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    Clinical experience in pregnancies complicated by adnexal torsion
    (7847050 Canada Inc, 2016) Basaranoglu, S.; Agacayak, E.; Tunc, S. Y.; Icen, M. S.; Turgut, A.; Peker, N.; Evsen, M. S.
    Objective: The purpose of this study was to present data on clinical and operational management and postoperative outcomes of pregnancies complicated by adnexal torsion (AT). Materials and Methods: Twenty-four pregnant women who presented to the present clinic between January 2007 to December 2013 and were intraoperatively diagnosed with AT were included in this study. Demographic data such as age and data on obstetric history, gestational week, current trimester, previous gynecologic and non-gynecologic operations, type of surgery that was performed, average size, location and number of adnexal masses, surgical techniques that were employed, postoperative complications, and pathology results were investigated and noted. Results: In this study, 132 patients were operated due to AT, and the rate of pregnant women with AT was 18.2% (24/132). The mean age of the patients was 29.25 +/- 6.27 years, and the mean gestational week was 18.25 +/- 7. Eight patients were in their first trimester (33.3%) whereas 13 were in their second trimester (54.2%), and three were in their third trimester (12.5%) when they presented to the hospital. The mean AT size was 95.3 +/- 53.9 mm, as measured by ultrasonography. All the patients were operated by laparotomy. Regarding the types of abdominal incision, 13 patients (54.2%) had a Pfannenstiel incision, three patients (12.5%) had an infra-umbilical median incision, and eight patients (33.3%) had a pararectal incision. Duration of operation was significantly shorter in patients with pararectal incisions (p < 0.01) compared to those with Pfannenstiel and infra-umbilical median incisions. Regarding the types of treatment, ten patients (41.7%) underwent unilateral salpingo-oophorectomy (USO), eight patients (33.3%) underwent adnexal detorsion+cystectomy, and six patients (25%) underwent adnexal detorsion only. Conclusion: AT is a gynecologic emergency that requires early diagnosis and treatment, as it is capable of complicating the pregnancy. Determination of the current gestational week prior to the surgical intervention will assist and guide the surgeon in identifying the suitable type of surgery for a particular patient. Pararectal incision should be the incision of choice for a shorter duration of operation, which is crucial in pregnant women for reduced exposure to anesthesia.
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    Comparison of long-term results of obliterative colpocleisis and reconstructive vaginal surgery including sacrospinous ligament fixation in patients with total genital prolapse
    (Wolters Kluwer Medknow Publications, 2022) Agacayak, E.; Bulut, M.; Peker, N.; Gunduz, R.; Tunc, S.; Evsen, M.; Gul, T.
    Background: Treatment of total genital prolapse in elderly patients is still controversial in terms of postoperative objective and subjective results. Aim: The present study aimed to compare the long-term objective and subjective cure rates of sacrospinous ligament fixation and Le Fort operation for treatment of total genital prolapse. Patients and Methods: Patients over the age of 60 with stage 3 or 4 pelvic organ prolapse that presented to the Obstetrics and Gynaecology Clinic of the Faculty of Medicine of *** University. The study sample consisted of 17 patients that underwent Le Fort operation and 29 patients that underwent sacrospinous ligament fixation. Data on duration of operation, intraoperative complications, duration of hospital stay, and differences between preoperative and postoperative estimated blood loss, postoperative complications, and relapse in the long term were obtained. Questionnaires exploring quality of life, incontinence, and pelvic floor disorders were applied to the patients. Results: As subjective cure rates, postoperative patient satisfaction (P = 0.001), regret rate (P = 0.038) and recommendation rate (P = 0.044), as well as postoperative questionnaire results, Pelvic Floor Impact Questionnaire and SF36 were found to be significantly better in the Le Fort group (respectively P = 0.039 and 0.042). As objective cure rates, there was no difference between the two groups in terms of postoperative cystocele, rectocele, and cystorectocele (P = 0.955) and postoperative recurrence of prolapse beyond the hymen (P: 0.893). Duration of operation and duration of hospital stay were found to be significantly shorter in the Le Fort group (respectively P = 0.032 and 0.012). Conclusion: Le Fort operation could be the intervention of choice in sexually inactive elderly patients with stage 3 or 4 pelvic organ prolapse.