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Urogynecologic Pelvic Floor Dysfunction
Published in Laurence R. Sands, Dana R. Sands, Ambulatory Colorectal Surgery, 2008
Vivian C. Aguilar, Willy Davila
Posterior vaginal wall prolapse may result from distinct defects or tears in different areas of posterior vaginal wall support. This may include central defects in the midline rectovaginal septum, lateral detachment of the posterior vagina to the arcus tendineous fascia rectovaginalis, at the apical attachment of the rectovaginal fascia to the vaginal cuff resulting in an enterocele, or transverse avulsion distally from the perineal body. Symptoms of posterior vaginal wall prolapse may include vaginal bulge, pelvic pressure, obstructed defecation, and constipation. Although repair of rectoceles and enteroceles may successfully correct anatomic defects, symptoms of defecatory dysfunction and constipation may not be alleviated by surgery.
Does the Way Hysterectomy Is Performed Make a Difference? How to Prevent Prolapse at the Time of Hysterectomy
Published in Victor Gomel, Bruno van Herendael, Female Genital Prolapse and Urinary Incontinence, 2007
Harry Reich, Iris Kerin Orbuch, Tamer Seckin
This connective tissue that envelopes the vagina to its apex is termed endopelvic fascia and is made up of fibroblasts, smooth muscle cells, elastin, and collagen, creating a fibro muscular elastic layer (7). The presacral fascia of the second, third, and fourth sacral vertebrae attaches to uterosacral ligaments. The uterosacral ligaments coalesce with the cardinal ligaments on each side near the pericervical ring. The cardinal ligaments envelope the uterine vessels and fuse with the pericervical ring. This pericervical fascial ring merges with the pubocervical fascia anteriorly and with the rectovaginal fascia posteriorly. Laterally the rectovaginal fascia attaches to the pelvic sidewall. The pubocervicovesicular fascia (the connective tissue at the anterolateral part of the vagina) is attached laterally to the fascia of the obturator internus muscle and creates the arcus tendineus fascia pelvis or “white line”. The “white line” originates at the ischial spine and inserts at the pubic bone. Superiorly, the rectovaginal fascia converges with the arcus tendineus half way between the pubic symphysis and ischial spine. Inferiorly, the rectovaginal fascia fuses with the perineal body.
Ultralight type I transvaginal mesh: an alternative for recurrent severe posterior vaginal prolapse
Published in Climacteric, 2022
W. Tian, Y. Dai, P. Feng, Y. Ye, Q. Gao, J. Guo, Z. Zhang, Q. Yu, J. Chen, L. Zhu
A previously described standard surgical procedure was used [16,17]. We performed preoperative skin preparation, vaginal irrigation and enema, and administered prophylactic intravenous antibiotics of cephalosporins combined with metronidazole just before incision to minimize the infection. The middle and posterior compartments were reconstructed in the same procedure. A senior urogynecologist, Lan Zhu, performed all operations and a supplementary video of operation demonstrated the detailed procedure. The rectovaginal fascia was hydro-dissected, and the posterior vaginal mucosa was incised longitudinally to separate the posterior vaginal wall from the rectum. The ultralight mesh was cut into three parts, one cruciform mesh to repair the posterior wall and two rectangular mesh to reinforce the apex. Next, an especially designed needle was used to puncture from within the vagina to the skin 3 cm anterior to the ischial spines and the posterior meshes pulled through the ischial spinous fascia. Silk threads were left protruding from the skin. Rectangular mesh strips were pulled from inside the vagina to outside the skin and fixed to the posterior vaginal mucosa using a Prolene suture. The mesh was placed, so it was not under tension, after which any superfluous mesh was trimmed. The distal two-thirds of the posterior vaginal wall was then repaired as necessary by performing standard posterior colporrhaphy.
The use of 3D ultrasound in comparing surgical techniques for posterior wall prolapse repair: a pilot randomised controlled trial
Published in Journal of Obstetrics and Gynaecology, 2021
Alexandros Derpapas, Gopalan Vijaya, Kostis Nikolopoulos, Manolis Nikolopoulos, Dudley Robinson, Ruwan Fernando, Vik Khullar
The prevalence of posterior vaginal wall prolapse ranges from 20 to 76% (Olsen et al. 1997). Although the most appropriate method for repairing posterior vaginal wall prolapse is still debatable amongst gynaecologists and colorectal surgeons, there is level I evidence to suggest that the vaginal approach is superior to the transanal one (Nieminen et al. 2004; Maher and Baessler 2006). Significant variations, however, exist in the literature regarding the methods of vaginal repair employed by gynaecologists. The traditional levator ani muscle (LAM) transverse plication technique yields acceptable anatomical outcomes; however, it is associated with a high rate of dyspareunia and bowel dysfunction (Francis and Jeffcoate 1961; Kahn and Stanton 1997). Several reports have demonstrated favourable anatomical outcomes of transverse fascial plication over discrete rectovaginal fascia defect repair, alongside improvement in bowel and sexual function (Cundiff et al. 1998; Kenton et al. 1999; Porter et al. 1999), which has popularised the former as the standard method for posterior colporrhaphy (Abramov et al. 2005).
Complications and clinical outcomes of laparoscopic sacrocolpopexy for pelvic organ prolapse
Published in Journal of Obstetrics and Gynaecology, 2021
Hirotaka Sato, Hirokazu Abe, Atsushi Ikeda, Tomoaki Miyagawa, Katsuhiko Sato
The procedures for the first 20 patients were performed by a relatively inexperienced surgeon under the direct supervision of the senior author. From the twenty-first case onwards, surgeries were performed by the first surgeon and a senior urological surgeon. Briefly, LSC was performed with four trocars, one for the scope and three side trocars. The vaginal vault was lifted using a malleable metal retractor. The peritoneum was dissected to expose the region from the sacral promontory to the vesicovaginal and rectovaginal fascia. Anterior (vesicovaginal fascia) dissection was performed down to the trigone of the bladder. Posterior (rectovaginal fascia) dissection was performed down to the levator ani muscle and the perineal body. Two separate long-tailed polypropylene meshes (GYNEMESH PS; Ethicon, Somerville, NJ, USA) were cut, preoperatively. One mesh was anchored anteriorly as far down the distal end of the vaginal wall as possible using five point fixation with 3-0 non-absorbable sutures (Tefdesser II; Kono Seisakusyo, Chiba, Japan) and was laid along the anterior vaginal wall. The other mesh was anchored posteriorly as far down the distal end of the vaginal wall as possible with 2–0 non-absorbable sutures (Tefdesser II; Kono Seisakusyo). Both meshes were anchored together to the median or lateral edge of the cervical stump and bilaterally to the uterosacral ligaments. Their cranial ends were attached to the sacral promontory with a 1–0 non-absorbable suture (Tefdesser II; Kono Seisakusyo) and retroperitoneally using a 2–0 absorbable suture (Monocryl; Ethicon).