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    Conservative management of placental invasion anomalies with an intracavitary suture technique
    (Wiley, 2018) Acar, Ali; Ercan, Fedi; Pekin, Aybike; Atilgan, Adeviye Elci; Sayal, Hasan Berkan; Balci, Osman; Gorkemli, Hueseyin
    Objective: To assess the efficacy and safety of a new surgical suture technique for uterine preservation among patients with placental invasion anomalies. Methods: The present prospective case series included women diagnosed with placental invasion anomalies undergoing cesarean deliveries who desired future fertility at the obstetrics department of a Turkish university hospital between January 10, 2013, and April 20, 2017. Patients were diagnosed with ultrasonography and Doppler ultrasonography; the type of placental invasion anomaly (placenta accreta, increta, or percreta) was confirmed intraoperatively. Surgical management involved an intracavitary suture technique after the proximal branch of the uterine artery was clamped and utero-ovarian anastomoses had been blocked. Outcomes included units of blood transfused, intraoperative and postoperative adverse events, duration of hospital admission, and hysterectomy rate. Results: There were 62 patients included. The mean operative blood loss was 1350 +/- 750mL (range 600-5000 mL). Blood transfusion required a mean of four units (range 2-15). Bleeding was controlled with the intracavitary sutures in 58 (94%) patients. Three patients experienced postoperative wound infections and two patients developed endometritis that required therapy with broad-spectrum antibiotics. The mean length of hospital stay was 3.61.6 days (range 2-11). None of the patients required reoperation after the initial surgery. Conclusion: The novel uterus-sparing suture technique was highly effective among patients with placental invasion anomalies.
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    Management of Adnexal Torsion: A 13-Year Experience in Single Tertiary Center
    (Mary Ann Liebert, Inc, 2019) Balci, Osman; Energin, Hasan; Gorkemli, Hueseyin; Acar, Ali
    Purpose: Adnexal torsion constitutes 2.7% of gynecological emergencies, it is more frequently seen in reproductive age. Delay in diagnosis and treatment may lead to loss of the ovary. In this study, we aimed to assess patients who had adnexal torsion and compare laparoscopy with laparotomy in the treatment of these patients and point the most appropriate surgery according to age groups of the patients and comparison of patient characteristics and management between adnexal torsion in postmenopausal and premenopausal patients. Materials and Methods: This study was carried out in Necmettin Erbakan University, Meram Medicine Faculty, Department of Obstetrics and Gynecology. The study retrospectively analyzed 380 patients presented to our clinic with abdominal pain between January 2005 and December 2017 and had surgery for adnexal torsion. Results: The study included 380 patients who had surgery for adnexal torsion. A total of 220 patients had laparoscopy and 160 patients had laparotomy. Laparoscopy group consisted of young patients with low parity, whereas laparotomy group consisted of 160 patients of which 92 (57.5%) were in menopause. Teratomas were the most common pathological finding followed by follicular cysts. Fourteen ovarian malignancies and 11 borderline tumors had been reported. Eleven ovarian malignancies had been reported in postmenopausal patients and three in premenopausal patients. Conclusion: Laparoscopic surgery is preferred for young patients who want to preserve their fertility, but postmenopausal ovarian masses presenting with torsion should be analyzed with frozen section whenever possible, if not possible or not conclusive, staging surgery is more appropriate especially if there is suspicion of malignancy.