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Background: The use of total laparoscopic hysterectomy is increasing. However, as with conventional abdominal hysterectomy, vaginal bacteria-related postoperative complications need to be managed in total laparoscopic hysterectomy. Therefore, we started to combine metronidazole vaginal tablets with intravenous administration of cephem antibiotics immediately before starting surgery to reduce complications. To evaluate the effect of this combination, and to determine the risk factors for these complications, we retrospectively collected medical records from our hospital and performed a multivariate analysis. Methods: We reviewed the medical records of 520 patients who underwent total laparoscopic hysterectomy from 1 January 2015 to 31 December 2021. Among these cases, we identified 16 cases as having vaginal bacteria-related postoperative complications, defined as needing more than one additional day for treatment of postoperative complications, namely postoperative infection (10 cases) and vaginal dehiscence (6 cases). First, we evaluate the effect of metronidazole vaginal tablets by dividing the patients into two groups according to whether metronidazole vaginal tablets were used, and comparing the vaginal bacteria-related postoperative complication rates and other indices. Second, we performed a multivariate logistic regression analysis to assess the influence of each of 17 representative factors, including patient characteristics and symptoms, uterus and leiomyoma sizes, concomitant procedures such as laparoscopic cystectomy and pelvic lymphadenectomy, and others. Results: In the multivariate analysis of the 520 cases, we confirmed that the use of metronidazole vaginal tablets could reduce the vaginal bacteria-related postoperative complications rate by more than half (odds ratio, 0.36). In addition to metronidazole vaginal tablets use, concomitant laparoscopic cystectomy and blood transfusion were associated with significant increases in the vaginal bacteria-related postoperative complication rate. Conclusions: The effect of the addition of metronidazole vaginal tablets to pre- and postsurgical treatment on the reduction of vaginal bacteria-related postoperative complications was confirmed. This easy, safe, and low-cost method may improve the management of total laparoscopic hysterectomy. [ABSTRACT FROM AUTHOR]

Abstract: Aim: The aim of this study was to identify predictive factors for emergent surgical interventions in patients with ovarian endometriomas hospitalized for pelvic inflammatory disease (PID). Methods: We retrospectively identified 22 patients with ovarian endometriomas who were hospitalized to manage PID. Patients were divided into two groups: those who required emergent surgery after failed antibiotic therapy (emergent surgery group, n = 6) and those who were discharged with successful antibiotic therapy (conservative group, n = 16). Logistic regression analysis was performed to analyze the factors associated with emergent surgery. Results: Patients in the emergent surgery group were significantly more likely to have intrauterine or intrapelvic procedures before the onset of PID compared to those in the conservative group (83% vs 38%, odds ratio 8.33, 95% confidence interval 1.02–181.3; P = 0.048). The mean interval between the onset of PID symptoms and the commencement of parenteral antibiotic therapy was significantly longer in the emergent surgery compared to the conservative group (6.5 vs 1 day, odds ratio 1.28, 95% confidence interval 1.01–1.75; P = 0.041). Conclusion: A history of an intrauterine or intrapelvic procedure before the onset of PID was more likely to result in emergent surgery. A longer interval between the onset of PID symptoms and the commencement of parenteral antibiotics was also associated with emergent surgery. These findings could help to identify patients with ovarian endometriomas hospitalized with PID at higher risk of emergent surgical intervention. [ABSTRACT FROM AUTHOR]

Background: To determine the prevalence of and risk factors for malignant transformation of ovarian endometrioma during dienogest therapy, which is very rare, we examined multiple cases of malignant transformation of ovarian endometrioma during dienogest therapy and performed a multivariate analysis of the records in our hospital.Methods: The medical records of 174 patients who underwent DNGT for the treatment of OMA from June 1, 2011, to May 31, 2018, were reviewed retrospectively with the approval of the Human Ethical Committee of the University of Teikyo Hospital. And we provided one representative case of MT with obtaining written informed consent. To assess the effects of six representative factors, including advanced age, parity, surgical history, and endometrial cyst characteristics (including 3 factors), on the possibility of malignant transformation, we performed a multivariate logistic regression analysis.Results: Of the 174 cases, 4 were diagnosed with malignant transformation, and these cases are reported. In the multivariate analysis, advanced age (P = 0.0064), nullipara (P = 0.0322), and enlargement (P = 0.0079) showed significant differences for malignant transformation occurrence. All 4 malignant transformation cases were among the 19 patients who had all of these 3 factors.Conclusions: For a more accurate determination of the treatment approach, a larger sample size will be needed to determine the risk factors for malignant transformation during dienogest therapy. [ABSTRACT FROM AUTHOR]