V. Gomel - Academia.edu (original) (raw)

Papers by V. Gomel

Fertility and Sterility, 1983

Lysis of periadnexal adhesions (salpingo-ovariolysis) by laparoscopy was performed on 92 infertil... more Lysis of periadnexal adhesions (salpingo-ovariolysis) by laparoscopy was performed on 92 infertile patients who subsequently have been followed for at least 9 months. In each instance, the duration of infertility was longer than 20 months. Periadnexal adhesions were severe in most cases and moderate in the remainder. Moreover, only those cases where ovum pickup by the oviduct with the lesser pathology was deemed impossible or greatly hampered were included in this series. There were no significant postoperative complications. Of the total of 92 patients, 57 (62%) achieved at least one intrauterine pregnancy, 54 (58.7%) had one or more full-term pregnancies, and 5 patients (5.4%) had ectopic pregnancies. With appropriately selected patients and in trained hands, laparoscopic salpingo-ovariolysis is a low-risk procedure associated with a surprisingly good success rate. It can be performed on a day-care basis with considerable savings to the patient in terms of both hospital stay and avoidance of major abdominal surgery.

Facts, Views & Vision in ObGyn, 2020

Introduction Uterine malformations are common and may contribute to infertility and adverse pregn... more Introduction Uterine malformations are common and may contribute to infertility and adverse pregnancy outcomes. After an accurate diagnosis, correcting the abnormal uterine morphology is the main goal to optimize reproductive outcomes. The principal objective of this study was to assess the impact of metroplasty for T-shaped (U1a) and septate uteri (U2) on live birth rates in infertile patients. Methods This was a prospective observational study of infertile women with either U1a or U2 uterine anomaly. Patients with unexplained infertility and repeated (IVF/ICSI) failure were included. Hysteroscopic metroplasty was performed by a single experienced surgeon. Fertility outcomes of all cases were evaluated prospectively evaluated. The main outcome parameter was a live birth rate either achieved spontaneously or with assisted conception. Results A total of 48 patients were included in U1a group and bilateral longitudinal uterine-lateral wall incision was carried out. A total of 63 patie...

Facts, Views & Vision in ObGyn, 2019

Statistical significance is used to analyse research findings and is together with biased free tr... more Statistical significance is used to analyse research findings and is together with biased free trials the cornerstone of evidence based medicine. However traditional statistics are based on the assumption that the population investigated is homogeneous without smaller hidden subgroups. The clinical, inflammatory, immunological, biochemical, histochemical and genetic-epigenetic heterogeneity of similar looking endometriosis lesions is a challenge for research and for diagnosis and treatment of endometriosis. The conclusions obtained by statistical testing of the entire group are not necessarily valid for subgroups. The importance is illustrated by the fact that a treatment with a beneficial effect in 80% of women but with exactly the same but opposite effect, worsening the disease in 20%, remains statistically highly significant. Since traditional statistics are unable to detect hidden subgroups, new approaches are mandatory. For diagnosis and treatment it is suggested to visualise i...

Journal De Gynecologie Obstetrique Et Biologie De La Reproduction, 2003

Avancées thérapeuthiques Prises en charge alternatives Pour le traitement chirurgical du syndrome... more Avancées thérapeuthiques Prises en charge alternatives Pour le traitement chirurgical du syndrome des ovaires polykystiques D'après la communication de V.

Human Reproduction Update, 2009

hysteroscopic treatment of intrauterine adhesions are lacking. Hysteroscopy in the cycle precedin... more hysteroscopic treatment of intrauterine adhesions are lacking. Hysteroscopy in the cycle preceding a subsequent IVF attempt nearly doubles the pregnancy rate in patients with at least two failed IVF attempts compared with starting IVF immediately (RR ¼ 1.7; 95% CI: 1.5-2.0). conclusions: Scarce evidence on the effectiveness of hysteroscopic surgery in subfertile women with polyps, fibroids, septate uterus or intrauterine adhesions indicates a potential benefit. More randomized controlled trials are needed before widespread use of hysteroscopic surgery in the general subfertile population can be justified.

Fertility and Sterility, 1995

Clinical Obstetrics and Gynecology, 1995

Fertility and Sterility, 1992

To assess the significance of pathological midtubal occlusion in infertility. Retrospective descr... more To assess the significance of pathological midtubal occlusion in infertility. Retrospective descriptive case review. Tertiary referral center. Sixteen women, 26 to 38 years of age presenting with infertility and diagnosed as having midtubal occlusion. Assessment of the etiology of the occlusive disease and yield of microsurgical tubotubal anastomosis. Histologic examination of occluded tubal segment and fertility outcome subsequent to anastomosis. Occlusion was because of tuberculous salpingitis (n = 6), resolved tubal pregnancy (n = 3), endometriosis (n = 2), chronic inflammatory reaction (n = 1), tubal cyst (n = 1), intratubal adhesions (n = 1), infant hernia repair (n = 1), and calcification (n = 1). Of eight women (including the patient with tuberculous salpingitis) who underwent tubal anastomosis only for midtubal occlusion, three had subsequent term deliveries, two had tubal pregnancies, and three women did not conceive. Midtubal occlusion of the tube because of an infectious process is rare. Excluding tuberculous salpingitis, microsurgical anastomosis yields satisfactory fertility, albeit with significant risk of ectopic pregnancy.

Fertility and Sterility, 1991

The aim of this study was to determine the effectiveness of hyaluronic acid solution in preventin... more The aim of this study was to determine the effectiveness of hyaluronic acid solution in preventing intraperitoneal (IP) adhesions. The study design was prospective, randomized and blinded and involved 83 rats. Measured serosal injury was inflicted using a CO2 laser on the right uterine horn of the rat. Animals randomized to groups 1 and 2 received either 0.4% hyaluronic acid or its diluent phosphate-buffered saline (PBS) intraperitoneally before and after the injury. In groups 3 and 4, the same solutions were used only after the injury. Postoperative adhesions were assessed at second-look laparotomy. Histologic assessment of the fresh laser injury was carried out on uteri pretreated with hyaluronic acid, PBS, or nothing. Pretreatment with hyaluronic acid was associated with a significant reduction in postoperative adhesions and a significantly decreased crater depth. Hyaluronic acid appears to reduce postoperative IP adhesion formation by coating the serosal surfaces and decreasing the extent of initial tissue injury.

Background The genetic-epigenetic theory postulates that endometriosis is triggered by a cumulati... more Background The genetic-epigenetic theory postulates that endometriosis is triggered by a cumulative set of genetic-epigenetic (GE) incidents. Pelvic and upper genital tract infection might induce GE incidents and thus play a role in the pathogenesis of endometriosis. Thus, this article aims to review the association of endometriosis with upper genital tract and pelvic infections. Methods Pubmed, Scopus and Google Scholar were searched for ‘endometriosis AND (infection OR PID OR bacteria OR viruses OR microbiome OR microbiota)’, for ‘reproductive microbiome’ and for ‘reproductive microbiome AND endometriosis’, respectively. All 384 articles, the first 120 ‘best match’ articles in PubMed for ‘reproductive microbiome’ and the first 160 hits in Google Scholar for ‘reproductive microbiome AND endomytriosis’ were hand searched for data describing an association between endometriosis and bacterial, viral or other infections. All 31 articles found were included in this manuscript. Results W...

Human Reproduction, 2006

BACKGROUND: The objective of the study is to evaluate the short-and long-term efficacy of complet... more BACKGROUND: The objective of the study is to evaluate the short-and long-term efficacy of complete laparoscopic excision of deep endometriosis, without rectum involvement, with the opening and partial excision of the posterior vaginal fornix. METHODS: Thirty-one patients were included in the study with symptomatic extensive disease including involvement of the cul-de-sac, rectovaginal space and posterior vaginal fornix without rectum involvement. Endoscopic surgery was performed with complete separation of rectovaginal space and in-block resection of the diseased tissue, opening and partial excision of the posterior vaginal fornix and vaginal closure either by laparoscopic or by vaginal route. Patients filled in questionnaires on pain before and 12, 24, 36, 48 and 60 months after surgical treatment. RESULTS: No intraoperative complications were observed; 65% were free of analgesic on post-operative day 2, 38% had total remission of chronic pain and 22% were improved; 38% had total remission of dysmenorrhoea and 22% were improved; 45% had total remission of dyspareunia and 25% were improved. Follow-up improvement of symptoms was statistically significant and was maintained for 5 years without recurrence of the disease or repeated surgery (P < 0.001). CONCLUSION: Complete surgical resection of deep infiltrative endometriosis with excision of the adjacent tissue of the posterior vaginal fornix improves quality of life with persistence of results for long time in patients not responsive to medical treatment.

Clinical Obstetrics and Gynecology, 1980

The American Journal of Surgery, 1976

Laparoscopy is the visualization of the peritoneal cavity through the anterior abdominal wall wit... more Laparoscopy is the visualization of the peritoneal cavity through the anterior abdominal wall with the use of an endoscope after the induction of a pneumoperitoneum. The value of the information obtained is undisputed. In the last seven years since its reintroduction to North America, laparoscopy has become increasingly popular. The procedure has been primarily embraced by the gynecdogist. Other specialities have been relatively slow in recognizing the value of this procedure.

Fertility and Sterility, 2001

Acta Europaea fertilitatis

This study was undertaken to analyze the factors associated with fertility outcome following tuba... more This study was undertaken to analyze the factors associated with fertility outcome following tubal pregnancy. Eighty-six patients were analyzed in this regard. The chances of a favourable outcome (intrauterine pregnancy) decreased and an unfavorable outcome (repeated tubal pregnancy or no pregnancy) increased with a history of previous tubal pregnancy and also with an absent or diseased contralateral tube at the time of surgery. History of infertility, prior reconstructive tubal surgery, status of the ipsilateral tube at the time of surgery, the treatment modality (laparoscopy vs laparotomy) or the surgical approach (conservative vs radical) did not significantly affect fertility outcome.

The Journal of reproductive medicine, 1996

To review the mechanism of adhesion formation and to briefly discuss the possible sites of action... more To review the mechanism of adhesion formation and to briefly discuss the possible sites of action of various preventive measures and adjuvants. Literature review. Although good surgical technique, designed to minimize trauma, is a crucial part of adhesion prevention, technique alone cannot effectively eliminate de novo formation and especially reformation of adhesions. To date, no adjuvant has proven uniformly effective in preventing postoperative adhesions. Nonreactive barriers show promise in selected situations, especially in the presence of apposing, injured peritoneal surfaces. Development of new and more effective compounds and advances in molecular cell biology may provide a more definitive answer to this perplexing problem, which has eluded surgeons for so long.

Fertility and sterility, 1991