Stephen Dobbs

TitleDoes apronectomy improve outcomes for the morbidly obese patient undergoing gynae cancer surgery? A review of four casesAimsThe aim is to describe the short-term outcomes of performing apronectomy at the time of laparotomy for gynae malignancy in the morbidly obese patient.BackgroundFor the morbidly obese patient undergoing laparotomy and pelvic clearance in the context of an oestrogen-driven gynae cancer, concomitant apronectomy confers multiple benefits - optimising intra-operative pelvic access; improving post-operative recovery and general health; as well as also having the potential to reduce future peripheral oestrogen production, with positive implications for cancer recurrence. MethodsA retrospective case-note review of morbidly obese patients undergoing apronectomy as a component of gynae cancer surgery between 2017 and 2019 in a district general hospital in Northern Ireland was performed. ResultsFour patients were identified, with mean age 56 years and mean BMI 53kg/m2. Three patients were undergoing laparotomy for endometrial adenocarcinoma, and the fourth for suspected ovarian malignancy. At each surgery, the operating team consisted of a minimum of three Consultants: one gynae-oncologist, one gynaecologist and one plastic surgeon. No anaesthetic complications occurred. Each patient received intra-operative antibiotic prophylaxis and underwent TAH, BSO, omentectomy/omental biopsy and apronectomy with re-siting of the umbilicus. The average weight of apron excised was 9.6kg. Each patient had two negative-pressure wound drains placed. Skin was closed with monofilament sutures and negative-pressure dressings applied. No intra-operative complications occurred, the maximum blood loss was 300mls and mean operating time 217 minutes. One patient required HDU for 24hours. Immediate post-operative complications included anaemia (50%); wound infection/partial dehiscence (50%); one case of return to theatre for debridement of a non-viable umbilicus; paralytic ileus (25%); and urinary tract infection (25%). The mean length of stay was 16 days. In the 30 day post-operative period, one patient was readmitted with wound infection.ConclusionsOverall, apronectomy appears to be a safe addition to laparotomy in this challenging patient population.

Does Apronectomy Improve Outcomes for the Morbidly Obese Patient Undergoing Gynae Cancer Surgery? A Review of Four Cases

Ash Monga

First published in 1919 under the title Diseases of Women, Gynaecology by Ten Teachers has become a world-renowned textbook in its field. The eighteenth edition of this classic book is thoroughly updated in line with the new curriculum, integrating clinical material and incorporating the latest advances in Gynaecology. The book also retains its comprehensive coverage of the subject area, and the much-loved textual features of previous editions. Each chapter is highly structured, with an overview, definition, prevalence, aetiology, clinical features, differential diagnosis, investigations, treatment, key points, new developments, and references where appropriate. With a new Editor and a new team of contributing authors, the eighteenth edition combines authoritative detail with a clear guide to essential knowledge. Both Gynaecology and Obstetrics volumes are carefully edited to ensure consistency of structure, style and level of detail, and to avoid overlap of material. This book owes a great debt to Professor Stuart Campbell who, along with the present editor Ash Monga, was responsible for introducing the concepts and features to the seventeenth edition that are continued here.

Gynaecology by Ten Teachers 18Ed

First published in 1919 as 'Diseases of Women', Gynaecology by Ten Teachers is well established as a concise, yet comprehensive, guide within its field. The nineteenth edition has been thoroughly updated, integrating clinical material with the latest scientific advances. With an additional editor and new contributing authors, the new edition combines authoritative detail while signposting essential knowledge. Retaining the favoured textual features of preceding editions, each chapter is highly structured, with overviews, definitions, aetiology, clinical features, investigation, treatments, key points and additional reading where appropriate. Together with its companion Obstetrics by Ten Teachers, the volume has been edited carefully to ensure consistency of structure, style and level of detail, as well as avoiding overlap of material. For almost a century the 'Ten Teachers' titles have together found favour with students, lecturers and practitioners alike. The nineteenth editions continue to provide an accessible 'one stop shop' in obstetrics and gynaeology for a new generation of doctors. Key features Fully revised - some chapters completely rewritten by brand-new authors Plentiful illustrations - text supported and enhanced throughout by colour line diagrams and photographs Clear and accessible - helpful features include overviews, key points and summaries Illustrative case histories - engage the reader and provide realistic advice on practicing gynaecology

Stephen Dobbs

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