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SBA Questions
Published in Justin C. Konje, Complete Revision Guide for MRCOG Part 2, 2019
A 60-year-old had a vaginal hysterectomy 3 years ago and now presents with vault prolapse that is having a significant impact on her quality of life. What is the best approach to treat this patient?Conservative treatment with pessariesSacrocolpopexySacrospinous fixationVaginal repairVault mesh repair
Complications of Synthetic Mesh Used to Repair Pelvic Organ Prolapse
Published in Linda Cardozo, Staskin David, Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
Mickey Karram, John B. Gebhart
sAcrocolpopexy is An AbdominAl, lApAroscopic, or robotic procedure thAt involves AttAching A Y-shAped grAft (usuAlly synthetic mesh) to the Anterior And posterior vAginAl wAll And securing it to the Anterior longitudinAl ligAment of the sAcrum. Mesh complicAtions After AbdominAl sAcrocolpopexy Are fAirly rAre And primArily center on mesh or suture erosion (Figure 91.1). A comprehensive review of AbdominAl sAcrocolpopexy reveAled An overAll mesh erosion rAte of 3.4%. Polypropylene hAd the lowest erosion rAte At 0.5%, while teflon hAd the highest rAte of erosion At 5.5% [15]. A more
Urogynecologic Pelvic Floor Dysfunction
Published in Laurence R. Sands, Dana R. Sands, Ambulatory Colorectal Surgery, 2008
Vivian C. Aguilar, Willy Davila
Abdominal sacrocolpopexy is performed by connecting the vaginal apex to the sacral promontory using a mesh bridge. The resulting suspension restores the vagina to a more physiologic axis than other procedures for vaginal vault prolapse (Fig. 8). Traditionally, the procedure has been performed via a transverse or vertical laparotomy incision. The laparoscopic approach for abdominal sacrocolpopexy involves considerable laparoscopic skill with a substantial learning curve. Many surgeons are utilizing robotic technology to master the laparoscopic techniques required to perform this procedure.
Perioperative, postoperative and anatomical outcomes of robotic sacrocolpopexy
Published in Journal of Obstetrics and Gynaecology, 2021
Gokhan Sami Kilic, Toy Lee, Kelsey Lewis, Cem Demirkiran, Furkan Dursun, Bekir Serdar Unlu
Pelvic floor disorders including genital prolapse, urinary incontinence and faecal incontinence affect more than 25% of women in the United States (Wu et al. 2014). More than 10% of women in the US will undergo surgical treatment for pelvic floor disorders at least once in their lifetime (Olsen et al. 1997; Fialkow et al. 2008). Apical and anterior compartment defects are challenging cases that urogynaecologists face on a daily basis. The abdominal sacrocolpopexy (SCP) is considered the gold standard treatment option for apical and anterior compartment defects. Compared to other apical support surgeries, abdominal SCP involves a potentially longer hospitalisation period and a higher morbidity rate: this is mostly attributed to its large abdominal incision (Culligan et al. 2002; Maher et al. 2004; Maher et al. 2010). As technology has advanced, minimally invasive approaches were implemented to overcome the shortcomings of open SCP (Elterman et al. 2014). The introduction of laparoscopy was followed by adding robotic-assistance to sacrocolpopexy surgery. In this study, we present 144 patients that underwent RSCP. Our aims were to analyse the anatomical, perioperative and postoperative outcomes of the procedure.
Staged repair of concomitant rectovaginal fistula and pelvic organ prolapse after removal of a neglected pessary
Published in Baylor University Medical Center Proceedings, 2020
Stacy Mathews, Shaked Laks, Carola LaFollette, T. Ignacio Montoya, Pedro A. Maldonado
There is a paucity of information to guide treatment with colpopexy using mesh at the time of a rectovaginal fistula repair. Sacrocolpopexy with mesh implant can raise concerns for mesh erosion through the rectum if the mesh is placed adjacent to the fistula repair. Instead, we propose that colpopexy with mesh be considered as a delayed repair after the fistula repair has healed, or as a concomitant repair with minimal posterior vaginal wall mesh application and a margin away from the fistula repair. In elderly patients with procidentia or advanced posthysterectomy prolapse who are no longer sexually active, colpocleisis can be considered either at the time of fistula repair or after the fistula has healed.6 Isolated posterior vaginal wall prolapse can pose more of a challenge. Delayed prolapse repair such as posterior colporrhaphy with or without enterocele repair or apical suspension should be entertained to allow for adequate fistula healing.
Advances in surgical strategies for prolapse
Published in Climacteric, 2019
A. Giannini, M. Caretto, E. Russo, P. Mannella, T. Simoncini
The last Cochrane revision on pelvic floor reconstructive surgery published in 201325 outlines how abdominal procedures (sacral colpo/cervicopexy) have superior outcomes in terms of anatomic and subjective and objective cure rates when compared to vaginal procedures, including transvaginal sacrospinous ligament suspension, uterosacral ligament suspension, and transvaginal meshes, particularly in elder women. Minimally invasive sacrocolpopexy is the gold standard procedure for stage III–IV apical prolapse treatment, and it is performed with traditional laparoscopy or, more frequently, robot-assisted surgery. Many operators tend to avoid this excellent procedure for the treatment of POP as the isolation of the presacral ligament requires working close to delicate anatomical structures such as the vena cava bifurcation and iliac vessels. Moreover, performing the dissection of the presacral space, a dangerous area, carries potentially life-threatening bleeding complications which can be difficult to manage. Therefore, the perfect tensioning of the mesh represents another critical surgical step of sacrocolpopexy: an excessive laxity of the prosthetic device can undermine the surgery’s utility, while excessive tension of the mesh can cause chronic pain and discomfort26. In this context, surgical planning of sacrocolpopexy with a patient-specific three-dimensional reconstruction of the pelvic anatomy could be helpful to perform a safer, patient-tailored surgery.