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Şahin F, Özdemir S, Doğan O. Should sacrouterine plication be added to lateral suspension surgery? A prospective study. J Obstet Gynaecol Res 2024; 50:1042-1050. [PMID: 38627198 DOI: 10.1111/jog.15941] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2024] [Accepted: 03/26/2024] [Indexed: 06/04/2024]
Abstract
AIM Laparoscopic lateral suspension is a novel approach for repairing anterior and apical pelvic organ prolapse (POP). According to integral theory, urinary symptoms and pelvic pain are believed to originate from suspensory ligaments. We aimed to investigate the objective and subjective outcomes of adding sacroterine plication to apical prolapse surgery. METHODS Sixty patients with Grade 2 or higher symptomatic apical POP were included in the study. The study sample was categorized into two groups: Group 1 underwent lateral suspension and Group 2 underwent lateral suspension and sacroterine plication. Anatomical cure was defined separately for the apical and anterior compartments as POP-Q scores for sites C and Ba of less than -1 cm for each compartment. A subjective cure was defined as the absence of bulge symptoms. Patient satisfaction, sexual function, prolapse-related quality of life, voiding dysfunction, nocturia, and constipation were assessed. RESULTS In Group 1, anatomical cure rates for apical and anterior prolapse were 100% and 70%, respectively (p <0.001). In Group 2, these rates were 100% for apical prolapse and 73.3% for anterior prolapse (p <0.001). The subjective cure was 96.6% in both groups. Furthermore, improvement in sexual and urinary symptoms was more significant in the group that underwent sacroterine plication (p <0.001). CONCLUSIONS The additional sacroterine plication (shortening) procedure with lateral suspension proved to be an effective and successful surgical approach for apical prolapse. Its routine addition to existing lateral suspension surgery can contribute significantly to the improvement of urinary and prolapse symptoms.
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Affiliation(s)
- Fatih Şahin
- Department of Obstetrics and Gynecology, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Savaş Özdemir
- Department of Obstetrics and Gynecology, Prof. Dr. Cemil Tascıoglu City Hospital, Istanbul, Turkey
| | - Ozan Doğan
- Department of Obstetrics and Gynecology, Private Clinic, Istanbul, Turkey
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Malanowska-Jarema E, Starczewski A, Melnyk M, Oliveira D, Balzarro M, Rubillota E. A Randomized Clinical Trial Comparing Dubuisson Laparoscopic Lateral Suspension with Laparoscopic Sacropexy for Pelvic Organ Prolapse: Short-Term Results. J Clin Med 2024; 13:1348. [PMID: 38592190 PMCID: PMC10931691 DOI: 10.3390/jcm13051348] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2023] [Revised: 01/23/2024] [Accepted: 02/05/2024] [Indexed: 04/10/2024] Open
Abstract
BACKGROUND Laparoscopic sacrocolpopexy (LSC) is the gold standard for the treatment of apical prolapse, although dissection of the promontory may be challenging. Laparoscopic lateral suspension (LLS) with mesh is an alternative technique for apical repair with similar anatomical and functional outcomes, according to recent studies. The purpose of this study was to compare these operative techniques. METHODS Women with uterine Pelvic Organ Prolapse Quantification (POP-Q) stage 2 were enrolled in this prospective study and were randomly allocated to the LLS or LSC group. At the 12-month follow-up, primary measures included both anatomical and functional outcomes. Perioperative parameters and complications were recorded. RESULTS A total of 93 women were randomized, 48 in the LLS group and 45 in the LSC group, with 2 women lost to follow-up in both groups. LSC anatomic success rates were 81.82% for the apical compartment and 95.22% for the anterior compartment. LLS anatomic success rates for the apical and anterior compartments were 90% and 92.30%, respectively. The mean operative time for LLS was 160.3 min, while for LSC it was 168.3 min. The mean blood loss was 100 mL in both procedures. Conversion to laparotomy was necessary in three women. Mesh erosion was not observed in any of the cases. In terms of the complication, Clavien-Dindo grade 1 was observed in two patients in the LLS group and a complication rated grade 3b was observed in one patient in LSC group. CONCLUSIONS LLS is a good alternative to LSC, with promising anatomical and quality-of-life results.
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Affiliation(s)
- Ewelina Malanowska-Jarema
- Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University, 70-204 Szczecin, Poland; (E.M.-J.); (A.S.)
| | - Andrzej Starczewski
- Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University, 70-204 Szczecin, Poland; (E.M.-J.); (A.S.)
| | - Mariia Melnyk
- Department of Gynecology, Endocrinology and Gynecologic Oncology, Pomeranian Medical University, 70-204 Szczecin, Poland; (E.M.-J.); (A.S.)
| | - Dulce Oliveira
- Institute of Science and Innovation in Mechanical and Industrial Engineering (INEGI), 4200-465 Porto, Portugal;
| | - Matteo Balzarro
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy; (M.B.); (E.R.)
| | - Emanuel Rubillota
- Department of Urology, Azienda Ospedaliera Universitaria Integrata Verona, 37126 Verona, Italy; (M.B.); (E.R.)
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Ketenci Gencer F, Salman S, Kumbasar S, Bacak HB, Khatib O, Kaya C, Yildiz E, Coskun ES. Lateral suspension with V-NOTES for the treatment of pelvic organ prolapse with the Salman-Ketenci Gencer technique. Int Urogynecol J 2023; 34:1583-1591. [PMID: 36625926 DOI: 10.1007/s00192-022-05433-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/24/2022] [Indexed: 01/11/2023]
Abstract
INTRODUCTION AND HYPOTHESIS Pelvic organ prolapse (POP) is a common morbidity and 10-20% of the patients need surgical correction. Sacrocolpopexy or sacrohysteropexy procedures are satisfactory but still difficult. Lateral suspension (LS) as a safe and simple technique has become an alternative technique recently. Vaginal natural orifice transluminal endoscopic surgery (V-NOTES) is also a new modality and LS using V-NOTES has not been performed previously and should be promising. METHODS This prospective observational pilot study was conducted with a total of 38 women with stage 3 and 4 POP according to the Pelvic Organ Prolapse Quantification grading system (POP-Q). Lateral suspension via V-NOTES was performed with the Salman-Ketenci Gencer technique using a mesh for POP. The preoperative and postoperative 6-month POP-Q stages together with Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) scores were recorded and compared. RESULTS Comparison of the preoperative and postoperative 6-month POP-Q stages of the patients were statistically significant except for the total vaginal length (p<0.01). Compared with the preoperative total and subscale scores of PISQ-12, the postoperative values were considerably improved (p<0.001). CONCLUSIONS With the Salman-Ketenci Gencer technique not only good anatomical but also good functional results were obtained with V-NOTES. Surgeons may focus on uterine sparing while using the Salman-Ketenci Gencer technique for apical prolapse owing to the higher rate of complications related to the colposuspension and better sexual results after the cervicosuspension.
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Affiliation(s)
- Fatma Ketenci Gencer
- Istanbul Gaziosmanpasa Training and Research Hospital, Department of Obstetrics and Gynecology, University of Health Sciences, Hizirefendi Street, 34255, Istanbul, Gaziosmanpasa, Turkey
| | - Suleyman Salman
- Istanbul Gaziosmanpasa Training and Research Hospital, Department of Obstetrics and Gynecology, University of Health Sciences, Hizirefendi Street, 34255, Istanbul, Gaziosmanpasa, Turkey.
| | - Serkan Kumbasar
- Istanbul Gaziosmanpasa Training and Research Hospital, Department of Obstetrics and Gynecology, University of Health Sciences, Hizirefendi Street, 34255, Istanbul, Gaziosmanpasa, Turkey
| | - Havva Betul Bacak
- Istanbul Gaziosmanpasa Training and Research Hospital, Department of Obstetrics and Gynecology, University of Health Sciences, Hizirefendi Street, 34255, Istanbul, Gaziosmanpasa, Turkey
| | - Ozlem Khatib
- Istanbul Gaziosmanpasa Training and Research Hospital, Department of Obstetrics and Gynecology, University of Health Sciences, Hizirefendi Street, 34255, Istanbul, Gaziosmanpasa, Turkey
| | - Cihan Kaya
- Acibadem Bakirkoy Hospital, Department of Obstetrics and Gynecology, Acibadem Mehmet Ali Aydinlar University, Istanbul, Turkey
| | - Elif Yildiz
- Istanbul Gaziosmanpasa Training and Research Hospital, Department of Obstetrics and Gynecology, University of Health Sciences, Hizirefendi Street, 34255, Istanbul, Gaziosmanpasa, Turkey
| | - Enes Serhat Coskun
- Istanbul Gaziosmanpasa Training and Research Hospital, Department of Obstetrics and Gynecology, University of Health Sciences, Hizirefendi Street, 34255, Istanbul, Gaziosmanpasa, Turkey
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Russo E, Montt Guevara MM, Sacinti KG, Misasi G, Falcone M, Morganti R, Mereu L, Dalprà F, Tateo S, Simoncini T. Minimal Invasive Abdominal Sacral Colpopexy and Abdominal Lateral Suspension: A Prospective, Open-Label, Multicenter, Non-Inferiority Trial. J Clin Med 2023; 12:jcm12082926. [PMID: 37109262 PMCID: PMC10147058 DOI: 10.3390/jcm12082926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Revised: 03/29/2023] [Accepted: 04/13/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Abdominal minimally invasive surgery has become increasingly prominent for the treatment of prolapse. Abdominal sacral colpopexy (ASC) is the gold standard for the treatment of advanced apical prolapse; however, alternative surgical approaches such as the abdominal lateral suspension (ALS) have been developed to improve patient outcomes. This study aims to determine whether ALS improves outcomes compared to ASC in multicompartmental prolapse patients. METHODS A prospective, open-label, multicenter, non-inferiority trial was conducted in 360 patients who underwent ASC or ALS for the treatment of apical prolapse. The primary outcome was anatomical and symptomatic cure of the apical compartment at 1-year follow-up; secondary outcomes included prolapse recurrence, re-operation rate, and post-operative complications. A 300-patient cohort was subdivided into 200-patients who underwent ALS and 100-patients who underwent ASC. The confidence interval method was used to calculate the p-value of non-inferiority. RESULTS At the 12-months follow-up, the objective cure rate of the apical defect was 92% for ALS and 94% for ASC (recurrence rates were 8% and 6%, respectively, and the p-value for non-inferiority was <0.01). The mMesh complication rates were 1% and 2% for ALS and ASC, respectively. CONCLUSIONS This study demonstrated that the ALS technique is not inferior to the gold standard ASC for the surgical treatment of apical prolapse.
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Affiliation(s)
- Eleonora Russo
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, 56126 Pisa, Italy
| | - Maria Magdalena Montt Guevara
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, 56126 Pisa, Italy
| | - Koray Gorkem Sacinti
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, 56126 Pisa, Italy
- Department of Obstetrics and Gynecology, Ankara University School of Medicine, 06100 Ankara, Turkey
| | - Giulia Misasi
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, 56126 Pisa, Italy
| | - Maria Falcone
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, 56126 Pisa, Italy
| | - Riccardo Morganti
- SOD Clinical Trial Statistical Support, Azienda Ospedaliero Universitaria Pisana, 56126 Pisa, Italy
| | - Liliana Mereu
- Department of Provincial Health Services, Local Health of Trento, 38123 Trento, Italy
| | - Francesca Dalprà
- Department of Obstetrics and Gynecology, Santorso Hospital, 36014 Vicenza, Italy
| | - Saverio Tateo
- Department of Obstetrics and Gynecology, Centre Hospitalier de Troyes, 10003 Troyes, France
| | - Tommaso Simoncini
- Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine, University of Pisa, 56126 Pisa, Italy
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Baki Erin K, Taştan AŞ, Katırcı Y, Özdemir AZ, Güven D, Önem K, Önal M, Erin R, Kulaksiz D. Comparison of 2-year follow-up outcomes of laparoscopic lateral suspension and sacrospinous fixation in apical compartment prolapse: an observational study. Arch Gynecol Obstet 2023; 307:1859-1865. [PMID: 36808287 DOI: 10.1007/s00404-023-06958-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 02/01/2023] [Indexed: 02/23/2023]
Abstract
PURPOSE This study aimed to compare the results of patients with laparoscopic lateral suspension (LLS) and sacrospinous fixation (SSF). METHODS This prospective observational study included 52 patients who underwent LLS and 53 patients who underwent SSF due to pelvic organ prolapse. The pelvic organ prolapse's anatomical cure and the frequency of recurrence have been recorded. Female Sexual Function Index, Pelvic Organ Prolapse Symptom Score, and complications were evaluated preoperatively and at the postoperative 24th month. RESULTS In the LLS group, the subjective treatment rate was 88.4% and the anatomical cure rate for apical prolapse was 96.1%. In the SSF group, the subjective treatment rate was 83.0% and the anatomical cure rate for apical prolapse was 90.5%. There was a significant difference between the groups regarding Clavien-Dindo classification and reoperation (p < 0.05). Female Sexual Function Index, and the Pelvic Organ Prolapse Symptom Score were different between the groups (p < 0.05). CONCLUSIONS This study showed that there is no difference between two surgical techniques in apical prolapse cure rates. However, the LLS seem preferable in terms of the Female Sexual Function Index, Pelvic Organ Prolapse Symptom Score, reoperation, and complications. We need larger sample size studies in terms of incidence of complications and reoperation.
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Affiliation(s)
- Kübra Baki Erin
- Department of Obstetrics and Gynecology, Trabzon Kanuni Health Practice and Research Center, University of Health Sciences, Trabzon, Turkey.
| | - Ayşe Şeyma Taştan
- Department of Obstetrics and Gynecology, Medical School, Ondokuz Mayıs University, Samsun, Turkey
| | - Yunus Katırcı
- Department of Obstetrics and Gynecology, Medical School, Ondokuz Mayıs University, Samsun, Turkey
| | - Ayşe Zehra Özdemir
- Department of Obstetrics and Gynecology, Medical School, Ondokuz Mayıs University, Samsun, Turkey
| | - Davut Güven
- Department of Obstetrics and Gynecology, Medical School, Ondokuz Mayıs University, Samsun, Turkey
| | - Kadir Önem
- Department of Urology, Medicine Faculty, Ondokuz Mayıs University, Samsun, Turkey
| | - Mesut Önal
- Department of Obstetrics and Gynecology, Medical School, Ondokuz Mayıs University, Samsun, Turkey
| | - Recep Erin
- Department of Obstetrics and Gynecology, Trabzon Kanuni Health Practice and Research Center, University of Health Sciences, Trabzon, Turkey
| | - Deniz Kulaksiz
- Department of Obstetrics and Gynecology, Trabzon Kanuni Health Practice and Research Center, University of Health Sciences, Trabzon, Turkey
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Damiani G, Pellegrino A, Villa M, Cesana M, Perrone A, Malvasi A, Loizzi V, Giampaolino P, Cicinelli E, De Iaco P. Robotic lateral pelvic organ prolapse suspension of multicompartment vaginal prolapse. Gynecol Minim Invasive Ther 2023; 12:44-45. [PMID: 37025440 PMCID: PMC10071865 DOI: 10.4103/gmit.gmit_97_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2021] [Revised: 11/15/2022] [Accepted: 11/17/2022] [Indexed: 02/11/2023] Open
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Isenlik BS, Aksoy O, Erol O, Mulayim B. Comparison of laparoscopic lateral suspension and laparoscopic sacrocolpopexy with concurrent total laparoscopic hysterectomy for the treatment of pelvic organ prolapse: a randomized controlled clinical trial. Int Urogynecol J 2023; 34:231-238. [PMID: 35737006 DOI: 10.1007/s00192-022-05267-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Accepted: 05/17/2022] [Indexed: 01/14/2023]
Abstract
INTRODUCTION AND HYPOTHESIS We compared the outcomes of women who underwent laparoscopic lateral suspension with concurrent total laparoscopic hysterectomy (LLS-TLH) with those of women who underwent laparoscopic sacrocolpopexy with concurrent total laparoscopic hysterectomy (LSC-TLH) for apical and/or anterior vaginal wall prolapse. METHODS Eighty women underwent LLS-TLH or LSC-TLH operations. According to the Pelvic Organ Prolapse Quantification System (POP-Q), women with symptomatic pelvic organ prolapse of stage 2 or higher apical and/or anterior compartment prolapse were enrolled in the study. The objective cure rate according to the POP-Q system was the primary (objective) outcome. The International Consultation on Incontinence Questionnaire-Vaginal Symptoms (ICIQ-VS), International Consultation on Incontinence Questionnaire-Short Form (ICIQ-SF), and Patient Global Impression of Improvement (PGI-I) questionnaire scores were the secondary (subjective) outcomes. The primary and secondary outcomes were evaluated at 1 year after surgery. RESULTS The primary and secondary outcomes indicated significant improvements in both groups (p < 0.05). The objective cure rate was 92.5% for apical and 78.6% for anterior compartment prolapse in the LLS-TLH group; the respective rates were 100% and 74.1% in the LSC-TLH group. The subjective cure rate was 87.5% for the LLS-TLH group and 90% for the LSC-TLH group. No statistically significant differences between groups were found in the objective cure rate, subjective cure rate, or ICIQ-VS, ICIQ-SF, or PGI-I scores at 1 year (p > 0.05). CONCLUSIONS LLS-TLH can serve as a safe, effective, and feasible alternative to LSC-TLH, with low complication rates and similar short-term objective and subjective outcomes.
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Affiliation(s)
- Bekir Sıtkı Isenlik
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Varlık Mah, Kazım Karabekir Cd., Muratpaşa/Antalya, 07100, Antalya, Turkey
| | - Orhan Aksoy
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Varlık Mah, Kazım Karabekir Cd., Muratpaşa/Antalya, 07100, Antalya, Turkey
| | - Onur Erol
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Varlık Mah, Kazım Karabekir Cd., Muratpaşa/Antalya, 07100, Antalya, Turkey
| | - Barıs Mulayim
- Department of Obstetrics and Gynecology, Antalya Training and Research Hospital, Varlık Mah, Kazım Karabekir Cd., Muratpaşa/Antalya, 07100, Antalya, Turkey.
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Campagna G, Vacca L, Panico G, Caramazza D, Lombisani A, Scambia G, Ercoli A. Laparoscopic lateral suspension for pelvic organ prolapse: A systematic literature review. Eur J Obstet Gynecol Reprod Biol 2021; 264:318-329. [PMID: 34364019 DOI: 10.1016/j.ejogrb.2021.07.044] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Revised: 06/14/2021] [Accepted: 07/25/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND Abdominal lateral suspension with mesh represents an alternative treatment to suspend the vaginal apex. OBJECTIVES The aim of this study was to summarize literature data regarding the anatomical and functional outcomes, and intra- and postoperative complications of this technique with minimally invasive approach (laparoscopic/robotic). SEARCH STRATEGY Systematic literature search using MEDLINE/PubMed, SCOPUS, Web of Science. DATA COLLECTION AND ANALYSIS Two authors extracted data on baseline characteristics (age, BMI, prior pelvic reconstructive surgery, preoperative POP stage), perioperative outcomes (operative time, estimated blood loss, intraoperative and postoperative complications, admission time), objective and subjective success rate, surgical failure, time of follow-up. Data were presented descriptively. MAIN RESULTS Thirteen studies were included in the review. The overall number of patients for our analysis was 1066. Patients referred for laparoscopic/robotic lateral suspension were most frequently postmenopausal, aged 50 to 65 years, BMI ≥ 25 kg/m2; 22.2% were already hysterectomized, while 17% had already a previous POP surgery. Operative time ranged from 78.4 ± 29.7 to 254 ± 45 min. The overall anatomic success was more than 90% in the apical compartment and more than 88% in the anterior compartment. Subjective cure rate varies from 78.4% to 100% in medium-term follow-up. Post-operative complication grade >= 3 according to Claiven-Dindo Scale was 1.03%. Mesh erosion rate varied between 0% and 13%. CONCLUSIONS Results coming from our systematic review suggest safety, efficacy and feasibility of minimally invasive lateral suspension with optimal anatomical and functional outcomes. Well-designed, randomized, controlled trials are required to confirm this data.
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Affiliation(s)
- Giuseppe Campagna
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Lorenzo Vacca
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy.
| | - Giovanni Panico
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Daniela Caramazza
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Andrea Lombisani
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Giovanni Scambia
- Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC di Ginecologia Oncologica, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Rome, Italy
| | - Alfredo Ercoli
- Università degli studi di Messina, Policlinico G. Martino, PID Ginecologia Oncologica e Chirurgia Ginecologica Miniinvasiva, Messina, Italy
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Akbaba E, Sezgin B. Modified laparoscopic lateral suspension with a five-arm mesh in pelvic organ prolapse surgery. BMC WOMENS HEALTH 2021; 21:244. [PMID: 34130664 PMCID: PMC8207729 DOI: 10.1186/s12905-021-01388-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/23/2021] [Accepted: 06/07/2021] [Indexed: 12/02/2022]
Abstract
Background Laparoscopic lateral suspension (LLS) is a laparoscopic technique used to treat pelvic organ prolapse (POP) in apical and anterior compartment defect with the use of a synthetic T-shaped mesh graft. The posterior compartment is repaired using a second mesh or a procedure along with LLS, such as posterior colporrhaphy. The aim of this study was to evaluate the clinical results of LLS for POP using a five-arm mesh instead of a T-shaped mesh graft to repair the defect of the posterior compartment in addition to the apical and anterior compartments.
Methods Data from 37 patients with a diagnosis of advanced-stage (≥ 3) POP undergoing LLS with the use of a five-arm mesh were retrospectively analysed. Pre-operative and post-operative examinations and, surgical outcomes were determined. The results of measurements and examinations, reoperation rates, erosion rates, lower urinary tract symptoms, and complications were analysed. The Prolapse Quality of Life Questionnaire (P-QOL) was also used. Results The median post-operative follow-up was 20 (13–34) months. There was a significant improvement in POP-Q scores in all treated compartments, with overall objective cure rates of 94.5% for the apical compartment, 86.4% for the anterior compartment, and 91.8% for the posterior compartment. The median operative time was 96 (76–112) minutes. The median length of hospitalization was 2 (1–3) days. A significant improvement in vaginal bulge, urinary urgency, incomplete voiding, urinary frequency, and constipation was observed after surgery. The sexuality among patients increased from 13 (35.1%) preoperatively to 22 (59.4%) post-operatively. De novo stress urinary incontinence developed in 7 (18.9%) patients. The P-QOL scores improved significantly after surgery. Conclusions In advanced-stage POP patients, the posterior compartment damage can also be repaired in LLS with the use of a single five-arm mesh without the need for an additional procedure, and the recurrence rate can be reduced.
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Affiliation(s)
- Eren Akbaba
- Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey.
| | - Burak Sezgin
- Obstetrics and Gynecology, Faculty of Medicine, Muğla Sıtkı Koçman University, Muğla, Turkey
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Genital Prolapse Surgery: What Options Do We Have in the Age of Mesh Issues? J Clin Med 2021; 10:jcm10020267. [PMID: 33450901 PMCID: PMC7828306 DOI: 10.3390/jcm10020267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/16/2022] Open
Abstract
Here, we describe the current laparoscopic procedures for prolapse surgery and report data based on the application of these procedures. We also evaluate current approaches in vaginal prolapse surgery. Debates concerning the use of meshes have seriously affected vaginal surgery and threaten to influence reconstructive laparoscopic surgery as well. We describe the option of using autologous tissue in combination with the laparoscopic approach. Study data and problematic issues concerning the existing techniques are highlighted, and future options addressed.
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A Minimally Invasive Technique for the 1-Stage Treatment of Complex Pelvic Floor Diseases: Laparoscopic-Pelvic Organ Prolapse Suspension. Female Pelvic Med Reconstr Surg 2021; 27:28-33. [PMID: 30946283 DOI: 10.1097/spv.0000000000000722] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
OBJECTIVE The aim of this prospective study was to assess the safety and effectiveness of a new single laparoscopic operation devised to relieve obstructed defecation, gynecologic and urinary symptoms in a large series of female patients with multiorgan pelvic prolapse. METHODS We submitted 384 female patients to laparoscopic pelvic organ prolapse suspension operation, a new technique based on suspension of the middle pelvic compartment, by using a polypropylene mesh and followed up 368 of them, with defecography performed 12 months after surgery and a standardized protocol. RESULTS The 368 patients were followed-up for 36.3 (±4.4) months, Recurrence rate was 4.9% for obstructed defecation syndrome and 3.3% for stress urinary incontinence. Complication rate was 2.9%. The mean period of daily activity resumption was 16.3 days (±4.8 days). Anorectal and urogynecologic symptoms and scores significantly improved after the operation (P < 0.001), with no worsening of anal continence. Incidence of postoperative fecal urgency was 0%. Postoperative defecography showed a significant (P < 0.001) improvement of all parameters in 315 patients (82%). Short Form 36 Health Survey score significantly improved after the operation (P < 0.01). An excellent/good overall Satisfaction Index was reported by 78.0% of patients. CONCLUSIONS In our experience the Laparoscopic-Pelvic Organ Prolapse Suspension seems to be safe and effective as a 1-stage treatment of associated pelvic floor diseases. Randomized studies with an appropriate control group and longer follow-up are now needed to assess the effectiveness of this promising technique.
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Mulayim B, Cimsir MT. Laparoscopic lateral suspension to treat neovaginal prolapse in a patient with Mayer-Rokitansky-Kuster-Hauser syndrome: A rare case report. J Obstet Gynaecol Res 2020; 47:847-850. [PMID: 33300272 DOI: 10.1111/jog.14598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Revised: 10/22/2020] [Accepted: 11/29/2020] [Indexed: 11/28/2022]
Abstract
Various methods have been described to treat neovaginal prolapse in patients with Mayer-Rokitansky-Küster-Hauser (MRKH) syndrome. In this case report, we describe neovaginal prolapse of a 21-year-old patient with MRKH syndrome which had been created by sexual intercourse dilation. Herein, the laparoscopic lateral suspension was performed for the surgical correction of neovaginal prolapse which is not available in the literature as far as we search. Prolapse was successfully corrected and vaginal length was provided at a sufficient length of 7 cm. Since after 1-year of operation, she has remained satisfied with her surgical outcome anatomically, sexually and psychologically. Laparoscopic lateral suspension is a safe and effective treatment in a patient who has neovaginal prolapse with MRKH syndrome and also can be used as a potentially alternative management in the treatment of neovaginal prolapse in patients with MRKH syndrome.
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Affiliation(s)
- Baris Mulayim
- Faculty of Medicine, Department of Obstetrics and Gynecology Alanya, Alaaddin Keykubat University, Antalya, Turkey
| | - Meral Tugba Cimsir
- Faculty of Medicine, Department of Obstetrics and Gynecology Alanya, Alaaddin Keykubat University, Antalya, Turkey
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13
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Pulatoğlu Ç, Yassa M, Turan G, Türkyılmaz D, Doğan O. Vaginal axis on MRI after laparoscopic lateral mesh suspension surgery: a controlled study. Int Urogynecol J 2020; 32:851-858. [PMID: 33175232 DOI: 10.1007/s00192-020-04596-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Accepted: 10/26/2020] [Indexed: 11/26/2022]
Abstract
INTRODUCTION AND HYPOTHESIS Laparoscopic lateral mesh suspension (LLMS) has emerged as a practical, safe, and feasible alternative to sacrocolpopexy (SCP) for treating female genital apical prolapse. Although several prior studies have reported changes in the vaginal axis in women who have undergone SCP or sacrospinous ligament fixation (SSLF) surgery for prolapse, there is a lack of data on changes in the vaginal axis after LLMS. This study was aimed at investigating the level of anatomical correction following LLMS and comparing the vaginal axis on magnetic resonance imaging (MRI) in patients with apical genital prolapse. METHODS Patients who underwent LLMS and a nulliparous control group were included in this observational prospective case-control study. MRI was performed on the control group and the study group pre- and postoperatively. The angle between the pubococcygeal line and the lower vaginal segment, the angle between the levator plate and the pubococcygeal line, and the angle between the lower and upper vaginal segments were measured and compared. RESULTS The angles measured between the pubococcygeal line and the lower vaginal segment and between the levator plate and the pubococcygeal line were significantly lower in the preoperative than in the postoperative measurements (p < 0.001). All angles were found to be similar in the nulliparous women and in the patients following LLMS surgery. The Pelvic Organ Prolapse Symptom Score (POP-SS) score decreased significantly after the operation (p < 0.001). CONCLUSION The vaginal axis was found to be near-normal in patients who underwent LLMS.
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Affiliation(s)
- Çiğdem Pulatoğlu
- Department of Obstetrics and Gynecology, Istinye University Hospital Gaziosmanpaşa Medical Park, Merkez mahallesi Hanımefendi Sokak 105/5 Şişli, İstanbul, Turkey.
| | - Murat Yassa
- Department of Obstetrics and Gynecology, Sancaktepe Şehit Professor İlhan Varank Training And Research Hospital, Acıbadem Mahallesi Nakkaş Sokak 26/4 Üsküdar, İstanbul, Turkey
| | - Gökçe Turan
- Department of Obstetrics and Gynecology, Faculty of Medicine, Gazi University, Ankara, Turkey
| | - Deniz Türkyılmaz
- Department of Radiology, Şişli Hamidiye Etfal Training and Research Hospital, Clinic of Radiology, Health Sciences University, Istanbul, Turkey
| | - Ozan Doğan
- Department of Obstetrics and Gynecology, Private Clinic, 19 mayıs mah. Binbaşı Refik sok. 20/12 Şişli, İstanbul, Turkey
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14
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Zalewski M, Kołodyńska G, Mucha A, Bełza Ł, Nowak K, Andrzejewski W. The assessment of quality of life and satisfaction with life of patients before and after surgery of an isolated apical defect using synthetic materials. BMC Urol 2020; 20:104. [PMID: 32689981 PMCID: PMC7370467 DOI: 10.1186/s12894-020-00666-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2020] [Accepted: 07/06/2020] [Indexed: 12/12/2022] Open
Abstract
Background Pelvic floor static disorders constitute a significant clinical and social problem. The incidence of the problem increases with the age of female patients up to 80 years of age. Due to various methods of procedural treatment, eligibility for surgery should be carefully discussed with the patient. Ideally, the surgery should be effective and with the least possible number of complications. The objective of this study was to assess the quality of life of patients before and after the surgery of an isolated apical defect with the use of BSC mesh. Methods The study involved 60 patients who were diagnosed with pelvic floor static disorder on the basis of physical examination. Standardised questionnaires were used to assess the quality of life and satisfaction with life: the Perceived Quality of Life (P-QOL) and the Satisfaction With Life Scale (SWLS). Results The P-QOL results for each domain were higher in patients before surgery compared to the results obtained after the surgery. For almost all domains, the results obtained were statistically significant. The results obtained in the SWLS questionnaire in most answers also show that after the procedure there was an improvement in satisfaction with life in the examined female patients. Conclusion In most patients, surgical treatment of an isolated apical defect using BSC mesh results in the subsidence of bothersome symptoms and improves the quality of life.
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Affiliation(s)
- Maciej Zalewski
- Faculty of Health Sciences, Medical University of Wrocław, Wrocław, Poland.,Independent Public Health Care Center of the Ministry of the Interior and Administration in Wroclaw, Gynecology Department, Wroclaw, Poland
| | - Gabriela Kołodyńska
- Department of Physiotherapy, University School of Physical Education, Wrocław, Poland.
| | - Anna Mucha
- Department of Genetics, Wrocław University of Environmental and Life Sciences, Wroclaw, Poland
| | - Łukasz Bełza
- Independent Public Health Care Center of the Ministry of the Interior and Administration in Wroclaw, Gynecology Department, Wroclaw, Poland
| | - Krzysztof Nowak
- Independent Public Health Care Center of the Ministry of the Interior and Administration in Wroclaw, Gynecology Department, Wroclaw, Poland
| | - Waldemar Andrzejewski
- Department of Physiotherapy, University School of Physical Education, Wrocław, Poland.,Department of Physiotherapy, Opole Medical School, Opole, Poland
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15
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Giannini A, Caretto M, Russo E, Mannella P, Simoncini T. Advances in surgical strategies for prolapse. Climacteric 2020; 22:60-64. [PMID: 30721638 DOI: 10.1080/13697137.2018.1543266] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Pelvic floor dysfunctions are a complex condition in elderly women; pelvic organ prolapse, urinary or fecal incontinence, constipation, pelvic pain, and sexual dysfunction are common problems. The goal of surgical treatment is functional reconstruction with symptom management and repair of anatomic defects. The recent advancements in surgical treatment of pelvic floor dysfunction allow several good options for choosing the best surgery for each patient. The vaginal procedure is traditionally the gold standard approach for elderly patients, but abdominal surgery is increasing as a mini-invasive approach and the robotic approach is gaining acceptance for treatment of pelvic floor dysfunctions. In elderly individuals, a multitude of factors affects the final result of any reconstructive surgery such as postmenopausal or aging-associated changes in muscle tone and nerve function or changes in the function of the bladder or of the rectum: an understanding of the underlining functional status of pelvic organs is very important in aging women before proceeding to surgery. In this context, pelvic floor dysfunction, particularly in elderly women, should be addressed in a multidisciplinary manner and, at the forefront, centers for surgical planning could be helpful to perform safer, patient-tailored surgery.
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Affiliation(s)
- A Giannini
- a Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine , University of Pisa , Pisa , Italy
| | - M Caretto
- a Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine , University of Pisa , Pisa , Italy
| | - E Russo
- a Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine , University of Pisa , Pisa , Italy
| | - P Mannella
- a Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine , University of Pisa , Pisa , Italy
| | - T Simoncini
- a Division of Obstetrics and Gynecology, Department of Experimental and Clinical Medicine , University of Pisa , Pisa , Italy
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Laparoscopic approach to pelvic organ prolapse - the way to go or a blind alley? Wideochir Inne Tech Maloinwazyjne 2020; 14:469-475. [PMID: 31908691 PMCID: PMC6939204 DOI: 10.5114/wiitm.2019.88749] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 08/04/2019] [Indexed: 11/17/2022] Open
Abstract
Pelvic organ prolapse represents a relatively frequent diagnosis that requires attention due to its detrimental effect on quality of life. Not surprisingly, it is one of the commonest indications for surgery in premenopausal and postmenopausal women, often requiring a complex multidisciplinary approach. Traditional vaginal procedures are being gradually replaced by laparoscopic techniques, offering anticipated benefits in reduced recurrence and complication rates, while respecting the trend towards uterus sparing if desirable. Recently, questions about the safety of alloplastic materials used in pelvic organ prolapse surgery were raised, leading to official restrictions in their use, particularly for transvaginal application. As a result, laparoscopic procedures might appear slightly favored but caution must be taken to assure proper technique of mesh placement while maintaining high awareness of possible long-term mesh-related complications that require close surveillance. Therefore, adequate education and training becomes even more important to achieve optimal results and to avoid possible serious medico-legal charges.
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17
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Surgical management of recurrence of multicompartment pelvic organ prolapse after failure of laparoscopic lateral POP suspension (LLPOPS): initial report of six cases and outcomes at 2 years follow-up. Updates Surg 2020; 72:225-227. [PMID: 31912441 DOI: 10.1007/s13304-019-00698-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2019] [Accepted: 12/19/2019] [Indexed: 10/25/2022]
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Mang C, Huemer H, Birkenmaier A, Humburg J. Laparoscopic lateral suspension: a single-site and single-surgeon experience. ACTA ACUST UNITED AC 2019. [DOI: 10.1186/s10397-019-1067-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Abstract
Background
In the reconstructive surgery for pelvic organ prolapse (POP), different newer mesh fixation techniques as an alternative to sacrocolpopexy has been developed. In order to gain more data about the different techniques, it is important to analyze success and recurrence rates of surgical procedures.
Methods
Collection and analysis of data from patients treated with laparoscopic lateral suspension (LLS). Patients were followed up for 6 weeks after surgery. Consultations were continued, if needed, up to 2.5 years. Main outcome measures were anatomic results, POP recurrence, mesh exposure and reoperation rate, and potential risk factors for relapse.
Results
Thirty-nine patients were treated between July 2015 and November 2017. In the first visit, one patient was diagnosed with an early relapse (success rate: 95%). Another six women relapsed during follow-up (mean, 13.5 months; success rate, 82%). Patients with recurrence were younger (62 vs. 68 years) and had initially a higher degree of prolapse, a higher parity (3.8 vs. 1.9), more previous surgeries, and longer operating times.
Early exposures were seen in 5.3% patients and raised up to 13% during follow-up; all but one were treated successful with local estrogen therapy. Risk factors for exposure were higher age and longer operating time.
The whole reoperation rate was 13%.
Conclusions
LLS might be a valid alternative to the laparoscopic sacrocolpopexy in women with prolapse in the anterior compartment and apical descent. Younger women with higher parity and higher degree of prolapse in the middle compartment had a higher recurrence rate after LLS.
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19
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Mereu L, Tateo S, D'Alterio MN, Russo E, Giannini A, Mannella P, Pertile R, Cai T, Simoncini T. Laparoscopic lateral suspension with mesh for apical and anterior pelvic organ prolapse: A prospective double center study. Eur J Obstet Gynecol Reprod Biol 2019; 244:16-20. [PMID: 31770687 DOI: 10.1016/j.ejogrb.2019.10.026] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2019] [Revised: 10/08/2019] [Accepted: 10/17/2019] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The present study analyzed long-term outcomes and complications of laparoscopic lateral suspension (LLS) with mesh to treat apical and anterior pelvic organ prolapse (POP). STUDY DESIGN A prospective cohort study on 125 patients with vaginal bulge and apical +/- anterior prolapse scheduled for LLS who consecutively underwent LLS between April 2013 and January 2017 in Gynecologic Department of Santa Chiara Hospital in Trento and University of Pisa. The main outcome measure was anatomic and symptomatic POP outcome; the secondary outcomes measures were recurrence, reoperation rate, de novo posterior POP and complications. Percentage distribution of the pre- and postoperative POP-Q stages was compared at mean follow-up. Wilcoxon signed rank sum test was used to compare preoperative POP-Q stage and postoperative POP-Q stage ate mean follow up, for each patient (paired data) and for each type of prolapse. RESULTS 120 patients were included in the study. At 2 years 89 % of patients were asymptomatic and anatomic success rate was 94.2 % for the anterior compartment, 94.9 % for the apical compartment. Concerning posterior compartment prolapse 2 (1.7 %) patients referred stage 3 de novo prolapse during follow-up. The complication rate of Clavien-Dindo >3 was 0,8 %. Repeat surgery for POP occurred in 6.4 % of cases. The appearance of POP-Q recurrences was concentrated at 6 months follow-up. BMI > 25 was correlated with de novo posterior compartment appearance during follow-up. CONCLUSIONS LLS for the treatment of apical and anterior POP is a technique with optimal results in term of safety and effectiveness after 2 years follow-up.
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Affiliation(s)
- Liliana Mereu
- Department of Obstetrics and Gynecology, S Chiara Hospital, Trento, Italy.
| | - Saverio Tateo
- Department of Obstetrics and Gynecology, S Chiara Hospital, Trento, Italy
| | - Maurizio Nicola D'Alterio
- Department of Obstetrics and Gynecology, S Chiara Hospital, Trento, Italy; University of Cagliari, Italy
| | - Eleonora Russo
- Department of Obstetrics and Gynecology, University of Pisa, Italy
| | - Andrea Giannini
- Department of Obstetrics and Gynecology, University of Pisa, Italy
| | - Paolo Mannella
- Department of Obstetrics and Gynecology, University of Pisa, Italy
| | - Riccardo Pertile
- Clinical and Evaluative Epidemiology Department - Trento Health Service, Trento, Italy
| | - Tommaso Cai
- Department of Urology, S Chiara Hospital, Trento, Italy
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20
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Yassa M, Tug N. Uterus-preserving Laparoscopic Lateral Suspension with Mesh Operation in Pelvic Organ Prolapse: Initial Experience in a Single Tertiary Center with a Median 24-Month Follow-up. Geburtshilfe Frauenheilkd 2019; 79:983-992. [PMID: 31523099 PMCID: PMC6739200 DOI: 10.1055/a-0941-3485] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2019] [Revised: 05/25/2019] [Accepted: 05/27/2019] [Indexed: 01/01/2023] Open
Abstract
Introduction Laparoscopic lateral suspension with mesh (LLSM) is an effective and less invasive technique for the correction of pelvic organ prolapse. We discuss the primary objectives, subjective success rate and pelvic floor ultrasound outcomes of uterus-preserving LLSM operations. Patients and Methods Seventeen patients who underwent uterus-preserving LLSM (abdominocervicopexy) in a tertiary center were included in this prospective study. Anatomical cure was defined separately for the apical and anterior compartments as a Pelvic Organ Prolapse Quantification (POP-Q) score of less than - 1 cm for each compartment. Subjective cure was defined as the absence of bulge symptoms. Patient satisfaction, sexual function, prolapse-related quality of life, voiding dysfunction, nocturia and constipation were assessed. Transperineal ultrasonography was used to measure anterior compartment mobility and hiatal anteroposterior diameter. Results The anatomical cure rate was 100% for the apical and 88.2% for the anterior compartment, with one symptomatic stage-II cystorectocele and one asymptomatic stage-II cystocele. The subjective cure and patient satisfaction scores were 94.12 and 100%, respectively. Ba and C points were significantly improved, and vaginal lengthening was 10.14 ± 4.19 mm. Bp ascent was 5.72 ± 11.27 mm (p = 0.053). Proximal urethral rotation and retrovesical angles were reduced by 6.24 ± 11.95° and 27 ± 47.2°, respectively (p1 = 0.047; p2 = 0.032). The hiatal anteroposterior diameter was shortened by 4.36% (p = 0.039). A significant improvement was seen with regard to nocturia episodes but not for constipation. No mesh exposure was observed. Conclusions Uterus-preserving LLSM (abdominocervicopexy) was found to be effective for the correction of apical and anterior prolapse with high levels of patient satisfaction. Significant improvements in urge symptoms and frequency of nocturia were observed. Pelvic floor ultrasound outcomes may be useful when comparing this procedure with other surgical techniques.
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Affiliation(s)
- Murat Yassa
- Department of Obstetrics and Gynecology, Health Sciences University, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
| | - Niyazi Tug
- Department of Obstetrics and Gynecology, Health Sciences University, Sancaktepe Sehit Prof. Dr. Ilhan Varank Training and Research Hospital, Istanbul, Turkey
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Szymczak P, Grzybowska ME, Wydra DG. Comparison of laparoscopic techniques for apical organ prolapse repair - a systematic review of the literature. Neurourol Urodyn 2019; 38:2031-2050. [PMID: 31452267 DOI: 10.1002/nau.24115] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/23/2019] [Accepted: 07/05/2019] [Indexed: 11/10/2022]
Abstract
AIMS Apical defect is a pelvic organ prolapse disorder, with 5%-15% prevalence. The aim of the study was to investigate methods of laparoscopic repair of apical defect and compare them with other techniques (open, vaginal, and robotic). METHODS A systematic search of the literature was conducted in MEDLINE/PubMed and ClinicalTrials.gov databases using the following key words: apical prolapse and treatment procedures. The search was limited by using the humans filters. Only articles published in English between 2010 and 2018 were considered. Two independent authors reviewed the publications for inclusion on the basis of the following criteria: (a) use of laparoscopic techniques, and (b) apical support loss as indication for surgery. RESULTS A total of 1002 papers were initially identified; 24 studies fulfilled the inclusion criteria. Four main laparoscopic procedures were found. The reported anatomical success rate (POP-Q < II stage) was 77%-100%, with patient satisfaction for pectopexy, laparoscopic sacropexy (LS), lateral ligament suspension and laparoscopic uterosacral ligament suspension (LUSLS) of 96.4%-97.6%, 71.0%-100%, 66.7%-87.8%, and 95%-95.5%, respectively. Major complications included hemorrhage, bladder, ureter, and/or bowel injuries were rare. Prolapse recurrences after LUSLS and LS were reported in 13.2% and 10.4% of patients, respectively; with reoperation rate for LS 2.2%-12.8%. CONCLUSIONS Most studies reported anatomical and subjective outcomes, with follow-up ranging from 1 month to >7 years. Success rates for laparoscopic and abdominal corrections of apical defect were similar; laparoscopy was superior in terms of perioperative blood loss, length of hospital stay, and recovery.
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Affiliation(s)
- Paulina Szymczak
- Department of Gynecology, Gynecologic Oncology, and Gynecologic Endocrinology, Medical University of Gdańsk, Poland
| | - Magdalena Emilia Grzybowska
- Department of Gynecology, Gynecologic Oncology, and Gynecologic Endocrinology, Medical University of Gdańsk, Poland
| | - Dariusz Grzegorz Wydra
- Department of Gynecology, Gynecologic Oncology, and Gynecologic Endocrinology, Medical University of Gdańsk, Poland
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Gil Ugarteburu R, Rúger Jiménez L, Rodríguez Villamil L, Blanco Fernández R, González Rodríguez I, Cruceyra Betriú G, Pello Fonseca JM, Mosquera Madera J. Laparoscopic Abdominopexy: Surgery for Vaginal Prolapse. JSLS 2019; 23:JSLS.2019.00012. [PMID: 31223227 PMCID: PMC6570527 DOI: 10.4293/jsls.2019.00012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objectives: We present a new surgery based on the round ligament anatomy that is called laparoscopic abdominopexy, which uses a synthetic mesh without fixation at any pelvic point. The aim of this study is to provide a step-by-step description of the laparoscopic abdominopexy technique and present the first anatomical and functional results of the procedure. Methods: This prospective cohort study included patients with apical and anterior vaginal prolapse who were subjected to laparoscopic abdominopexy. Before and after surgery, the Pelvic Organ Prolapse Quantification (POP-Q) scale, Overactive Bladder Questionnaire-Short Form (OABq-SF), and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) were used to evaluate the vaginal prolapse stage, storage, and sexual symptoms, respectively. The surgical technique is described step by step. Results: Twenty patients were included with follow-up times between 6 and 25 months. The mean surgical time was 78.4 minutes. A statistically significant improvement was observed in the Aa (P ≤ 10−5), Ba (P ≤ 10−5), C (P = 5 × 10−5), D (P = .002) and tvl (P = .02) POP-Q points and in OABq-SF (22.2%; P = .02). Successful surgery was observed in 100% of patients for the apical compartment and 90% of patients for the anterior compartment. Conclusion: Laparoscopic abdominopexy is a quick, safe, and reproducible surgical technique with beneficial anatomical and functional results that preserve the pelvic floor anatomy.
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Affiliation(s)
| | - Laura Rúger Jiménez
- Department of Urology, University Hospital of Cabueñes, Gijón (Asturias), Spain
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23
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Russo E, Giannini A, Guevara MM, Mannella P, Misasi G, Falcone M, Simoncini T. Medium-term outcomes after robotic-assisted lateral suspension with mesh for advanced multi-compartmental prolapse. Int Urogynecol J 2019; 31:1647-1653. [PMID: 31388718 PMCID: PMC7363728 DOI: 10.1007/s00192-019-04069-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2019] [Accepted: 07/22/2019] [Indexed: 11/30/2022]
Abstract
Introduction and hypothesis Robotic abdominal lateral suspension (RALS) is an innovative mini-invasive surgical technique that allows treating apical and anterior prolapse. The safety and efficacy of this strategy have not yet been tested. Methods We completed a prospective case series of 115 RALS to treat apical and anterior prolapse stage III or IV, with no or minimal (stage I) posterior defect. Clinical evaluation was performed with a simplified POP quantification system (POP-Q). Mean follow-up was 28 ± 4 months. Primary outcomes were objective and subjective cure; secondary outcomes were reoperation rate for recurrence, erosion rate and complications. Objective cure was defined as POP-Q ≤ 1. Subjective cure was defined as absence of vaginal bulge. Patient’s satisfaction was measured using the Patient Global Impression of Improvement Scale (PGI-I). Results There was a significant improvement in POP-Q score in all treated compartments with an objective cure rate of 88.7% for the anterior and 93.1% for the apical compartment (p < 0.0001). Subjective cure rate was 82%. The emergence of de novo high rectoceles was not significant in the cohort, as much as the development of de novo stress or urge urinary incontinence. Reoperation rate for POP was 11.3% (8 recurrent cystoceles without apical descent and 5 apical and anterior relapses). No postoperative complications of Clavien-Dindo grade ≥ 3a were seen. Mesh exposure rate was 0.9%; 58.2% patients compiled a PGI-I score at 18–24 months post-surgery, reporting high satisfaction rates. Conclusions RALS is highly effective at a mid-term follow-up for the treatment of advanced apical and anterior POP.
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Affiliation(s)
- Eleonora Russo
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Andrea Giannini
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Magdalena Montt Guevara
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Paolo Mannella
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Giulia Misasi
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Maria Falcone
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy
| | - Tommaso Simoncini
- Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Via Roma, 67, 56126, Pisa, Italy.
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24
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Regarding "Modified Laparoscopic Lateral Suspension: The Mulayim Technique". J Minim Invasive Gynecol 2018; 26:571-572. [PMID: 30366114 DOI: 10.1016/j.jmig.2018.09.788] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2018] [Accepted: 09/26/2018] [Indexed: 11/22/2022]
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25
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Wu Y(M, Reid J, Chou Q, MacMillan B, Leong Y, Welk B. Association between method of pelvic organ prolapse repair involving the vaginal apex and re-operation: a population-based, retrospective cohort study. Int Urogynecol J 2018; 30:537-544. [DOI: 10.1007/s00192-018-3792-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 10/08/2018] [Indexed: 11/24/2022]
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26
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Mulayim B, Sendag F. Modified Laparoscopic Lateral Suspension: The Mulayim Technique. J Minim Invasive Gynecol 2018; 26:407-408. [PMID: 30064004 DOI: 10.1016/j.jmig.2018.07.014] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2018] [Revised: 07/19/2018] [Accepted: 07/20/2018] [Indexed: 10/28/2022]
Abstract
STUDY OBJECTIVE To demonstrate a modified technique of laparoscopic lateral suspension for pelvic organ prolapse (POP). DESIGN A video illustrating this modified technique of laparoscopic lateral suspension (Canadian Task Force classification III). SETTING The benign gynecology department at a university hospital. INTERVENTIONS Laparoscopic lateral suspension using mesh is a minimally invasive technique that effectively treats POP [1-4]. We present a modified technique of laparoscopic lateral suspension that differs from previously described methods [1-4]. The prominent differences are as follows: first, our modified technique uses Mersilene tape on a 48-mm round-bodied needle (Ethicon Inc, Somerville, NJ,USA). We suspend the vaginal vault, taking a double bite using Mersilene tape without knotting placed as a transversal hammock. Thanks to the Mersilene tape, meshes, sutures, tackers, or fasteners are not needed. Mersilene tape ensures much easier suturing and an inexpensive artificial material. The second difference is that port placement sites (Fig. 1). The third difference is the number of incisions we make (Fig. 1). We do not need 2 additional incisions as used in previously described methods references [1-4]. We use the same incision for lateral trocar insertion and for pulling out the distal end of the Mersilene tape, which is 2 cm above the iliac crest and 4 cm posterior to the anterior superior iliac spine (Fig. 1). Our technique has the potential to be easier, shorter, more cost-efficient, less invasive, and safer when compared with previously described methods. CONCLUSION Modified laparoscopic lateral suspension, the so-called Mulayim technique, might be considered as an alternative treatment for POP surgery; however, studies should be conducted in a larger number of patients with longer postoperative follow-up periods (Fig. 1).
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Affiliation(s)
- Baris Mulayim
- Department of Obstetrics and Gynecology, Saglik Bilimleri University, Antalya Education and Research Hospital, Antalya, Turkey.
| | - Fatih Sendag
- Department of Obstetrics and Gynecology, Ege University Medical Faculty, İzmir, Turkey
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Martín Del Olmo JC, Toledano M, Martín Esteban ML, Montenegro MA, Gómez JR, Concejo P, Rodríguez de Castro M, Del Rio F. Outcomes of laparoscopic management of multicompartmental pelvic organ prolapse. Surg Endosc 2018; 33:1075-1079. [PMID: 29998390 DOI: 10.1007/s00464-018-6357-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2018] [Accepted: 07/06/2018] [Indexed: 12/26/2022]
Abstract
BACKGROUND Pelvic organ prolapse (POP) is an increasing medical problem with complex diagnostics and controversial surgical management. It causes a series of dysfunctions in the gynecological, urinary, and anorectal organs. Numerous procedures have been proposed to treat these conditions, but in recent years, ventral mesh rectocolposacropexy (VMRCS) has emerged as the procedure of choice for the surgical treatment of POP, especially by a laparoscopic approach. This surgical technique limits the risk of autonomic nerve damage, and the colpopexy allows the correction of concomitant prolapse of the middle compartment. However, symptoms derived from anterior compartment prolapse remain a major morbidity and sometimes require an additional procedure. The aim of this study is to evaluate the results of laparoscopic prosthetic rectocolposacropexy (LRCS) and colposacropexy (LCS) procedures performed to manage combined multicompartmental POP. METHODS Between November 2008 and December 2017, 38 patients with symptomatic POP underwent rectocolposacropexy (RCS) or colposacropexy (CS) by a laparoscopic approach. Demographics, mortality, morbidity, hospital stay, and functional outcomes were retrospectively analyzed. RESULTS The median operating time was 200 min (IQR 160-220). Additional simultaneous surgery for POP was performed in nine cases: five suburethral slings and four hysterectomies were performed. No mortality was recorded. The conversion rate was 7.89%. There were two intraoperative complications (5.26%): one enterotomy and one urinary bladder tear. Late complications occurred in 5.26% of cases. After a mean follow-up of 20 months, constipation was completely resolved or improved in 83.33% of patients, urinary stress incontinence was resolved or improved in 52.94%, and gynecological symptomatology was resolved or improved in 93.75%. The recurrence rate was 5.26%. CONCLUSIONS Laparoscopic mesh rectocolposacropexy and colposacropexy are safe and effective techniques associated with very low morbidity. In the medium term, they provide good results for POP and associated symptoms, but urinary symptomology has a worse outcome.
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Affiliation(s)
- J C Martín Del Olmo
- Department of General Surgery, Medina del Campo Hospital, Valladolid, Spain. .,, Madrid, Spain.
| | - M Toledano
- Department of General Surgery, Medina del Campo Hospital, Valladolid, Spain
| | - M L Martín Esteban
- Department of General Surgery, Medina del Campo Hospital, Valladolid, Spain
| | - M A Montenegro
- Department of General Surgery, Medina del Campo Hospital, Valladolid, Spain
| | - J R Gómez
- Department of General Surgery, Medina del Campo Hospital, Valladolid, Spain
| | - P Concejo
- Department of General Surgery, Medina del Campo Hospital, Valladolid, Spain
| | - M Rodríguez de Castro
- Department of Obstetrics and Gynecology, Medina del Campo Hospital, Valladolid, Spain
| | - F Del Rio
- Department of Urology, Medina del Campo Hospital, Valladolid, Spain
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Abstract
PURPOSE OF REVIEW Recommendations for the surgical treatment of pelvic organ prolapse have undergone significant changes over the last few decades.First described to be too difficult, the laparoscopic technique has gained popularity but is still controversial. The recent warning on vaginal mesh was the sign of revival and we start now to have many articles published on results and on techniques for laparoscopic prolapse repair. RECENT FINDINGS If nothing is new in the comparison of the routes including vaginal mesh placement, the new articles are very interesting in terms of technical information and recommendations. Those articles are very important and help us understand some failures in the laparoscopic approach mainly in the anterior compartment. SUMMARY New models have been created and eventually in the future, we will be able to simulate the repair on our own patients and to assess virtually the mobility of each compartment preoperatively. This will allow us to adjust and tailor the treatment to each patient.
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Dubuisson JB, Veit-Rubin N, Wenger JM, Dubuisson J. [Laparoscopic lateral suspension, another way to treat genital prolapse]. ACTA ACUST UNITED AC 2017; 45:32-36. [PMID: 28238313 DOI: 10.1016/j.gofs.2016.12.009] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 10/21/2016] [Indexed: 11/29/2022]
Abstract
The laparoscopic sacrocolpopexy is the treatment of choice of pelvic organ prolapses since more than twenty years. The laparoscopic lateral suspension with mesh is an alternative technique. Its originality is the subperitoneal passing of the lateral arm of the mesh in the lateral abdominal wall, leaving the skin above the iliac crest, in a place without risks of vascular, nerve, bowel injuries. We report in this article the results of the three main publications on the subject. The indications are cystocele and apical descent. It can be envisaged when the access of the promontory is difficult; for instance in the presence of obesity, adhesions, sigmoid megacolon, or low position of the left common iliac vein, partially covering the promontory. It is also a practical technique for surgeons having a moderate experience of the promontory access.
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Affiliation(s)
- J B Dubuisson
- Clinique La Colline, université de Genève, 1206 Genève, Suisse.
| | - N Veit-Rubin
- Service de gynécologie-obstétrique, centre hospitalo-universitaire vaudois, 46, rue de Bugnon, 1011 Lausanne, Suisse
| | - J M Wenger
- Service de gynécologie-obstétrique, hôpitaux universitaires de Genève, 30, boulevard de la Cluse, 1205 Genève, Suisse
| | - J Dubuisson
- Service de gynécologie-obstétrique, hôpitaux universitaires de Genève, 30, boulevard de la Cluse, 1205 Genève, Suisse
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Uterine Conservation at the Time of Pelvic Organ Prolapse Treatment: the Options for Patients and Providers. CURRENT OBSTETRICS AND GYNECOLOGY REPORTS 2016. [DOI: 10.1007/s13669-016-0146-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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Abstract
INTRODUCTION Vaginal vault prolapse is one of the distressing conditions which occur after hysterectomy. This is due to the weakness or detachment of sacrouterine cardinal ligament complex from the vaginal cuff. Till now, the most accepted procedure for this condition is sacrocolpopexy. MATERIALS AND METHODS We present a cohort of patients who underwent abdominal sacrocolpopexy (ASC) from April 2009 to August 2013. These patients were followed till April 2014 and were evaluated for subjective and objective outcomes following ASC. RESULTS One patient had intraoperative hemorrhage and postoperative hematoma formation. One patient had vault abscess which was managed conservatively. Hundred percent success rate was noted at 1 year. Long-term patient satisfaction score was 85 (70-90).
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Affiliation(s)
- Shikha Rani
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India
| | - Dilpreet Kaur Pandher
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India
| | - Anju Huria
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India
| | - Reeti Mehra
- Department of Obstetrics and Gynaecology, Government Medical College and Hospital, Chandigarh, India
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Mannella P, Giannini A, Russo E, Naldini G, Simoncini T. Personalizing pelvic floor reconstructive surgery in aging women. Maturitas 2015; 82:109-15. [DOI: 10.1016/j.maturitas.2015.06.032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2015] [Accepted: 06/14/2015] [Indexed: 10/23/2022]
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Abstract
Pelvic organ prolapse (POP) is a major health issue with a lifetime risk of undergoing at least one surgical intervention estimated at close to 10%. In the 1990s, the risk of reoperation after primary standard vaginal procedure was estimated to be as high as 30% to 50%. In order to reduce the risk of relapse, gynecological surgeons started to use mesh implants in pelvic organ reconstructive surgery with the emergence of new complications. Recent studies have nevertheless shown that the risk of POP recurrence requiring reoperation is lower than previously estimated, being closer to 10% rather than 30%. The development of mesh surgery - actively promoted by the marketing industry - was tremendous during the past decade, and preceded any studies supporting its benefit for our patients. Randomized trials comparing the use of mesh to native tissue repair in POP surgery have now shown better anatomical but similar functional outcomes, and meshes are associated with more complications, in particular for transvaginal mesh implants. POP is not a life-threatening condition, but a functional problem that impairs quality of life for women. The old adage "primum non nocere" is particularly appropriate when dealing with this condition which requires no treatment when asymptomatic. It is currently admitted that a certain degree of POP is physiological with aging when situated above the landmark of the hymen. Treatment should be individualized and the use of mesh needs to be selective and appropriate. Mesh implants are probably an important tool in pelvic reconstructive surgery, but the ideal implant has yet to be found. The indications for its use still require caution and discernment. This review explores the reasons behind the introduction of mesh augmentation in POP surgery, and aims to clarify the risks, benefits, and the recognized indications for its use.
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Affiliation(s)
- Patrick Dällenbach
- Department of Gynecology and Obstetrics, Division of Gynecology, Urogynecology Unit, Geneva University Hospitals, Geneva, Switzerland
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