Although TAP block after a total laparoscopic hysterectomy reduced the pain score at discharge compared with placebo, its role in this setting is debatable due to the possible lack of clinical significance of the small difference found.

To determine the surgical time, suture time, presence of postoperative dyspareunia, and complications that occur after closing the vaginal cuff with a barbed suture compared with conventional suture. Design: A randomized, controlled clinical trial (Canadian Task Force classification I). Setting: Private gynecologic clinic in Medellin, Colombia. Patients: One hundred fifty women who underwent total laparoscopic hysterectomy for benign pathology. Interventions: The patients underwent total laparoscopic hysterectomy with intracorporeal closure of the vaginal cuff and were randomized to 2 groups, 1 using a barbed suture (V-Loc 90; Medtronic/Covidien, New Haven, CT) and 1 using polyglactin 910 (coated Vicryl suture; Ethicon/Johnson & Johnson, New Brunswick, NJ). Measurements and Main Results: The total operative time, closing time of the vaginal vault, presence of complications in the cuff, and incidence of postoperative dyspareunia were recorded. The patients were evaluated at a postoperative office visit 2 weeks after the procedure and by telephone interview at 24 weeks. Seventy-five patients were included in the barbed suture group and 75 patients in the polyglactin 910 group. The average time to complete the suture of the vaginal cuff was 12.01 minutes (§ 5.37 standard deviation) for the barbed suture group versus 13.49 minutes (§ 6.48) in the polyglactin 910 group (95% confidence interval, −.44 to 3.4; p = .130). Blood loss was 31.56 § 22.93 mL in the barbed suture group versus 30.82 § 21.75 mL in the polyglactin 910 group (95% confidence interval, −7.95 to 6.47; p = .840). The frequency of postoperative events such as hematoma, cellulitis, cuff dehiscence, fever, emergency consultation, and hospitalization was not statistically significant between groups. No statistically significant difference was found regarding deep dyspareunia at 24 postoperative weeks. Conclusion: No differences were found in surgical time or frequency of adverse events when comparing patients after vaginal cuff closure with barbed suture versus polyglactin 910.

Objetivo: conocer la evolución a un año de las pacientes a quienes se les ha realizado tratamiento quirúrgico laparoscópico de la endometriosis profunda infiltrante.Metodología: cohorte de 24 pacientes con edades comprendidas entre 22 y 51 años a quienes se les realizó tratamiento quirúrgico de la endometriosis profunda infiltrante en la Unidad de Endoscopia Ginecológica de la Clínica del Prado y Profamilia, en Medellín, entre septiembre del 2007 y febrero del 2008. Se evaluaron las variables sociodemográficas, síntomas dolorosos, localización anatómica de la endometriosis profunda infiltrante, características de la lesión, tratamiento, tiempo quirúrgico, complicaciones.Resultados: se presentó una lesión de recto como única complicación en esta serie (4,1%). Hubo una disminución estadísticamente significativa de los síntomas dolorosos. Tres pacientes (12%) tuvieron recurrencias al año de seguimiento.Conclusión: el tratamiento laparoscópico de la endometriosis profunda infiltrante surge como una alternativa para el tratamiento de la endometriosis infiltrativa profunda.