pediatric gynecology

quote from "Pediatric Surgery (Springer Surgery Atlas)" by Prem Puri, Michael E. Höllwarth - "Hydrometrocolpos presents at the two extremes of childhood: initially during the neonatal period, when there is a high level of maternal hormones, and then at early puberty, when the patient herself begins to have production of estrogenic hormones. The distal vaginal obstruction is mostly due to imperforate hymen (in two thirds of cases), followed by a transverse vaginal septum and less commonly, vaginal atresia (with or without persistence of a urogenital sinus or cloaca)." "Associated anomalies are common and quite often severe. These include anorectal malformations and unilate…

video 1

video 1

Quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns - "There is no good prospective data to support the use of ovariopexy and its practice appears to be surgeon dependent [12]. Some specific situations may warrant ovariopexy, such as patients undergoing pelvic radiation for a malignancy, bilateral torsion, or recurrent ipsilateral torsion may benefit from a pexy procedure. In addition, pexy may be beneficial if torsion occurs on an ovary with a malformed or excessively long utero-ovarian ligament or in a patient with a single ovary. Clipping the utero-ovarian ligament or infundibulopelvic ligament …

Quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns - "An ovary that does not appear viable after detorsion, if left to remain, can be viable in future US surveillance. At follow-up US, if there is a persistent mass, then removal may be warranted and is still a consideration" Quote from "The SAGES Manual of Pediatric Minimally Invasive Surgery" by Danielle S. Walsh, Todd A. Ponsky, Nicholas E. Bruns - "The lesion must be thoroughly examined and its borders identified. Blunt retractors are used to detorse the ovary and ensure the vascular pedicle is no longer twisted. Ovarian preservation is preferr…

Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay - "The torsion rate increased with size from 0% in cysts <20 mm to 33% in cysts >50 mm. In between 0 and 40 mm, there is a higher rate of spontaneous resolution, and the median time to postnatal resolution was 10 (5–27) weeks in those treated conservatively [2]. Other publications suggest a similar pattern of spontaneous resolution [3]. So, it is recommended a conservative approach and postnatal ultrasound monitoring. Those cysts which exceed 5 cm and do not shrink postnatally may require surgical treatment [4]." Quote from "ESPES Man…

video 1

video 1

Quote from "ESPES Manual of Pediatric Minimally Invasive Surgery" by Ciro Esposito, François Becmeur, Henri Steyaert, Philipp Szavay - "After birth there are two scenarios [3]: first is the presence of a complex cyst at ultrasound. The ovary is lost, and surgery will be delayed for several weeks; second is a simple cyst of more than 5 cm. In this case a US-guided transcutaneous evacuating puncture may be tried, or patient is put on the operating table for a punction under laparoscopic control very soon after birth in order to avoid torsion and loss of the ovary [4, 5]."