[Show abstract][Hide abstract] ABSTRACT: Background Endoscopic resection (ER) with or without ablation is the first choice treatment for early Barrett’s neoplasia. Adequate staging is important to assure a good oncological outcome.
Preview · Article · Jan 2016 · United European Gastroenterology Journal
[Show abstract][Hide abstract] ABSTRACT: To investigate whether the pattern or pain or bleeding during levonorgestrel intrauterine system (LNG-IUS) insertion and in the first 6 weeks thereafter is altered by LNG-IUS malposition.
Prospective cohort of 413 women undergoing LNG-IUS insertion or replacement. A first questionnaire on pain perception was completed by the women immediately after insertion. In a second questionnaire the women were asked to record pain in the 3 days following insertion and both pain and bleeding from 4 to 6 weeks after insertion. Six weeks after insertion a 2D- and 3D-ultrasound examination was performed to evaluate the position of the LNG-IUS and of the uterus.
Parity was inversely related to pain at insertion, in the first 3 days and at 4-6 weeks. LNG-IUS insertion was less painful in the postpartum period. Women who had had a LNG-IUS as prior contraceptive method reported a higher percentage of amenorrhea at 4-6 weeks. The position of the LNG-IUS or of the uterus did not influence the pain scores or the bleeding pattern. The fact that the LNG-IUS arms appeared embedded in the uterine wall on coronal 3D-volume reconstruction did not influence pain or the bleeding pattern.
Because neither pain nor bleeding is a reliable predictor of LNG-IUS position, we suggest an ultrasound examination to confirm correct LNG-IUS placement in all patients at about 6 weeks after insertion.
No preview · Article · Aug 2013 · European journal of obstetrics, gynecology, and reproductive biology
[Show abstract][Hide abstract] ABSTRACT: The present experimental study is aimed at a combined uniaxial and biaxial mechanical characterization of the deformation behavior of two types of prosthetic meshes, SPMM (heavy-weight) and Gynemesh M (light-weight, partly absorbable), after integration in the host tissue. Explants from a full-thickness-abdominal-wall-defect-rabbit-model were tested in the two loading conditions. Corresponding protocols and data analysis procedures for biaxial inflation tests and uniaxial tensile tests were developed. Biaxial responses were observed to be by factor 2-4 stiffer compared to corresponding uniaxial experiments, depending on the material tested. In biaxial loading conditions, SPMM explants were stiffest. Gynemesh M explants and native tissue were similarly compliant at low membrane tensions (<5N/cm) (abdominal wall: 40±23N/cm, Gynemesh M: 59±44N/cm, SPMM: 145±36N/cm). At high membrane tensions (>5N/cm), there were distinct differences in the stiffness of the three groups, SPMM explants being the stiffest, followed by Gynemesh M explants and native tissue being the most compliant. In uniaxial loading conditions, the two explants were similarly stiff and distinctly stiffer than native tissue at low membrane tensions (<5N/cm) (abdominal wall: 9±1N/cm, Gynemesh M: 21±5N/cm, and SPMM: 24±5N/cm). At high membrane tension (>5N/cm), differences between all groups vanished. Biaxial and uniaxial tests yield different results with respect to the mechanical behavior of mesh explants. These findings demonstrate that an evaluation of the mechanical biocompatibility of prosthetic meshes should be based on an experimental configuration (uniaxial or biaxial tension) which reproduces the expected in vivo conditions of mechanical loading and deformation.
No preview · Article · May 2013 · Journal of Biomechanics
[Show abstract][Hide abstract] ABSTRACT: Laparoscopy offers great exposure and surgical detail, reduces blood loss and the need for excessive abdominal packing and bowel manipulation making it an excellent modality to perform pelvic floor surgery. Laparoscopic repair of level I or apical vaginal prolapse may be challenging, due to the need for extensive dissection and advanced suturing skills. However it offers the efficacy of open abdominal sacrocolpopexy, such as lower recurrence rates and less dyspareunia than sacrospinous fixation, as well as the reduced morbidity of a laparoscopic approach.
No preview · Article · Dec 2011 · Ceska gynekologie / Ceska lekarska spolecnost J. Ev. Purkyne
[Show abstract][Hide abstract] ABSTRACT: Please cite this paper as: Ozog Y, Konstantinovic M, Werbrouck E, De Ridder D, Mazza E, Deprest J. Persistence of polypropylene mesh anisotropy after implantation: an experimental study. BJOG 2011; DOI: 10.1111/j.1471-0528.2011.03018.x.
Objective To determine whether anisotropy persisted after incorporation into the host, using a standardised rabbit model for abdominal wall reconstruction.
Design Investigator-initiated prospective-controlled experimental study.
Setting Centre for Surgical Technologies, Medical Faculty KU-Leuven.
Sample Fifteen New Zealand White rabbits.
Methods In each rabbit, four full thickness primarily repaired abdominal wall defects were covered by a 4 × 5-cm Prolift+M implant (Johnson & Johnson, Norderstedt, Germany), either with the stiffest (n = 6 rabbits) or most elastic (n = 6) direction parallel to the body axis. Prolift+M contains 32 g/m2 polypropylene, reinforced with polyglecaprone fibres. Harvesting was performed after 30, 60 and 120 days (n = 2 each time-point). The abdominal wall of three unoperated rabbits was used as negative control.
Main outcome measures Contraction, compliance and maximal strain and stress determined by uniaxial tensiometry.
Results Anisotropy properties persist at lower, more physiological displacements, but not at higher displacements. The stiffness of a mesh-augmented repair in the lower strain range remains above that of native tissue. Eventual mesh contraction was limited to 4.3%.
Conclusions Anisotropic properties of Prolift+M persist in vivo and shrinkage is minimal. Compliance of mesh-augmented repair remains less than that of native tissue. The functional consequences of this remain to be studied.
Full-text · Article · Jun 2011 · BJOG An International Journal of Obstetrics & Gynaecology
[Show abstract][Hide abstract] ABSTRACT: The experiment evaluated different lightweights (<32 g/m(2)) in terms of shrinkage and biomechanics.
PP-8 (polypropylene of 7.6 g/m(2)), PP-s (PP-8 with absorbable sheets), PP-32 (PP with absorbable fibers; 32.0 g/m(2)) and polyvinylidinefluoride (PVDF; 24.9 g/m(2)) augmented primary sutured repairs of the anterior abdominal wall in a total of 40 rabbits. Rabbits were implanted by only one type of mesh at four abdominal sites. After 7, 14, 30, 60 and 120 days, 2 rabbits were sacrificed per group. Three additional unoperated rabbits were used as controls. Shrinkage and uni-axial tensiometry were evaluated.
PP-s implants wrinkled in 70%. PP-32 did not shrink whereas PP-8 and PVDF shrank by 20%. Explants were as strong as the controls; however, they differed in compliance. At lower stress, the tested materials were equally stiff.
The biomechanical behaviour of the tested lightweights does not mimic that of native controls. Weight reduction does not prevent shrinkage.
No preview · Article · May 2011 · International Urogynecology Journal
[Show abstract][Hide abstract] ABSTRACT: Laparoscopy offers great exposure and surgical detail, reduces blood loss and the need for excessive abdominal packing-- and bowel manipulation making it an excellent modality to perform pelvic floor surgery. Laparoscopic repair of level I or apical vaginal prolapse may be challenging, due to the need for extensive dissection and advanced suturing skills. However, it offers the efficacy of open abdominal sacrocolpopexy, such as lower recurrence rates and less dyspareunia-- than sacrospinous fixation, as well as the reduced morbidity of a laparoscopic approach.
[Show abstract][Hide abstract] ABSTRACT: To compare saline infusion sonography (SIS) with gel instillation sonography (GIS) in terms of feasibility and diagnostic accuracy.
Prospective cohort study.
Leuven University bleeding clinic.
A total of 804 patients: two consecutive cohorts of 402 women undergoing SIS or GIS.
Vaginal ultrasound (n=804) followed by SIS (n=402) or GIS (n=402); office hysteroscopy in 685 patients, and endometrium sampling in 487 patients; surgery in 274 women: operative hysteroscopy (n=230) or hysterectomy (n=44).
Patients' characteristics, technical failure rates, and final diagnosis. Pathology was defined as endometrial hyperplasia, polyp, cancer, or intracavitary myomas.
The technical failure rate (difference between proportions and confidence interval) was 5.0% for SIS versus 1.8% for GIS, respectively (3.21; [0.69-5.95]). Failure due to inadequate distension was 1.5% versus 0.3% for SIS and GIS, respectively (1.25; [-0.16-2.99]). Pathology was diagnosed in 180 patients (49%) of the SIS group versus 147 patients of the GIS group (40.2%) (8.88; [1.69-15.95]). The sensitivity was 77.8% and 85.0%, respectively (NS). The negative predictive value was 79.1% for SIS and 88.6% for GIS (9.54; [2.17-16.89]).
Gel instillation sonography is a feasible, accurate alternative for SIS in the evaluation of women with abnormal bleeding, and has fewer technical failures.
No preview · Article · Jan 2011 · Fertility and sterility
[Show abstract][Hide abstract] ABSTRACT: Laparoscopy may yield better exposure and surgical detail, reduce blood loss and the need for excessive abdominal packing
and bowel manipulation, which may all lead to a lesser morbidity.1 Laparoscopy has now also found its way to the field of urogynecology. Recently, laparoscopic colposuspension was shown to
be equally effective as an open procedure at 2-years follow-up.2 Whereas colposuspension as primary therapy for urinary stress incontinence is on its way back, because of a lesser invasive
and equally effective vaginal approach, other urogynecologic procedures may still benefit from an abdominal approach. Surgical
repair of level I or apical vaginal defects, that also preserves vaginal function, can be performed either vaginally or through
abdominal approach.3 Randomized trials, however, have shown that sacrocolpopexy offers lower recurrence rates and less dyspareunia than sacrospinous
fixation, but at the expense of a longer recovery time.4 Logically, laparoscopic sacrocolpopexy (LSC) may reduce the latter morbidity. LSC was embraced later than colposuspension,
probably because vault prolapse occurs more rarely and LSC needs extensive dissection and advanced suturing skills.5 Data on LSC initially were limited to observational studies of variable size.6–14 They covered issues such as perioperative parameters, reported short-term results, and were usually retrospective in design.