Charles-André Philip

Background: Ovarian cancer is the leading cause of mortality from gynecological cancers in the U.S and bilateral salpingectomy can decrease the risk of ovarian cancer. Objective: To compare the effect of salpingectomy during hysterectomy on ovarian reserve and to compare coagulation techniques on ovarian reserve. Methods: This is a prospective randomized controlled trial whereby women undergoing laparoscopic total hysterectomy and bilateral salpingectomy for benign conditions were included. Participants were randomly assigned to salpingectomy using bipolar coagulation or ultrasonic energy. Outcomes: The primary outcome measured was AMH levels at 3 months post-op. Secondary outcome included AMH levels, Doppler ultrasonography, and quality of life in menopause. Results: 80 women were randomized (40 per group). Quality-of-life scores did not differ significantly (17.50 +/- 13.27 in group A and 17.28 +/- 9.49 in group B, p=0.93). Surgical time was comparable between groups. Both groups experienced significant post-op AMH decline. No significant differences were found in most biological markers, except for FSH levels at 18 months (68.80 ± 68.19 vs. 16.07 ± 28.21; p=0.03). Right ovarian volume was lower in the ultrasonic group at 3 months (4766.31 ± 5211.97 vs. 9160.35 ± 10435.49; p=0.04). Conclusions: Opportunistic salpingectomy during hysterectomy appears to have a systematically harmful effect on ovarian reserve, with no clinically significant differences between bipolar and ultrasonic energy techniques. What is new? This randomized trial provides mid-term evidence that opportunistic salpingectomy may adversely affect ovarian reserve, regardless of the energy modality used.

Objective: To investigate, in the context of endometriosis management, the perceptions of patients and healthcare professionals regarding hormonal treatment options. Design: Qualitative study using semi-structured focus group methodology. Setting: University hospitals and academic research center. Subject(s): Patients with endometriosis (n=20) and healthcare professionals (n=13) involved in their care. Intervention(s): Not applicable Main Outcome Measure(s): Focus group topics investigated representations on the concept of treatment effectiveness, emotion associated to this medical management and the perceived impact of these therapies on patient-professional and patient-environment relationship. Result(s): We highlighted a discrepancy between patients and doctors regarding the concept of efficacy of hormonal therapies. Long-term amenorrhea is the main priority for healthcare professionals, whereas pain reduction remains the immediate wait for patients. Interviewed patients reported a lack of listening and empathy, a shared-information deficit as regards treatment options and side-effects and a need to involved partner and family in care. These factors contribute to communication issues between patients and doctors and appear to contribute to significant mental burden on both sides. Among healthcare professionals, mental burden appears to arise primarily from the resource-intensive demands of endometriosis management, whereas among patients it is driven more by the need to take an active role in their own care to compensate for insufficient information provided by physicians. Conclusion: In this study, we highlighted the ambiguities surrounding the concept of therapeutic efficacy of hormonal therapies and collected several factors to try to improve shared-decision-making process in the management of endometriosis. This is designed to help us create a shared decision-making tool in the near future.

Purpose: To compare laparoscopic sacrocolpopexy using synthetic glue for mesh fixation to laparoscopic suturing in the treatment of pelvic organ prolapse. Materials and methods: This prospective randomized controlled trial included 54 patients with stage III or IV pelvic organ prolapse who underwent surgical correction and were allocated to two groups: a glue group which underwent laparoscopic sacrocolpopexy using synthetic cyanoacrylate glue for mesh fixation and a sutures group which underwent the same procedure using suturing for mesh fixation. Operative time, success rate, and perioperative complications were compared between the two groups. Patients were followed up at 1, 12, and 24 months postoperatively. Results: The median operative time was 108.8 min [83.2–155.6] in the glue group and 111.4 min [90.2–186.2] in the sutures group, without significant difference between the groups. However, the time required for anterior mesh fixation was significantly lower in the glue group compared to the sutures group (4.6 min [0.5–29.6] vs. 25.4 min [1.7–44.7], p = 0.0001). The anatomical success rates ranged from 100 to 92.6% at 1 month postoperatively, and from 88.2 to 73.7% at 24 months in the glue and sutures groups, respectively, without statistically significant difference. Conclusions: The use of synthetic glue in laparoscopic sacrocolpopexy is a safe and effective alternative to suturing. However, larger studies with extended follow-up are required to further assess long-term efficacy and complication rates.

Objective: We conducted a comparative retrospective bicentric study of rectal endometriosis treatment with high‐intensity focused ultrasound (HIFU) and surgery in terms of symptoms and treatment‐related morbidity at 6 months. Methods: All patients with a single symptomatic rectal nodule who had failed hormonal treatment were included in the present study. Patients' symptomatology was assessed using questionnaires: gynecologic and digestive symptoms (visual analog scale [VAS]), health status (MOSSF‐36), fecal incontinence (Wexner), constipation (Knowles Eccersley Scott Symptom [KESS] score) and overall sexual health (FSFI). We also assessed the morbidity according to the Clavien–Dindo classification. Results: A total of 120 patients, 60 in each group, received HIFU or rectal surgery. The characteristics of rectal nodules were similar in both groups. In the HIFU and surgery groups, Clavien–Dindo grades 2 and 3 complication rates were 3.3% versus 21.7% ( P = 0.002) and 0% versus 10% ( P = 0.01), respectively. Hospitalization duration was also significantly shorter for the HIFU group (1 vs 3 days; P < 0.001). In the HIFU group, significant improvement was observed in acute pelvic pain/dysmenorrhea ( P < 0.001), dyspareunia ( P < 0.001), diarrhea ( P < 0.001), tenesmus/spasms ( P < 0.001), pain on defecation ( P < 0.001), and urinary urgency ( P < 0.026). In the surgical arm, significant improvement was observed in acute pelvic pain/dysmenorrhea ( P < 0.017), diarrhea ( P < 0.002), tenesmus/spasms ( P < 0.001), and pain on defecation ( P < 0.002). In both groups, an improvement in FSFI, KESS, and Wexner scores and health status was noted at 6 months. Conclusion: In selected patients with only one rectal location, HIFU treatment enables a similar symptom‐related and quality‐of‐life outcome with a significant reduction in the risk of postoperative complications.

Study objective: The aim of this study was to assess the impact of endometriosis surgery in the retrocervical area and/or USL on the thickness of the posterior uterine isthmus, and subsequently the potential risk of posterior uterine rupture during labor. Design: Retrospective observational study. Setting: Improving the management of patients with deep infiltrating endometriosis, keeping in mind potential obstetric consequences. Patients: All endometriosis patients treated surgically at the Croix-Rousse University Hospital during the study period for the resection of a lesion on one or both USL and/or in the retrocervical region were included if preoperative and postoperative MRI images were available in their medical record. Interventions: Evaluating the variation of posterior uterine isthmus thickness on MRI images after retrocervical surgery for deep infiltrating endometriosis. Searching for predictive markers of posterior uterine isthmus thinning. Measurements and mean results: Forty-two patients were included between 2016 and 2020. We observed a significant decrease in the sagittal thickness of the median posterior uterine isthmus after surgery (-2.25 mm, 95% CI -3.18 to -1.32, p <.01). A significant association was also found between the thinning of the median posterior uterine isthmus on the sagittal section and preoperative urinary symptoms ( p =.04), a history of digestive resection with ileostomy ( p =.02) and the presence of post-voiding residue ≥ 100 cc postoperatively ( p <.01). We observed 6 pregnancies in 4 patients (9.5%). Four pregnancies were carried to term with cesarean delivery. Conclusion: The resection of retrocervical endometriosis is associated with postoperative thinning of the posterior uterine isthmus, which seems positively associated with the complexity of the rest of the surgery.