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Fritel X, de Tayrac R, de Keizer J, Campagne-Loiseau S, Cosson M, Ferry P, Deffieux X, Lucot JP, Wagner L, Debodinance P, Saussine C, Pizzoferrato AC, Carlier-Guérin C, Thubert T, Panel L, Bosset PO, Nkounkou E, Ramanah R, Boisramé T, Charles T, Raiffort C, Charvériat A, Ragot S, Fauconnier A. Serious complications and recurrences after pelvic organ prolapse surgery for 2309 women in the VIGI-MESH registry. BJOG 2021; 129:656-663. [PMID: 34541781 DOI: 10.1111/1471-0528.16892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2021] [Indexed: 11/27/2022]
Abstract
OBJECTIVE To assess the incidence of serious complications and reoperations for recurrence after surgery for pelvic organ prolapse (POP) and compare the three most common types of repair. DESIGN Prospective cohort study using a registry. SETTING Nineteen French surgical centres. POPULATION A total of 2309 women participated between 2017 and 2019. METHODS A multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. MAIN OUTCOME MEASURES Serious complications and subsequent reoperations for POP recurrence. RESULTS The median follow-up time was 17.6 months. Surgeries were native tissue vaginal repairs (n = 504), transvaginal mesh placements (n = 692) and laparoscopic sacropexies with mesh (n = 1113). Serious complications occurred among 52 women (2.3%), and reoperation for POP recurrence was required for 32 women (1.4%). At 1 year the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair, 3.9% for transvaginal mesh and 2.2% for sacropexy, and the rates for reoperation for recurrence of POP were 1.5, 0.7 and 1.1%, respectively. Compared with native tissue vaginal repair, the risk of serious complications was higher in the transvaginal mesh group (weighted hazard ratio, wHR 3.84, 95% CI 2.43-6.08) and the sacropexy group (wHR 2.48, 95% CI 1.45-4.23), whereas the risk of reoperation for prolapse recurrence was lower in both the transvaginal mesh (wHR 0.22, 95% CI 0.13-0.39) and sacropexy (wHR 0.29, 95% CI 0.18-0.47) groups. CONCLUSIONS Our results suggest that native tissue vaginal repairs have the lowest risk of serious complications but the highest risk of reoperation for recurrence. These results are useful for informing women and for shared decision making. TWEETABLE ABSTRACT Laparoscopic sacropexy had fewer serious complications than transvaginal mesh and fewer reoperations for recurrence than vaginal repair.
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Affiliation(s)
- X Fritel
- Service de Gynécologie, CHU de Poitiers, Poitiers, France.,Université de Poitiers, INSERM CIC 1402, Poitiers, France
| | - R de Tayrac
- Service de Gynécologie, CHU Carémeau, Nîmes, France
| | - J de Keizer
- Université de Poitiers, INSERM CIC 1402, Poitiers, France
| | | | - M Cosson
- Service de Gynécologie, CHU de Lille, Lille, France
| | - P Ferry
- Service de Gynécologie, CH de La Rochelle, La Rochelle, France
| | - X Deffieux
- Service de Gynécologie, APHP Antoine-Béclère, Clamart, France
| | - J-P Lucot
- Service de Gynécologie, Hôpital Saint-Vincent-de-Paul, Lille, France
| | - L Wagner
- Service d'Urologie, CHU Carémeau, Nîmes, France
| | - P Debodinance
- Service de Gynécologie, CH de Dunkerque, Dunkerque, France
| | - C Saussine
- Service d'Urologie, CHU de Strasbourg, Strasbourg, France
| | | | - C Carlier-Guérin
- Service de Gynécologie, CH de Châtellerault, Châtellerault, France
| | - T Thubert
- Service de Gynécologie, CHU de Nantes, Nantes, France
| | - L Panel
- Service de Gynécologie, Clinique Beau-Soleil, Montpellier, France
| | - P-O Bosset
- Service d'Urologie, Hôpital Foch, Suresnes, France
| | - E Nkounkou
- Service de Gynécologie, CH de Béthune, Béthune, France
| | - R Ramanah
- Université de Franche-Comté, CHU de Besançon, Besançon, France
| | - T Boisramé
- Service de Gynécologie, CHU de Strasbourg, Strasbourg, France
| | - T Charles
- Service d'Urologie, CHU de Poitiers, Poitiers, France
| | - C Raiffort
- Service de Gynécologie, Groupe Hospitalier Diaconesses-Croix-Saint-Simon, Paris, France
| | - A Charvériat
- Service de Gynécologie, CHU de Poitiers, Poitiers, France
| | - S Ragot
- Université de Poitiers, INSERM CIC 1402, Poitiers, France
| | - A Fauconnier
- Service de Gynécologie, CHI Poissy-Saint-Germain, Poissy, France
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Charles T, De Tayrac R, Campagne-Loiseau S, Cosson M, Ferry P, Deffieux X, Lucot JP, Wagner L, Debodinance P, Saussine C, Pizzoferrato AC, Carlier-Guérin C, Thubert T, Panel L, Bosset PO, Nkounkou E, Ramanah R, Boisramé T, Raiffort C, Chavériat A, Fauconnier A, Fritel X. Serious complications and recurrences after pelvic organ prolapse surgery for 2,309 women in the VIGI-MESH registry. Eur Urol 2021. [DOI: 10.1016/s0302-2838(21)00763-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Belghiti J, Tassin M, Raiffort C, Zappa M, Poujade O, Bout H, Mandelbrot L. [Uterine necrosis after arterial embolization for postpartum hemorrhage]. ACTA ACUST UNITED AC 2012; 42:126-128. [PMID: 22342505 DOI: 10.1016/j.gyobfe.2011.07.045] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2011] [Accepted: 05/31/2011] [Indexed: 11/15/2022]
Abstract
Radiologic embolization of the uterine arteries is increasingly used to treat severe postpartum hemorrhage, as an alternative to surgical procedures. Guidelines have been published in order to standardize the indications as well as the technique. An important objective was to limit severe complications such as uterine necrosis. We report a case of a uterine necrosis after arterial embolization for severe postpartum hemorrhage due to uterine atony on a uterus with fibroids. This complication occurred despite the use of the recommended technique.
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Affiliation(s)
- J Belghiti
- Hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92701 Colombes, France
| | - M Tassin
- Hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92701 Colombes, France
| | - C Raiffort
- Hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92701 Colombes, France
| | - M Zappa
- Hôpital Beaujon, AP-HP, hôpitaux universitaires Paris Nord Val de Seine, université Paris-Diderot, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - O Poujade
- Hôpital Beaujon, AP-HP, hôpitaux universitaires Paris Nord Val de Seine, université Paris-Diderot, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - H Bout
- Hôpital Beaujon, AP-HP, hôpitaux universitaires Paris Nord Val de Seine, université Paris-Diderot, 100, boulevard du Général-Leclerc, 92110 Clichy, France
| | - L Mandelbrot
- Hôpital Louis-Mourier, AP-HP, 178, rue des Renouillers, 92701 Colombes, France.
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Abstract
The management of a pheochromocytoma during pregnancy is uncommon and is at high risk for both mother and foetus. We report a case of a patient whose first pregnancy was complicated by foetal demise in a context suggestive of preeclampsia. She was diagnosed with pheochromocytoma as she was beginning a second pregnancy. A laparoscopic adrenalectomy was performed in the first trimester of pregnancy, and maternal and neonatal outcome were favourable. This case illustrates the difficulty of diagnosing pheochromocytoma in pregnancy, and the benefits of laparoscopic treatment in the first trimester.
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Affiliation(s)
- P Oger
- Service de Gynécologie-Obstétrique, Hôpital Louis-Mourier (AP-HP), 178, rue des Renouillers, 92700 Colombes, France
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Huchon C, Raiffort C, Chis C, Messaoudi F, Jacquemot MC, Panel P. [Caesarean section: closure or non-closure of peritoneum? A randomized trial of postoperative morbidity]. ACTA ACUST UNITED AC 2006; 33:745-9. [PMID: 16154376 DOI: 10.1016/j.gyobfe.2005.08.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2005] [Accepted: 08/04/2005] [Indexed: 11/29/2022]
Abstract
OBJECTIVE To evaluate postoperative morbidity with non-closure of the visceral and parietal peritoneum during caesarean section. PATIENTS AND METHODS A prospective randomized study of 170 patients. Operative time, postoperative pain, postoperative morbidity (febrile morbidity, wound haematoma, wound infection, postoperative ileus) and length of hospital stay were compared between the two groups. RESULTS Duration of operation was significantly shorter without peritoneal closure (38.89 vs 42.00 minutes; P<0.05). Wound haematoma were more frequent when peritoneum was closed (P<0.029). There were no significant difference between the two groups for postoperative ileus, length of hospital stay, postoperative pain and other complications. DISCUSSION AND CONCLUSION We report the first French study on this subject. In this study, non-closure of both visceral and parietal peritoneum is associated with shorter operation duration and seems to reduce immediate complications. A long-term evaluation of morbidity, regarding adhesions is necessary.
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Affiliation(s)
- C Huchon
- Service de gynécologie-obstétrique, hôpital André-Mignot, centre hospitalier de Versailles, 177, rue de Versailles, 78157 Le-Chesnay cedex, France
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