Browsing by Author "Kosmas, Ioannis (6505812615)"

Uterine fibroids or myomas are the most common pathology of the female genital system. They affect one in three women aged 35 and over, with a rate increase from the age of 40, involve a direct and indirect healthcare expense for the diagnosis and medical and surgical treatment, resulting in a high social cost of the disease. Uterine fibroids unfortunately create both gynecological and obstetric problems, as they determine most hysterectomies and cause infertility, abortions, and obstetric complications, for example, premature births or placental abruption. In this chapter we will deal with the complex world of fibroids, with a complete overview, starting from biology, passing through histology and anatomy, continuing through gynecology, and ending in obstetrics. The authors propose to illustrate everything there is to know about fibroids in gynecology and obstetrics, up to complete the roundup with surgical treatments in both gynecology and obstetrics. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.

Uterine fibroids or myomas are the most common pathology of the female genital system. They affect one in three women aged 35 and over, with a rate increase from the age of 40, involve a direct and indirect healthcare expense for the diagnosis and medical and surgical treatment, resulting in a high social cost of the disease. Uterine fibroids unfortunately create both gynecological and obstetric problems, as they determine most hysterectomies and cause infertility, abortions, and obstetric complications, for example, premature births or placental abruption. In this chapter we will deal with the complex world of fibroids, with a complete overview, starting from biology, passing through histology and anatomy, continuing through gynecology, and ending in obstetrics. The authors propose to illustrate everything there is to know about fibroids in gynecology and obstetrics, up to complete the roundup with surgical treatments in both gynecology and obstetrics. © The Editor(s) (if applicable) and The Author(s), under exclusive license to Springer Nature Switzerland AG 2023.

Uterine rupture constitutes a critical obstetric emergency that presents substantial risks to both the maternal and fetal populations. This investigation evaluated the surgical interventions available for uterine rupture, emphasizing laparoscopic repair subsequent to uterine rupture. Laparoscopic repair serves as a fertility-sustaining alternative to conventional laparotomy, demonstrating comparable operative durations of 80 min (interquartile range [IQR] 60–114) for laparoscopic procedures versus 78 min (IQR 58–114) for laparotomy interventions. Nevertheless, laparoscopic approaches confer significant advantages, including a reduced incidence of intensive care unit (ICU) admissions (14.2% vs. 40% for laparotomy), a diminished requirement for blood transfusions (14.2% vs. 60%), and abbreviated hospital stays (median of 3 days vs. 5 days for laparotomy). The investigation explored the contentious discourse surrounding single-layer versus double-layer suturing methodologies, noting that barbed sutures significantly decrease uterine closure times (224 ± 46 vs. 343 ± 75 s for traditional sutures). Single-layer suturing is advocated as sufficient for maintaining uterine integrity in suitably selected cases. The necessity of meticulous postoperative monitoring, particularly concerning the assessment of recurrence in subsequent pregnancies, is emphasized, with recurrence rates varying from 4.8% to 19.4%. Finally, authors also proposed a feasible laparoscopic technique to repair a uterine rupture (the “CHEESE” method [closure of hemodynamically stable, early uterine rupture, via endoscopic surgery after spontaneous delivery]), appropriate for hemodynamically stable patients with minor ruptures. This review underscores the progressive role of minimally invasive techniques in the management of uterine rupture and seeks to optimize clinical outcomes for both maternal and neonatal health. © 2025 International Federation of Gynecology and Obstetrics.

Purpose: To study whether it is better to perform or not a myomectomy, in terms of surgical and reproductive outcomes in patients of advanced reproductive age, by an observational prospective study in university-affiliated and Community Hospitals. Materials and methods: 40 years and older patients affected by non-submucous symptomatic uterine fibroids and desiring future fertility were enrolled and treated by laparoscopic intracapsular myomectomy by (LIM) or by open laparotomy (OIM), or by a non-surgical management as control group, while attempting to conceive. The primary outcome measures were fibroid characteristics, pre- and post-surgical parameters, pregnancy achievement; the secondary outcome measures were the spontaneous or ART pregnancy outcomes, eventual week of abortion and type of delivery. Propensity scores have been calculated with logistic regression for binary and continuous variables. Results: 202 patients completed the study: 112 operated by LIM, 40 by OIM and 50 patients as control group. Patients undergoing OIM have a worse surgical outcome than LIM. No difference was seen in pregnancy either after myomectomy or control group during follow-up. In the LIM group, there were 44 pregnancies (39.2%), and in the OIM group, there were 9 (22.5%) and 16 in the control group (32%). The weeks of delivery were statistically greater for the control group versus the surgical groups, with no difference in Apgar score between the 3 groups. Conclusion: Patients aged over 40 years did not show substantial differences in reproductive outcome, whether operated or not. Myomectomy in over 40-year-old patients has no detrimental effect on future pregnancy rates and over when compared to expectant management. © 2023, The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.