ESMYA non è più utilizzato per mioma dal GIB

ESMYA per MIOMA GIB non utilizza più Treatment of Myoma by GIB : suspension of ESMYA treatment Symptomatic  uterine myoma’s need  treatment.  Symptoms can be discomfort and/or pain especially when larger.  Submucous myoma’s can contribute to infertility. The etiology of most –if not all- myoma’s are genetic or epigenetic incidents to the myometrial cells, similar to the etiology of endometriosis. This explains  racial and hereditary differences in prevalence. It also suggest that similar to endometriosis myoma’s can be heterogeneous and that all myoma’s do not react in a similar manner to estrogens and progestogens.  Surgical treatment Being a benign tumour the primary treatment is surgery which can be Hysteroscopic myomectomy for intracavitary or submucous myoma’s.  We explain the possibilities and relative benefits of a 2 step surgery  when these myoma’s are bigger than 4-5 cm or intramural. This will permit a personal choice by the individual woman. Laparoscopic myomectomy . The relative benefits and possibilities of a laparoscopic myomectomy,  of eventually multiple myomectomies  and of a subtotal hysterectomy will be explained. This will permit women to take personal decisions after taking into account age, and fertility. Also for very large myoma’s  it will be discussed beforehand when we consider that a mini-laparotomy is preferable  to extensive laparoscopic suturing Also the risk and benefits of morcellation  and the risk of sarcoma spreading  are discussed  in order to permit individual choices. Medical treatment Until the recent introduction of ESMYA there was no effective medical treatment of myoma’s. Results have been promising especially for bleeding. ESMYA an antiprogestin.  Recently serious liver injury, including liver failure leading to transplantation was reported. Therefore the...

Consenso informato ed isterectomia

consenso informato ed isterectomia A laparoscopic hysterectomy should always be preferred unless the uterus is more than 1 kgr. A bigger uterus can be operated by laparoscopy but this is technically more difficult. The biggest we operated was 1850 gram (in Oxford) There is a serious problem concerning informed consent for hysterectomy. Informed consent should inform the patient also about all alternative treatments, including those not performed by the gynecologist. Yet the incidence of total laparoscopic hysterectomies (TLH) is less than 10% in Belgium and in most counties of this world. Subtotal laparoscopic hysterectomy (SLH) is performed in less than 5%. Even if LAVH (laparoscopic assisted vaginal hysterectomy ) is considered a laparoscopic hysterectomy the incidence is less than 25%. Why is a laparoscopic hysterectomy better ? The advantages of a TLH for the patient are less pain, less scar, faster recovery and less adhesions. Without disadvantages. It is clear that the complication rate of a TLH is comparable or less provided the surgeon is an experienced laparoscopist. If accidents occur videoregistration is useful. Without videoregistration the technique might be blamed. Conversions ( start by laparoscopy and end by laparotomy) are extremely rare. Personally we never did a conversion. If more than 5% conversions occur , as often indicated in the literature, there must be a problem of indication and or skills of the surgeons. Again videoregistration is necessary to prove this. TLH cause less adhesions. Adhesions decrease further if the duration of surgery is short and associated with little bleeding. ” a better surgeon causes less adhesions” Training thus becomes a problem knowing that during training duration of...

Shiny Trinket

Shiny trinkets are shiny.