdominal sacrocolpopexy: case report and literature review. Hernia 2011; 17:279-83. [PMID: 21761210 DOI: 10.1007/s10029-011-0848-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2011] [Accepted: 06/18/2011] [Indexed: 10/18/2022]
Abstract
PURPOSE To report a case of transvaginal small intestinal hernia following abdominal sacrocolpopexy and review this clinical presentation in the current literature. METHODS A review of our case and a literature review of vaginal evisceration were carried out. RESULTS The patient underwent sacrocolpopexy and a Burch procedure. Six months later, a recurrent enterocele through a 1 cm defect in the vaginal vault was diagnosed. Several weeks later she presented with an incarcerated and strangulated loop of small intestine extending beyond the introitus. This required an urgent exploratory laparotomy, ileocecal resection, and vaginal vault closure. Postoperatively, she experienced gradual prolapse recurrence and is currently successfully managed with a pessary. Risk factors that include vaginal atrophy, chronic constipation, and previous pelvic surgery may have contributed to the evisceration, mesh erosion, and may have caused the breakdown in the vaginal vault mucosa ultimately responsible for the evisceration. In addition, placement of the sacrocolpopexy mesh without tension, and utilization of an interposition graft to reinforce the weakened vaginal vault tissue, are aspects of the surgical procedure that may influence outcomes. At the time of evisceration repair, the best approach to resuspend the vaginal vault, and prevent recurrent prolapse or evisceration, is currently unknown. CONCLUSION Vaginal evisceration is a potential complication of abdominal sacrocolpopexy. Early recognition and treatment of this complication is critical, and prolapse recurrence may occur even after surgical repair.
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Affiliation(s)
- Y Halwani
- Department of Surgery, St Paul's Hospital and University of British Columbia, C 303-1081 Burrard Street, Vancouver, BC, V6Z 3W8, Canada
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Siddiqui I, Samee A, Hall C, Cooper J, O'Mahony F. Spontaneous vaginal evisceration. BMJ Case Rep 2011; 2011:2011/mar02_1/bcr1020103410. [PMID: 22707628 DOI: 10.1136/bcr.10.2010.3410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Management of vaginal prolapse in the elderly lacks a uniform consensus and continues to remain challenging. The authors report a case of an elderly lady who presented with a spontaneous vaginal evisceration. She had a long-standing vaginal prolapse being controlled by a shelf pessary, which, in her case became displaced 2 weeks prior to admission. The patient underwent a laparotomy with an intent to replace the bowel back within the peritoneal cavity and repair the vault. During the pelvic floor repair, she sustained an inadvertent button-hole injury to the rectum, which was oversewn. She went on to develop a rectovaginal fistula requiring a de-functioning colostomy. The patient made good recovery subsequently.
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Affiliation(s)
- I Siddiqui
- Department of Obstetrics and Gynaecology, University Hospital of North Staffordshire, Stoke-on-Trent, UK
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Sinclair MDJ, Davies AR, Sankaran S, Agnihotri S, Andreani SM. Laparoscopic repair of spontaneous vaginal evisceration of small bowel: report of a case. Ann R Coll Surg Engl 2010; 92:W3-5. [PMID: 20056044 DOI: 10.1308/147870810x476610] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Spontaneous vaginal evisceration of the small bowel is a rare event. It is precipitated in the postmenopausal woman commonly by hysterectomy and in the premenopausal woman by vaginal trauma. We report a case of a 75-year-old woman presenting with a protruding mass in her vagina and associated abdominal pain. A combined laparoscopic and transvaginal method of repair is described and the advantage of using both techniques highlighted.
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A prospective comparison of vaginal stump suturing techniques during total laparoscopic hysterectomy. Arch Gynecol Obstet 2009; 282:631-8. [DOI: 10.1007/s00404-009-1300-0] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2009] [Accepted: 11/12/2009] [Indexed: 10/20/2022]
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Lundvall L, Jensen F, Roed H, Ottosen C, Ewertsen C, Henriksen BM. Vaginal rupture caused by transvaginal ultrasonography in follow-up for ovarian cancer. BMJ Case Rep 2009; 2009:bcr05.2009.1860. [PMID: 21841949 DOI: 10.1136/bcr.05.2009.1860] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
Vaginal rupture is a rare complication of hysterectomy. It is, among others, related to age and the incidence is higher in postmenopausal women. The rupture can occur spontaneously or in relation to clinical follow-up. In ovarian cancer the follow-up after surgery includes clinical examination, cancer antigen (CA)-125, and transabdominal and transvaginal ultrasonography. We experienced vaginal rupture in three patients with ovarian cancer. All patients had undergone surgery for ovarian cancer and were receiving chemotherapy. The rupture occurred shortly after transvaginal ultrasonography, performed by separate radiologists specialised in ultrasonography. All patients had acute surgery without any complications. Caution should be taken when performing transvaginal ultrasonography in hysterectomised patients and the complication of vaginal rupture should always be borne in mind.
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Affiliation(s)
- Lene Lundvall
- Rigshospitalet, Copenhagen University Hospital, Department of Gynaecology, Blegdamsvej 9, Copenhagen OE, DK-2100, Denmark
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