Genetic Predisposition of Postoperative Adhesions Varies in Substrains of BALB/c Mice.

Postoperative adhesions are a major clinical problem because of the associated infertility, chronic pain, bowel obstruction, and the associated costs. Variability in adhesion formation was suggested by clinical observations that apparently similar interventions can cause little to severe adhesions. This is supported by the presence of polymorphisms and genetic predisposition to develop adhesions in animal models and humans.

NO strongly prevents adhesion formation and postoperative pain in open surgery through a drug-like effect.

Background: Microsurgical tenets and peritoneal conditioning during laparoscopic surgery (LS) decrease postoperative adhesions and pain. For a trial in human, the strong beneficial effects of NO needed to be confirmed in open surgery (OS).

Results: In a mouse model for OS, the effect of the gas environment upon adhesions was evaluated.

Corifollitropin alfa followed by hpHMG in GnRH agonist protocols. Two prospective feasibility studies in poor ovarian responders.

In two prospective uncontrolled feasibility trials, we examined the effect of corifollitropin alfa (CFA) followed by highly purified human menopausal gonadotrophin (hpHMG) in a short flare-up gonadotropin-releasing hormone (GnRH) agonist and a long GnRH agonist protocol for women with poor ovarian response. Overall, 45 patients were treated with short flare-up and 47 patients with the long agonist protocol. All patients received a single dose of 150 μg CFA, followed by 300 IU hpHMG 7 days later, triggering with 10 000 IU hCG, CSI and day 3 embryo transfer.

A mixture of 86% of CO, 10% of NO, and 4% of oxygen permits laparoscopy under local anesthesia: a pilot study.

The aim of this study is to verify that 10 % of NO in CO sufficiently reduces pain to permit laparoscopy under local anesthesia. In nine patients undergoing laparoscopy under local anesthesia for tubal sterilization, a mixture of 86 % of CO, 10 % of NO, and 4 % of oxygen (the Gas Mixture) was used for the pneumoperitoneum. For CO2, NO, and for the Gas Mixture, the pain when blowing over the tongue tip and the pH changes of saline and Hartmann's solution were estimated.

Live birth rates in Bologna poor responders treated with ovarian stimulation for IVF/ICSI.

This retrospective study determined the efficacy of ovarian stimulation for IVF/intracytoplasmic sperm injection (ICSI) in poor ovarian responders fulfilling the Bologna criteria for poor ovarian response and identified predictors of live birth rates. Overall, 485 patients undergoing 823 ovarian stimulation cycles for IVF/ICSI with maximum gonadotrophin dose (≥ 300 IU) between January 2009 and December 2011 were included. Patients were considered eligible, irrespective of the treatment protocol, if they were classified as poor responders based on the recently developed definition for poor ovarian response by the European Society of Human Reproduction and Embryology, the Bologna criteria.

Conditioning of the abdominal cavity reduces tumor implantation in a laparoscopic mouse model.

Purpose: The addition of 4 % O2 and 10 % N2O to the CO2 pneumoperitoneum (PP), together with slight cooling and humidification (conditioning), contributes to reducing adhesions by preventing mesothelial damage. We investigated the effect of peritoneal damage during laparoscopy on tumor implantation.

Methods: In Experiment 1, different tumor cell concentrations were injected into control mice without PP and into mice with 60-min dry CO2PP (mesothelial damage).

Peritoneal full-conditioning reduces postoperative adhesions and pain: a randomised controlled trial in deep endometriosis surgery.

Background: To translate the concept of full-conditioning (FC) from animal experiments to the human, and to evaluate the efficacy for adhesion prevention. FC consisted of decreasing acute inflammation by 86% CO2+ 10% N2O + 4% O2 for the pneumoperitoneum, cooling of the peritoneal cavity, humidification, heparinized rinsing solution and 5 mg of dexamethasone as demonstrated in animal models.

Methods: A randomized controlled trial (RCT: NCT01344486) comparing standard laparoscopy with full conditioning together with a barrier in a 2/3 ratio in 44 women undergoing deep endometriosis surgery at KULeuven.

Addition of nitrous oxide to the carbon dioxide pneumoperitoneum strongly decreases adhesion formation and the dose-dependent adhesiogenic effect of blood in a laparoscopic mouse model.

Objective: To evaluate the effect of addition of nitrous oxide (N2O) to the carbon dioxide (CO2) pneumoperitoneum (PP) and the effect of blood, plasma, or red blood cells (RBCs) on postoperative adhesions in a laparoscopic mouse model.

Design: Prospective randomized controlled trial.

Setting: University laboratory research center.

Intraperitoneal temperature and desiccation during endoscopic surgery. Intraoperative humidification and cooling of the peritoneal cavity can reduce adhesions.

This study was conducted to document quantitatively the intraperitoneal temperature and desiccation during laparoscopic surgery. The temperature, relative humidity, and flow rate were measured in vitro and during laparoscopic surgery, at the entrance and at the exit of the abdomen. This permitted us to calculate desiccation for various flow rates using either dry CO(2) or CO(2) humidified with 100% relative humidity at any preset temperature between 25 and 37°C.

The impact of the learning curve on adhesion formation in a laparoscopic mouse model.

Objective: To evaluate the impact of surgeon training on adhesion formation in a laparoscopic mouse model. Laparoscopic surgery and bowel manipulation was demonstrated to enhance postoperative adhesion formation.

Design: Prospective randomized, controlled trial.

Postoperative inflammation in the abdominal cavity increases adhesion formation in a laparoscopic mouse model.

Objective: To investigate acute inflammation in the peritoneal cavity in adhesion formation.

Design: Prospective randomized, controlled trial.

Setting: University laboratory research center.

Effect of upper abdomen tissue manipulation on adhesion formation between injured areas in a laparoscopic mouse model.

Study Objective: These experiments were designed to examine the effect of manipulation during surgery as a cofactor in adhesion formation at trauma sites.

Design: Randomized, controlled trial. Canadian Task Force Classification-class 1.

Intercoat gel (oxiplex): efficacy, safety, and tissue response in a laparoscopic mouse model.

Study Objective: To study the efficacy and safety of Intercoat gel in a laparoscopic mouse model with pneumoperitoneum-enhanced adhesion formation.

Design: Randomized controlled trial. Evidence obtained from a properly designed, randomized, controlled trial (Canadian Task Force classification I).

Pathophysiology of cyclic hemorrhagic ascites and endometriosis.

Massive hemorrhagic ascites (4470 mL, range 1-10 L) in women with endometriosis is a rare condition occurring predominantly in black women. Of the 43 case reports published, 42 are compatible with the hypothesis that the hemorrhagic ascites is predominantly a consequence of excessive ovarian transudation similar to a Meigs syndrome. Indeed, bilateral ovariectomy cures the condition without recurrences, whereas after unilateral ovariectomy or cystectomy recurrence rate is more than 50%; during ovarian suppression by luteinizing hormone-releasing hormone agonist ascites disappears, but reappears after treatment.

Tension-free Vaginal Tapes and Pelvic Nerve Neuropathy.

Obturator nerve neuropathies after tension-free vaginal tape or transobturator tape are considered to be caused by nerve trauma, although it is unclear whether these are accidents or whether these injuries are inherent to the procedure of tape insertion. Two cases show that obturator nerve neuropathy can occur after tension-free vaginal tape without direct trauma to the obturator nerve possibly as a consequence of excessive fibrotic reaction or persisting low-grade inflammation. PubMed Entrez, Cochrane Library, and up-to-date databases were searched for obturator and pudendal neuropathy and for neuropathies associated with tension-free vaginal tape-transobturator tape and the symptoms, diagnosis, and therapy of the pudendal and obturator nerve neuropathies are reviewed.