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Open Abdominal Approach to Supporting the Vaginal Apex
Published in Linda Cardozo, Staskin David, Textbook of Female Urology and Urogynecology - Two-Volume Set, 2017
of which Are recognized to hAve higher rAtes of Me thAn polypropylene. Me mAy be Affected by other fActors. ConcomitAnt hysterectomy mAy increAse the risk of Me, with An AncillAry study of the CAre triAl reporting An or of 4.9 [5]. The sAme study showed current smoking increAsed Me with An odds rAtio (or) of 5.2. MAnAgement of Me requires thorough counseling of the pAtient. rArely does conservAtive mAnAgement with ApplicAtion of topicAl estrogen rectify the problem. Most women will require surgicAl revision of the mesh with An initiAl vAginAl ApproAch to excise the exposed mesh. Complete excision of the mesh mAy be required if the initiAl pArtiAl excision fAils. Quiroz et Al. reported on A series of women undergoing mesh revision surgery, with only 48% success with initiAl vAginAl surgery. Most women required more thAn one mesh revision, often through An AbdominAl ApproAch [27]. Multiple cAse reports of smAll bowel obstruction relAted to AbdominAl mesh or scAr tissue occurring up to 14 yeArs following AsC hAve been published, highlighting the need for ongoing follow-up of Any women undergoing these procedures [20,28–30]. A smAll number of cAse reports of discitis And osteomyelitis occurring 2 months to 8 yeArs After AsC hAve been published [31–34]. All required open explorAtion And removAl of the mesh, with debridement of the L5–s1 disc. The AbdominAl sAcrocolpopexy or sAcrohysteropexy is An effective procedure for the treAtment of ApicAl vAginAl prolApse. However, the significAnt morbidity AssociAted with the AbdominAl ApproAch must be cArefully weighed AgAinst potentiAl benefits when considering this option. There Are AdvAntAges And disAdvAntAges of All techniques, And the decision should be bAsed on the pAtient's needs And wishes once sensible discussion hAs occurred. relevAnt clinicAl fActors in mAking this decision Are the pAtient's Age And generAl heAlth, whether further pregnAncies Are desired, sexuAl Activity, presence of dyspAreuniA, And vAginAl size. The AbdominAl ApproAch will be preferAble in the presence of other AbdominAl pAthology requiring treAtment such As An ovAriAn cyst
Uterine torsion at term pregnancy associated with a previous pelvic organ prolapse (POP) surgery
Published in Journal of Obstetrics and Gynaecology, 2020
The predisposing factors for uterine torsion are fibroids, pelvic adhesions, ovarian cysts, sudden foetal or maternal movements, external cephalic versions (Havaldar and Ashok 2014; Karavani et al. 2017; Lai et al. 2018). In our case, sacro-hysteropexy procedure could be a reason for uterine torsion due to the change in uterine axis. For performing external cephalic version cases, before and after procedure sonographic evaluation should be done for comparison of changing placenta location or impaired uterine Doppler (Karavani et al. 2017). However, sacrohysteropexy is not yet reported as a reason for uterine torsion in the literature. In our case, unintended extension of posterior lower uterine transverse incision to the Douglas pouch occurred, probably caused by prior POP surgery, so we used lots of haemostatic sutures. Prior sacrohysteropexy in this patient had been done using visceral peritoneum of right side posterior adnexa from the promontorium to the cervix. Therefore, we think that a symmetrical surgical technique could theoretically prevent uterine torsion (Banerjee and Noé 2011; Tahaoglu et al. 2018). All patients should be informed about the complications of conservative POP surgery after pregnancy; including uterine torsion, so POP surgery like sacrohysteropexy and other procedures should preferably be performed when fertility is complete. A recent meta-analysis underlines that recommendations cannot be made about the long-term risks of recurrent prolapse or regarding pregnancy outcomes after uterus-preserving prolapse surgery, because the limits of the trials contained insufficient data on these outcomes (Meriwether et al. 2018). Of course, the long-term outcomes of these procedures are not well studied after pregnancy.
Safety and effectiveness of laparoscopic sacrocolpopexy as the treatment of choice for pelvic organ prolapse
Published in Arab Journal of Urology, 2019
Sherif Mourad, Hisham El Shawaf, Ahmed Farouk, Hisham Abdel Maged, Amr Noweir, Bruno Deval
Our present study is a prospective clinical study to evaluate and assess the safety and effectiveness of LSC/laparoscopic sacrohysteropexy (LSH) as a treatment option for female pelvic-organ prolapse (POP). We report operative data, perioperative and early postoperative complications, and functional outcomes for this approach.
Sacrospinous Ligament Fixation Under Local Anesthesia in Elderly Patients at High Risk of General Anesthesia
Published in Journal of Investigative Surgery, 2020
Mehmet Baki Senturk, Ozan Doğan
TheTABLE 1use of pessaries may be beneficial in elderly patients who are high-risk for surgery but treatment failure due to displacement of pessary, discomfort, and infection may be encountered.15 Surgery was applied to three of the current series due to failure of pessary treatment. Alternative obliterative procedures such as colpocleisis and Le-fort may be a treatment option for these poor operative candidates.7 However, these options do not really treat the relaxation of the pelvic floor and also cause loss of sexual function. SSLF has some advantages over obliterative methods. When performed in experienced hands, the incision is smaller and the dissection is easier, therefore the operating time is shorter.12,16 Again, although not fully comparable, it can be concluded that dissection of the large mucosal area will cause more blood loss than dissection of the avascular area.12,16 Another important advantage is that cervical vaginal examinations can be easily made after SSLF so diagnostic and therapeutic treatments can be performed easily if needed. The endometrium can be easily evaluated in cases such as abnormal uterine bleeding after SSLF but this is not possible after an obliterative procedure. This is a significant advantage of SSLF over obliterative methods. Even though colpocleisis is an effective method, sexual dysfunction may occur postoperatively. Thakar et al described the disadvantages of hysterectomy in respect of sexual function and stated that SSLF might not worsen sexual function with the option of preserving the uterus.17 In the current study, two of the patients were sexually active preoperatively. During follow-up, these two patients described a subjective improvement in sexual function. In future studies, this improvement could be shown with sexual function and quality of life questionnaires. One of the problems occurring after the Manchester operation, at a reported rate of approximately 11%, is cervical stenosis which makes it difficult to make cervical cytological examinations and endometrial sampling. Due to the complication profile and current high rates of recurrence, this method is not preferred.18 Costantini et al compared sacrocolpopexy and sacrohysteropexy in a study of uterine conservative surgery and reported no difference in subjective and objective outcomes and patient satisfaction.19 Maher et al found no significant difference in a study comparing vaginal hysterectomy and sacrospinous fixation.20 In other studies, similar results have been found such as less blood loss, shorter operation time, shorter hospitalization and fewer complications in the uterus preserving operation group.21,22 In the current study, uterine protective surgery was also preferred for elderly patients at high risk of anesthesia, to prevent surgical or anesthesia complications by avoiding a long operating time.