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Purpose: Patient-reported minimal clinically important differences (MCID) provide a standard to compare clinical outcomes. The purpose of this study was to calculate the MCID of PROMIS Physical Function (PF), Pain Interference (PI), Anxiety (AX), and Depression (DEP) scores in patients with pelvis and/or acetabular fractures. Methods: All patients with operatively treated pelvic and/or acetabular fractures were identified. Patients were categorized as either only pelvis and/or acetabular fractures (PA) or polytrauma (PT). PROMIS PF, PI, AX, and DEP scores were evaluated at 3-month, 6-month, and 12-month intervals. Distribution-based MCID and anchor-based MCID were calculated for the overall cohort, PA, and PT groups. Results: The overall distribution-based MCIDs were PF (5.19), PI (3.97), AX (4.33), and DEP (4.41). The overall anchor-based MCIDs were PF (7.18), PI (8.03), AX (5.85), DEP (5.00). The percentage of patients achieving MCID for AX was 39.8–54% at 3 months and 32.7–56% at 12 months. The percentage of patients achieving MCID for DEP was 35.7–39.3% at 3 months and 32.1–35.7% at 12 months. The PT group had worse PROMIS PF scores than the PA group at all time points [post-operative, 3-month, 6-month, and 12-month scores, (28.3 (6.3) vs. 26.8 (6.8) P = 0.016), (38.1 (9.2) vs. 35.0 (8.7) P = 0.037), (42.8 (8.2) vs. 39 (9.6) P = 0.015), (46.2 (9.7) vs. 41.2 (9.7) P = 0.011)]. Conclusion: An overall MCID for PROMIS PF was 5.19–7.18, PROMIS PI 3.97–8.03, PROMIS AX of 4.33–5.85, and PROMIS DEP of 4.41–5.00. The PT group had worse PROMIS PF at all time points. The percentage of patients achieving MCID for AX and DEP plateaued at 3 months post-operatively. Level of evidence: Level IV. [ABSTRACT FROM AUTHOR]

Ileus and pseudo-obstruction are clinical syndromes that are among the most common postoperative complications. Identifying an effective treatment approach for these conditions is essential. Therefore, the aim of this study is to investigate the effect of Dimethicone on preventing ileus in patients with pelvic and femoral fractures.This study was conducted on 120 patients, with 60 individuals in the Dimethicone group and 60 individuals in the control group. After recording demographic information and clinical notes, bowel movements and defecation after surgery were also recorded. The statistical tests of Chi-square, Fisher's exact-test, Mann-Whitney, and independent t-test were utilized to compare the data.The primary outcome of the study determined the incidence of ileus in the intervention and control groups (intervention group = 1.7 % and control group = 3.3 %) (P = 0.99). The secondary outcome involved comparing the time of gas expulsion between the two groups, intervention, and control (intervention group = 21.05 h and control group = 22.03 h) (P = 0.065). Although the time of gas and feces expulsion, as well as the initiation of bowel movements and the occurrence of ileus, were lower in the intervention group, there was no statistically significant difference in the postoperative results, particularly regarding the occurrence of ileus and the reduction in the duration of feces and gas expulsion and the initiation of bowel movements in patients receiving Dimethicone compared to the control group.Considering the lack of statistical significance in the obtained results and the absence of similar studies using Dimethicone, further research and larger sample size studies with Dimethicone or other pharmacological methods are needed to find the most effective treatment approach in reducing the occurrence of ileus after surgery.

Introduction: Albeit rare, open pelvic fractures are life threatening injuries associated with significant morbidity and mortality. Due to their rarity, there is paucity of data and literature on best management practices. An open pelvic fracture is one where there is a connection between the fracture site and either the skin, rectum, vagina, or genitourinary system. They commonly affect young individuals involved in high energy injuries. During resuscitation, prompt recognition and control of sepsis and stabilization of unstable fractures should precede definitive management. Materials and methods: We conducted a retrospective study of prospectively collected data between 2012 and 2022 for patients managed in two teaching hospitals in Kenya. All patients were followed up for at least 6 months. The Faringer classification was used to classify the soft tissue wounds and the Young and Burgess classification was used to classify the pelvic fractures. We investigated their functional outcomes using their ability to ambulate independently and the Merle d' Aubigne-Postel score. Results: Eight patients with an average age of 31 years were included. All were referrals. Three (37.5 %) developed sepsis but resolved. Four (50 %) needed a diverting stoma, which included 2 of the 3 patients who had developed sepsis. 5(62.5 %) needed an external fixator as part of definitive management. There were no mortalities. All achieved full independent ambulation; and all our patients achieved an average Merle d' Aubigne-Postel score of 17. Conclusion: Our study demonstrates that early sepsis control, appropriate fracture fixation and a multidisciplinary approach can yield satisfactory functional outcomes.

Pelvic schwannomas are rare tumors that may occur either sporadically or in the context of schwannomatosis. We retrospectively reviewed the charts of patients harboring a pelvic schwannoma under conservative management or operated at our reference center between 2016 and 2023. All patients were operated by a multidisciplinary team, combining a vascular surgeon and a neurosurgeon. Twenty-four patients harboring 33 pelvic tumors were included in the cohort, including 12 patients with sporadic lesions, 2 patients with NF2-related schwannomatosis, and 10 patients with NF2-independent schwannomatosis. Multi-nodular tumors were more frequent in schwannomatosis compared to sporadic cases (p = 0.005). The mean age at diagnosis was 41 years old. Schwannomas were located on branches of the sciatic nerve (23/33, 70%), the femoral nerve (6/33, 18%), and the obturator nerve (4/33, 12%). Over the course of the study, 16 patients were operated, including 11 sporadic cases. The indication for surgery was pain (12/16, 75%) or tumor growth (4/16, 25%). Complete resection was achieved in 14 of 16 patients (87%). The mean post-operative follow-up was 37 months (range: 2–168 months). At last-follow-up, complete pain relief was achieved in all 12 patients with pre-operative pain. Post-operative morbidity included 3 long-term localized numbness and one MRC class 4 motor deficit in a multi-nodular tumor in a schwannomatosis patient. Despite its limited size, our series suggests that nerve-sparing resection of pelvic schwannomas offers satisfying rates of functional outcome both in sporadic and schwannomatosis cases, except for multi-nodular tumors. [ABSTRACT FROM AUTHOR]

Abstract Background Limb salvage reconstruction for pelvic tumors, especially periacetabular tumors, is challenging. We combined the use of dual mobility bearing and 3D-printed hemipelvic prosthesis to improve function and reduce the probability of complications after hemi-pelvic resection in patients with primary acetabular malignancy. The purpose of this study was to evaluate the efficacy and safety of this combination. Methods Between October 2011 and May 2021, 11 patients with malignancies involving the acetabulum received hemipelvic replacement with a 3D-printed prosthesis and dual mobility bearing. Follow‐up of postoperative survival, complications, and Musculoskeletal Tumor Society 93 (MSTS-93) lower limb functional scores were carried out. A finite element model of the postoperative pelvis was developed and input into the finite element analysis software. The Von Mises equivalent stress formula was used to analyze the stress distribution of each part of the pelvis under one gait cycle and the stress distribution at different angles of the hip joint. Results By the last follow-up, 9 of the 11 patients (81.8%) were still alive, and 2 patients had local tumor recurrence. The complications including 1 deep infection and 1 dislocation of the artificial joint. Excluding 1 amputation patient, the average score of the remaining 8 patients at the last follow-up was 21.4/30 (71.3%) on the MSTS-93. In the reconstructed pelvis, stress distributions were concentrated on the junction between hemipelvic prosthesis and screw and iliac bone on the resected side, and between femoral prosthesis stem and femoral bulb, while the stress of polyethylene lining was small. Before impact, the polyethylene lining will rotate at a small angle, about 3°. The inner stress of polyethylene liner is greater than the outer stress in all conditions. The polyethylene liner has no tendency to slide out. Conclusion Pelvic tumor resection and reconstruction using 3D-printed hemipelvic prosthesis combined with dual mobility bearing was an effective treatment for pelvic tumors. Our patients achieved good early postoperative efficacy and functional recovery. The dual mobility bearing is beneficial to prevent dislocation, and the mechanical distribution and wear of the prosthesis are acceptable.

Introduction: The vermiform appendix is a worm-like tube situated in the right iliac fossa. It arises from the posteromedial caecal wall, 2 cm or less below the end of the ileum and suspended by a peritoneal fold known as meso appendix. Position of the appendix influences its mobility. Most common position of appendix has been reported to be retrocaecal followed by pelvic position. But there are other variable positions also reported by many. Aim: To study the anatomical variations of the positions of vermiform appendix in human cadavers. Materials and Methods: This was a descriptive cross-sectional study which was carried out in the Department of Anatomy, Assam Medical College, Dibrugarh, Assam, India, from June 2020 to May 2021. Total 14 adult cadavers and 66 newborn cadavers were included in the study. All the cadavers were dissected and abdominal cavity was explored. The position of the appendix was then noted in all specimens. Results: In most of the cases the position of vermiform appendix was found in retrocaecal position followed by pelvic, pre-ileal and paracolic. In adults, retrocaecal positions were more in males (88.9%) than females (40%) in contrast to newborns where retrocaecal positions were more in females (76.7%). As a whole, retrocaecal position (66.25%) of appendix was the commonest finding in all cadavers. This was followed by pelvic (30%) position. Paracolic (2.5%) and pre-ilial (1.25%) positions were also noted in newborn cadaver. Conclusion: Knowing the variations in the position of appendix will guide the surgeons during intraoperative procedures. Since the positions of appendix vary considerably signs and symptoms also vary depending upon the different positions. Hence, the knowledge of its diverse anatomical positions is of utmost importance which helps the surgeons in proper management of appendicular pathology

In recent years, endometrial cancer has taken the lead among oncological processes of the female reproductive system. The high prevalence of this disease leads to disability of the working-age population, large socio-economic losses, which determines the relevance of this problem and the search for new methods of screening, diagnostics, optimal selection of treatment, thereby affecting the quality of future life. The choice of the method of treatment of patients depends on the following main factors: age, general condition, reproductive plans of the patient, histological type of tumor, degree of its differentiation, size, localization in the uterine cavity, prevalence of the tumor process. The main treatment for endometrial cancer is surgical treatment. The principles of surgical treatment consist in the individual selection of the volume of surgical intervention, adequate lymphadenectomy, prevention of recurrence and metastases. Lymph node dissection for cancer of the uterine body has always been a controversial issue. Lymphadenectomy is necessary to accurately establish the stage of endometrial cancer. In recent years, the discussion about laparoscopic lymph node dissection in comparison with open access, to what level lymphadenectomy should be performed, how many lymph nodes, frequency of complications, prognosis of patient survival, frequency of relapses has been developing. The article highlights own vision of the role of lymphadenectomy both in laparotomy and in laparoscopy, the importance of the volume of surgical intervention and complications for each type of treatment.

Open pelvic ring fractures can have devastating functional consequences including prolonged disability, chronic pain, infection, and even death. These injuries are uncommon but often involve soft tissue defects. Without early and appropriate coverage, patients are likely to sustain infection, which can be fatal. Here, we present the successful use of a pedicled ALT flap in two patients with soft tissue defects due to open pelvic ring injury. The pedicled ALT flap can be harvested as a composite flap comprising a portion of the skin, fascia, and muscle depending on the defect. Although the ALT flap has often been employed for abdominal wall and abdomino-perineal reconstruction, this is the first case series to report the use of the ALT flap in a subacute traumatic setting for pelvic ring reconstruction.

BackgroundIn lumbo-iliac fixation, the iliac screw can be placed in several locations and directions. There is no uniform standard for the placement of a single iliac screw. Biomechanical tests and finite element analyses were used to compare the effect of bilateral single iliac screws with three channels on pelvic stability to determine the best channel.MethodsFive embalmed adult cadaver pelvic specimens were selected. An unstable Tile C1 pelvic injury model was established. Lumbo-iliac fixation for the treatment of left sacral Denis II fracture includes the following: three channels of bilateral, single iliac screws (channel A from posterior superior iliac spine (PSIS) to anterior inferior iliac spine (AIIS), channel B from 1 cm medial and 1 cm caudal of PSIS to AIIS, and channel C from 2 cm below PSIS to AIIS). Biomechanical testing was performed for stiffness evaluations. A finite element model was established to study the stress distribution of the model and the maximum von Mises stress of internal fixation.ResultsBiomechanical tests revealed that under vertical compression loading. The compressive stiffness fixed by channel B (246.15 ± 27.85 N/mm) was better than that fixed by channel A and channel C. Under torsional load, the torsional stiffness fixed by channel B (2.234 ± 0.223 N·m/°) was stronger than that fixed by channel A and channel C. However, there was no significant difference in terms of compressive and torsional stiffness between channel B and channel A (P > 0.05). Finite element analyses conformed that the maximum von Mises stress of the internal fixator fixed in channel B under the conditions of vertical, forwards bending, backwards extension, left bending, left rotating, and right bending (213.98 MPa, 338.96 MPa, 100.63 MPa, 297.06 MPa, 200.95 MPa and 284.75 MPa, respectively) was significantly lower than those fixed in channel A and channel C.ConclusionsThe construct stiffness of the channel from 1 cm medial and 1 cm caudal of PSIS to AIIS is better than that of the other two channels. This channel has the advantages of good biomechanical stability, small maximum von Mises stress of internal fixation.

Bladder exstrophy is a rare congenital anomaly that requires a complex multidisciplinary approach and multi-stage surgeries. We report two cases of bladder exstrophy, our management, and outcomes. Case 1 is a 17 days old female with lower abdominal mass on birth. Pelvic radiography showed a 7 cm pubic diastasis. Bladder closure and bilateral pelvic osteotomy with advancement flap were performed. Case 2 is a 1 year old female with lower abdominal mass and urinating problem. Pelvic radiography showed pubic diastasis. Bladder closure and anterior innominate osteotomy were performed. Both patients had satisfactory follow-up. Management goal is closure of the bladder with preserved renal function and satisfactory cosmetic and function of the genitalia. We showed that pelvic osteotomy combined with external fixation provided better wound healing. Pelvic osteotomy combined with external fixation resulted in better wound healing. Further research is required to determine best approach to osteotomy.

The destabilization of bone fixators has led to repeated surgical interventions that increased the risk of migrations of metal fixators, infectious and inflammatory complications as well. The modern trends in hip bone injury surgery are related to developing and using of metal fixators, which are effective in acute injury; however, sometimes the condition of the patient and the technical support of hospitals don’t allow performing surgery in the acute period, and these metal fixators are ineffective for chronic damage. Consequently, until now, the problem of finding the optimal design of structures for fixing chronic damage of anterior pelvic semi-ring which will be able to exclude its destabilization, is still of current interest.The purpose of the study: developing and experimental researching of durable features of original plate for reconstruction of the anterior pelvic semi-ring.Materials and methods: In order to ensure stable fixation of chronic pelvic injuries, the original metal plates have been worked out. They are made individually in accordance with the anatomical and functional structures of the anterior pelvic semi-ring of the patient with using additive technologies. The study of the reliability of the different variants of ostiosynthesis of the anterior pelvic semi-ring with using well-known pelvic plates and a new original design was carried out. Stability tests for different plate fixing methods and mechanical strength of metallophyxators were carried out on a universal test machine of LFM-50kN series.Results: one plate fixation in tensile test showed the lowest result – 0.341 kN, a low result of shear loads was received with the same object. The best result was shown by the polyaxial monolithic plate fixation in case of stretching – 0.51 kN at the shear loads – 0.591 kN. Necessary force applied to destabilizing of the metal structure while using a polyaxial monolithic plate was a half-higher than stretched, and a third higher than at shear loads, it demonstrates the benefits of using these metal fixators.Conclusion: It is experimentally confirmed that the polyaxial monolithic plate provides the highest stability of fixing anterior pelvic semi-ring indicator in contrast with fixing of one or two plates.

ObjectiveDiscrepancies exist among international guidelines on the surgical staging of para-aortic lymph nodes in locally advanced cervical cancer (LACC), varying from considering a para-aortic lymph node dissection, at least up to the inferior mesenteric artery, to a complete para-aortic lymph node dissection. In this study, we aim to assess the reproducibility of our recently reported robotic technique using indocyanine green for identifying besides primary pelvic sentinel lymph nodes (SLNs), secondary para-aortic SLNs in a first case-cohort of cervical cancer patients.MethodsA retrospective case series of LACC patients with/without suspicious pelvic lymph nodes (LNs) on imaging (including two patients with an additional suspicious para-aortic LN) is reported. All patients underwent a robotic pelvic SLN and para-aortic sentinel/nonsentinel LN dissection using the da Vinci Xi platform. Indocyanine green was used as a fluorescent tracer, at a concentration of 1.9 mg/mL, and injected as 0.5 mL in each quadrant of the cervix.ResultsIn a total of 10 cases, primary pelvic SLNs (90% bilateral) with subsequent secondary para-aortic SLNs were identified in all cases. Lower para-aortic SLNs were present in all cases, and upper para-aortic SLNs were found in 9 out of 10 cases. The mean age of the cervical cancer patients was 49.8 years (SD ± 6.89), and the mean body mass index (BMI; kg/m2) was 23.96 (SD ± 4.60). The median total operative time was 105.5 min (range: 89–141 min). The mean numbers of primary pelvic SLNs and secondary lower and upper para-aortic SLNs were 3.10 (SD ± 1.10), 2.90 (SD ± 0.74), and 2.30 (SD ± 1.57), respectively. The median number of total para-aortic LNs (PALNs) dissected per patient was 11.5. Six patients had positive primary pelvic SLNs, and two had secondary positive para-aortic SLNs. The nonsentinel para-aortic LNs were negative in all cases. There were no intra- or postoperative complications.ConclusionOur preliminary experience demonstrates the reproducibility of identifying, besides primary pelvic SLNs, secondary lower and upper para-aortic SLNs during robotic staging in LACC. A surgical approach limiting a complete para-aortic LN dissection could reduce the potential risks and morbidity associated with this procedure. To determine the sensitivity and negative predictive value of this new surgical approach, and whether the lower para-aortic SLNs under the inferior mesenteric artery are representative of the whole para-aortic region, large prospective observational studies are needed in LACC and/or those with suspicious pelvic LNs but apparent normal para-aortic LNs on imaging.

While the thrombotic risk associated with lower limb venous reflux has been clearly reported in the literature, evidence is lacking on the potentially similar procoagulant effect generated by a venous incompetence in the pelvic region. A recent publication identified an incidental periuterine venous plexus thrombosis in 3% of the women undergoing a gynaecological consultation for whatever reason, suggesting a potentially underestimated condition worthy of further investigation. The present paper analyses the available literature on the topic, providing an insight covering both pathophysiological and clinical aspects. [Turk J Vasc Surg 2021; 30(1.100): 22-6]

In recent years, endometrial cancer has taken the lead among oncological processes of the female reproductive system. The high prevalence of this disease leads to disability of the working-age population, large socio-economic losses, which determines the relevance of this problem and the search for new methods of screening, diagnostics, optimal selection of treatment, thereby affecting the quality of future life. The choice of the method of treatment of patients depends on the following main factors: age, general condition, reproductive plans of the patient, histological type of tumor, degree of its differentiation, size, localization in the uterine cavity, prevalence of the tumor process. The main treatment for endometrial cancer is surgical treatment. The principles of surgical treatment consist in the individual selection of the volume of surgical intervention, adequate lymphadenectomy, prevention of recurrence and metastases. Lymph node dissection for cancer of the uterine body has always been a controversial issue. Lymphadenectomy is necessary to accurately establish the stage of endometrial cancer. In recent years, the discussion about laparoscopic lymph node dissection in comparison with open access, to what level lymphadenectomy should be performed, how many lymph nodes, frequency of complications, prognosis of patient survival, frequency of relapses has been developing. The article highlights own vision of the role of lymphadenectomy both in laparotomy and in laparoscopy, the importance of the volume of surgical intervention and complications for each type of treatment. [ABSTRACT FROM AUTHOR]

Abstract Introduction: Hydatid cyst is a parasitic disease caused by Echinococcus granulosus, most commonly seen in the liver and lungs. The hydatid cyst is rarely seen in the heart and iliofemoral region, representing less than 2% of all cases. In this article, we report our cases of hydatid cysts in unusual loci. Methods: Between 2015 and 2018, 6 rare cases of hydatid cysts were diagnosed at the Cardiovascular Surgery Department of Harran University. Four of these patients had cardiac localization and two patients had their cysts located in the iliofemoral region, extending to the pelvic zone. All patients were female. Three patients had no other organ involvement. One patient with cardiac hydatid cyst underwent normothermic cardiopulmonary bypass + total pericystectomy + Cooley-like aneurysmectomy. Total pericystectomy was performed in three other patients with intrathoracic locus by normothermic cardiopulmonary bypass. Two patients who were referred to our clinic with palpable iliofemoral mass were evaluated with appropriate imaging methods and diagnosed accordingly. Multiple iliofemoral cysts were managed with pericystectomy and drainage by a single incision made over the inguinal ligament. Conclusion: Hydatid cyst disease can develop in cardiac chambers and inguinal region with or without hepatic or pneumatic involvement. Normothermic cardiopulmonary bypass can be safely used in patients with cardiac hydatid cysts, and capitonnage similar to ventricular aneurysm repair in patients with a widely involved cystic lesion can be very useful for the protection of ventricular functions.

Pelvic venous disease (PeVD) are a not rare cause of venous insufficiency in the leg that is frequently underestimated and poorly managed. Graduated compression stockings (GCSs) represents a pillar in lower limb chronic venous disease (CVD). Despite these first two considerations, clear GCS indications in PeVD are still missing due to the lack of literature data on this topic. In the present short report, we offer an insight on the topic and the potential rationale for GCS use in PeVD. [Turk J Vasc Surg 2021; 30(1.100): 27-9]

Abstract A 41‐year‐old man with abdominal enlargement, as a result of large retroperitoneal Schwannoma, was reported to our center. It was seen to have caused the displacement of the colon and was attached to the presacral region of the spine. Following the diagnosis, successful resection of Schwannoma was achieved.

Abstract Background A solitary fibrous tumor (SFT) is a mesenchymal lesion, which commonly develops in the thorax. Non-islet cell hypoglycemia is a rare paraneoplastic phenomenon caused by an extra-pancreatic tumor. We report a rare case of a pelvic SFT with severe hypoglycemia, which was considered to be Doege-Potter syndrome. Case presentation A 72-year-old man was referred to our hospital for treatment of hypoglycemia and a large pelvic tumor. His blood glucose level was 52 mg/dl; serum insulin level, 1.0 μIU/ml; C-peptide level, 0.2 ng/ml; and insulin-like growth factor-I (IGF-I) level, 31 ng/ml. Contrast-enhanced computed tomography (CT) showed a 13-cm mass in the pelvic cavity. Magnetic resonance imaging (MRI) revealed a lobulated tumor with iso- and high-intensity areas combined in T2-weighted images. No clear invasion to any adjacent organs was identified. The tumor was resected, and hypoglycemic symptoms disappeared immediately. Pathological diagnosis was an SFT with malignant potential that secreted IGF-II and caused hypoglycemia. There has been no tumor recurrence during the 1 year of follow-up. Conclusion Non-islet cell tumor hypoglycemia should be considered in the differential diagnosis of patients presenting with tumors and hypoglycemia.

A 73-year-old woman underwent deformity correction surgery (anterior lumbar interbody fusion of L2-L3-L4-L5-S1, pedicle subtraction osteotomy at L4, and posterior screw fixation from T10 to the pelvis) due to lumbar degenerative flat-back. Following the operation, the patient experienced pain in her back and buttocks, for which she regularly took medications. She reported frequently feeling a heavy and stretched sensation of pain after the operation in those areas, which made her regret undergoing the operation. However, at 33 months postoperatively, she reported that one day, while getting up from a chair, she felt a crack in her back, which was followed by an improvement in her back and buttock pain; thereafter, she stopped taking pain medications. Follow-up radiography revealed a bilateral rod fracture at the L4-5 level on the right side and at the L3-4 level on the left side. The overall pelvic parameters, except pelvic incidence, slightly changed after the rod fracture. Therefore, the broken rod was replaced and another rod was added to the broken rod area; however, the changed pelvic parameters were not corrected further during the reoperation. Following the reoperation, the patient showed improvements and she no longer required pain medication. [ABSTRACT FROM AUTHOR]

Background: There is little information on which to base the prognostic counselling as to whether an antenatally diagnosed fetal abdominal cyst will grow or shrink, or need surgery. This study aims to provide contemporary data on prenatally diagnosed fetal abdominal cysts in relation to their course and postnatal outcomes. Methods: Fetal abdominal cysts diagnosed over 11 years in a single centre were identified. The gestational age at diagnosis and cyst characteristics at each examination were recorded (size, location, echogenity, septation and vascularity) and follow-up data from postnatal visits were collected. Results: Eighty abdominal cysts were identified antenatally at 28 + 4 weeks (range 11 + 0--38 + 3). Most (87%) were isolated and the majority were pelvic (52%), simple (87.5%) and avascular (100%). Antenatally, 29% resolved spontaneously; 29% reduced in size; 9% were stable and 33% increased in size. Forty-one percent of cysts under 20 mm diameter increased in size, while only 20% of cysts with a diameter of over 40 mm increased in size. The majority of cysts were ovarian in origin (n = 45, 56%), followed by intestinal (n = 15, 18%), choledochal (n = 3, 4%), liver (n = 2, 3%) and renal/adrenal origins (n = 2, 3%), respectively. In 16% (n = 13), the antenatal diagnosis was not obvious. Seventy-five percent of the cysts that persisted postnatally required surgical intervention. Conclusion: Most antenatally diagnosed fetal abdominal cysts were ovarian in origin. Though most disappeared antenatally, nearly three quarters required surgical intervention when present after birth. Cysts of intestinal origin are more difficult to diagnose antenatally and often require surgery. [ABSTRACT FROM AUTHOR]

A 41‐year‐old man with abdominal enlargement, as a result of large retroperitoneal Schwannoma, was reported to our center. It was seen to have caused the displacement of the colon and was attached to the presacral region of the spine. Following the diagnosis, successful resection of Schwannoma was achieved. [ABSTRACT FROM AUTHOR]

Introduction and hypothesis: The objective of this study was to evaluate the effect of vaginal packing following pelvic floor surgery with regard to post-operative pain, bleeding and infection. This was a double-blind randomised study of women undergoing vaginal hysterectomy and/or pelvic floor repair at a tertiary urogynaecology unit. Methods: The primary outcome of day 1 post-operative pain was assessed using the short-form McGill Pain score. Secondary outcomes were haematological and infective morbidity, evaluated using changes in full blood count, and cultures of midstream urine and high vaginal swabs. A transvaginal ultrasound scan to exclude pelvic haematoma was performed at 6 weeks in all women who underwent vaginal hysterectomy with or without a pelvic floor repair. Results: In total, 190 women were recruited: mean age 58.3 years (27-91 years), mean body mass index 27.4 kg/m and median parity 3. Women were randomised into the 'pack' ( n = 86) and 'no pack' ( n = 87) arms with no demographic differences between the groups. No statistically significant differences in the post-operative pain scores or secondary outcome measures were demonstrated. Incidence of haematoma formation (14.8 % no pack, 7.3 % pack, p = 0.204) was not statistically significant. There were three clinically significant complications in the no pack group and none in the pack group. Conclusions: This is the first study to examine pain in association with post-operative vaginal packing. There is no evidence to suggest that packing increases pain scores or post-operative morbidity. A trend towards increased haematoma and significant complications was seen in the no pack group. As vaginal packing does no harm and may be of some benefit it may be argued that packing should be recommended as routine clinical practice. [ABSTRACT FROM AUTHOR]

This consensus document was developed as a reference for physicians caring for and advising women in pregnancy following prior surgical treatment for pelvic floor disorders. [ABSTRACT FROM AUTHOR]

Abstract: Background: Information on autonomic neurapraxia in female urogenital surgery is scarce, and a model to study it is not available. Objective: To develop a model to study the impact of autonomic neurapraxia on bladder function in female rats, as well as to assess the effects of corticosteroid therapy on the recovery of bladder function in this model. Design, setting, and participants: Female Sprague-Dawley rats were subjected to bilateral pelvic nerve crush (PNC) and perioperatively treated with betamethasone or vehicle. Bladder function and morphology of bladder tissue were evaluated and compared with sham-operated rats. Outcome measurements and statistical analysis: Western blot, immunohistochemistry, organ bath experiments, and cystometry. Results and limitations: Sham-operated rats exhibited regular micturitions without nonvoiding contractions (NVCs). Crush of all nerve branches of the pelvic plexus or PNC resulted in overflow incontinence and/or NVCs. Betamethasone treatment improved recovery of regular micturitions (87.5% compared with 27% for vehicle; p <0.05), reduced lowest bladder pressure (8±2cm H2O compared with 21±5cm H2O for vehicle; p <0.05), and reduced the amplitude of NVCs but had no effect on NVC frequency in PNC rats. Compared with vehicle, betamethasone-treated PNC rats had less CD68 (a macrophage marker) in the pelvic plexus and bladder tissue. Isolated bladder from betamethasone-treated PNC rats exhibited better nerve-induced contractions, contained more cholinergic and sensory nerves, and expressed lower amounts of collagen III than bladder tissue from vehicle-treated rats. Conclusions: PNC causes autonomic neurapraxia and functional and morphologic changes of isolated bladder tissue that can be recorded as bladder dysfunction during awake cystometry in female rats. Perioperative systemic betamethasone treatment reduced macrophage contents of the pelvic plexus and bladder, partially counteracted changes in the bladder tissue, and had protective effects on micturition function. [Copyright &y& Elsevier]

Summary: Background: This review aims to present a consensus for optimal perioperative care in rectal/pelvic surgery, and to provide graded recommendations for items for an evidenced-based enhanced recovery protocol. Methods: Studies were selected with particular attention paid to meta-analyses, randomized controlled trials and large prospective cohorts. For each item of the perioperative treatment pathway, available English-language literature was examined, reviewed and graded. A consensus recommendation was reached after critical appraisal of the literature by the group. Results: For most of the protocol items, recommendations are based on good-quality trials or meta-analyses of good-quality trials (evidence grade: high or moderate). Conclusions: Based on the evidence available for each item of the multimodal perioperative care pathway, the Enhanced Recovery After Surgery (ERAS) Society, European Society for Clinical Nutrition and Metabolism (ESPEN) and International Association for Surgical Metabolism and Nutrition (IASMEN) present a comprehensive evidence-based consensus review of perioperative care for rectal surgery. [Copyright &y& Elsevier]

Please cite this paper as: Moore EK, Roylance R, Rosenthal AN. Breast cancer metastasising to the pelvis and abdomen: what the gynaecologist needs to know. BJOG 2012;119:788-794. A small proportion of breast cancers metastasise within the peritoneal cavity. With increasing breast cancer incidence rates, gynaecologists and oncologists will encounter such women more frequently. Most women with intraperitoneal breast cancer are premenopausal. Although data are limited and are likely to be subject to selection bias, the median survival of women undergoing resection appears superior to those not undergoing surgery. Furthermore, survival is broadly similar to that for women undergoing advanced ovarian cancer surgery, particularly when tumour debulking is optimal. Obtaining data via randomised trials is unlikely to be feasible and therefore we recommend prospective data collection via the establishment of an international intraperitoneal breast cancer patient registry. For individual women where survival is anticipated to be more than a few months, we suggest considering referral to a gynaecological oncology team for discussion of surgical options. [ABSTRACT FROM AUTHOR]

Abstract: Background: Pelvic ring fractures caused by high-energy trauma are severe injuries with well described radiological and clinical outcomes, whereas description from the patient''s perspective is less well documented. The purpose of this study was to investigate patient-reported outcome following surgical treatment of pelvic fractures using quality of life instruments. Methods: All 54 patients (28 male/26 female, ages 16–68) with pelvic fractures referred to our institution for surgical treatment 2003–2005 were prospectively included. The most common trauma was motor vehicle accident (44%). Additional injuries were seen in 74% and in 31% the ISS was ≥16. There were 31 B and 23 C type fractures. Patients were followed for two years using two validated questionnaires, SF-36 and LiSat-11, the latter an instrument consisting of 11 questions for evaluation of satisfaction with different aspects of life. Results: 45 patients could be followed according to the study protocol for two years while 2 were untraceable and 1 died from unrelated causes. Of 6 nonresponders, 5 were unable due to psychiatric disorder. At two years pelvic fracture patients scored lower than the reference population in both physical and mental domains (SF-36). Highest mean score, 68, was in the domain Social Function (norm 89) while lowest mean score, 38, was in the domain Role Physical (norm 86). The mean score closest to the normative was for general health with 61 for patients and 78 for the normative group. In LiSat-11 pelvic fracture patients scored lower than the reference population in all areas. Satisfaction with life as a whole was 31% compared with 60% in the normative group. Conclusions: Two years after surgical treatment of pelvic ring fractures, patients reported substantially lower quality of life for both physical and mental domains, when compared with a reference population, even when radiological and clinical outcomes were considered favourable. [Copyright &y& Elsevier]

Abstract: Objective: Analyse the outcome of pelvic exenteration for gynaecological malignancies in a tertiary referral center. Post-operative in-hospital morbidity, long-term morbidity, disease free and overall survival rates were studied. Study design: Between 1991 and 2004, 42 patients underwent an anterior, total or posterior exenteration for gynaecological malignancies. Follow-up was obtained from patient files; disease free and overall survival were calculated and prognostic factors were studied. Results: A pelvic exenteration was performed in 14 patients for primary and 28 patients for recurrent gynaecological cancers. In-hospital complications occurred in 19 patients (45%) of whom seven patients needed a reoperation (17%). Late complications occurred in 31 patients (75%); 21 reinterventions were performed (50%). Five-year disease free and overall survival was, respectively, 48 and 52%. Age, type of surgery, histology, localisation of the tumour, lateral wall involvement, completeness of resection and primary versus recurrent cancer were not identified as prognostic factors for recurrence or survival. Conclusion: Long-term survival is possible in about 50% of patients after pelvic exenteration for gynaecological cancers, but is associated with significant post-operative morbidity. [Copyright &y& Elsevier]

Abstract: A 56-year-old man presented with long-standing, mild urinary frequency 6 years after radical prostatectomy. Pathologic assessment showed presence of organ confined prostate cancer (pT2a), Gleason 6 (3+3). Since the time of surgery, PSA level was undetectable and the patient remained without evidence of recurrent disease. However, digital rectal examination revealed the presence of a very large mass palpable on the anterior rectal wall. Therefore, the patient underwent abdmonibal/pelvic MRI which demonstrated presence of a solid, well-circumscribed pelvic mass extending from the level of the sacrum posteriorly to the anterior abdominal wall. Histologic examination of percutaneous biopsy of the mass was suggestive of schwannoma. The patient underwent laparotomic excision of the mass, which was confirmed to be a schwannoma, with its characteristic slender spill cells and elongate nuclei. No intra-operative complication was reported. The patient has no evidence of recurrence with complete resolution of urinary symptom one year after surgery. [Copyright &y& Elsevier]