Clinical effect of improved mesh in the treatment of severe pelvic organ prolapse / 中国综合临床

Objective To discuss the clinical effect of improved pelvic floor mesh implantation in the treatment of severe pelvic organ prolapse. Methods From January 2016 to April 2018, eighty-four patients with severe pelvic organ prolapse admitted to Harbin First Hospital were randomly divided into observation group and control group with 42 cases in each group. The control group was treated with traditional pelvic floor reconstruction,which used two meshes to reconstruct front and back of pelvic cavity. 42 cases of the observation group were treated with improved mesh-augmented vaginal reconstructive surgery, which used only one mesh to reconstruct total pelvic reconstruction by changing the location of puncture. The therapeutic effects of the two surgical methods were compared,including general condition of the whole body, perioperative period,operative period and follow-up. Results The amount of blood loss in the observation group were significantly lower than that in the control group((65. 32±20. 39) ml vs. (86. 52±30. 23) ml), and the difference was statistically significant ( t＝ 4. 56, P＜0. 05 ) . The average operation time in the observation group were significantly lower than that in the control group ((40. 35±12. 41) min vs. (57. 83± 17. 54) min),and the difference was statistically significant (t＝6. 56,P＜0. 05). The medical fees in the observation group were significantly lower than that in the control group ((10 600±1 012)yuan vs. (20 200 ±1 123)yuan),and the difference was statistically significant (t＝25. 38,P＜0. 05). After one year follow-up,there were 1 case (2. 4%,1/42) of mesh erosion,2 cases (4. 8%,2/42) of sexual discomfort and 2 cases (4. 8%) of recurrence in the observation group. In the control group,there were 3 cases (7. 1%) of mesh erosion,4 cases (9. 5%) of sexual discomfort and 3 cases ( 7. 1%) of recurrence. The complications caused by mesh in the observation group were significantly lower than those in the control group (2. 4%(1/42) vs.7.1%(3/42),4.8%(2/42) vs.9.5%(4/42)) (χ2 ＝3.98,3.46,P＜0.05).There was no significant difference in the time of catheter placement,the time of exhaust after operation and the recurrence rate between the two groups (t＝0. 08,0. 48,0. 05,P＞0. 05). Conclusion The improved mesh-augmented vaginal reconstructive surgery is an effective minimally invasive surgery,which has small trauma and fewer complications,faster recovery after surgery, can save medical costs, and has broad prospects for clinical application.

Comparison of Outcomes According to Surgical Method in Partially Accommodative Esotropia in Patients Over 4 Years of Age

PURPOSE: To compare postoperative outcomes according to surgical method in partially accommodative esotropia in patients over 4 years of age. METHODS: We compared motor and sensory outcomes between conventional and augmented surgery in 66 patients. The postoperative follow-up period was at least 24 months. The formula for the amount of the rectus muscle recession was based on the distant angle deviation after hyperopic correction in the conventional group and the average amounts of the distant angle deviation with and without full correction of hyperopia in the augmented group. In addition, the conventional group was divided into 2 sub-groups to compare surgical outcomes. The A group consisted of patients who underwent surgery with the amount of surgical correction based on distant angle deviation after full hyperopic correction. The B group consisted of patients under the same condition after reduced hyperopic correction to achieve best corrected visual acuity (BCVA). RESULTS: Among the patients who had an ocular alignment less than 10 PD, orthophoria was significantly higher in the conventional group than in the augmented group on the last follow-up. When comparing the 2 conventional sub-groups, the postoperative stereoacuity was better in group B than in group A. Among patients with a postoperative overcorrected alignment of more than 10 PD who underwent augmented surgery, 75% showed decreased postoperative stereoacuity compared to preoperative stereoacuity. CONCLUSIONS: In partially accommodative esotropia in patients over 4 years of age, conventional surgery compared to augmented surgery after reduced hyperopic correction is better in order to achieve BCVA for postoperative stereoacuity as well as ocular alignment.

Long-Term Outcome of Patients with Partially Accommodative Esotropia Who had Augmented Surgery

PURPOSE: To investigate the long-term outcome of patients with partially accommodative esotropia who had augmented surgery. METHODS: Twenty patients with partially accommodative esotropia who underwent augmented surgery were studied retrospectively. The amount of medial rectus recession was measured based on the average of the near deviation with and without spectacle correction. During the follow-up period, the changes of refractive error and angle of deviation were evaluated and the Titmus test and Worth 4-Dot test were performed. The follow-up period was at least 24 months. RESULTS: The average follow-up period was 51.6+/-18.16 months (28~86 months). Seventeen patients showed postoperative deviations of 10 PD or less, one patient was overcorrected, two patients were undercorrected. Sensory tests were performed in 17 patients. Worth 4-dot test resulted in a fusion response at far in 6 patients and at near in 8 patients. Titmus stereotest resulted in positive fly (3000 seconds of arc) in all patients and more than 80 seconds of arc in 3 patients. CONCLUSIONS: Surgical overcorrection in patients with partially accommodative esotropia who had augmented surgery is not worrisome and augmented surgery provides some degrees of stereoacuity and fusion.

Augmented Surgery for Partially Accommodative Esotropia

The conventional surgery, based on the nonaccommodative angle after full correction of a hypermetropic refractive error, has resulted in a high incidence of undercorrection in the partially accommodative esotropia. In this study, we compared the conventional surgery group (82 patients)to the augmented surgery group (102 patients)in a total of 184 patients.The follow-up period in each group was at least 6 months. Of the 82 patients in conventional surgery group, 55 (67%)showed postoperative deviations of 10 delta or less, 25 (30%)undercorrection, and 2 (3%)overcorrection.Of the 102 patients in augmented surgery group, 81 (79%)revealed postoperative deviations of 10 delta or less, 9 (9%)undercorrection, and 12 (12%) overcorrection.The deviation was improved toward orthotropia by spectacle reduction of less than +2.0 D in overcorrected patients (2 of 2 in conventional surgery group, and 9 of 12 in augmented group).But 3 patients in augmented surgery group remained overcorrected. Our conclusion is that augmented surgery, even if it increase overcorrection, provides better postoperative alignment than conventional surgery in partially accommodative esotropia.

The Clinical Effect of Augmented Surgery for Partially Accommodative esotropia

In the partially accommodative esotropia, conventional operation based only on the nonaccommodative angle often results in undercorrection. To decrease the incidence of postoperative undercorrection, the authors augmented the amount of the surgical correction to be the average of the near deviation with and without correction. In this study we compared augmented surgery to conventional surgery in patients who underwent bilateral medial rectus recessions. 36 patients with hypermetropia of +2.50 or more, were retrospectively studied. The follow up on each group was at least 3 months. Of the 18 patients in nonaugmented group, 8(44%) had postoperative deviations of 10 prism diopters or less and 10(56%) showing a undercorrection. Of the 18 patients of augmented surgery, 14(78%) had postoperative deviations of 10 prism diopters or less and 2(11%) was exotropic while wearing full hyperopic correction. But of the 2 patients with a consecutive exodeviation, 1 was corrected to orthophoria by reducing the spectacle correction and 1 after removing spectacles. The overall success rate of 89% for the augmented surgery is much higher than that of the conventional surgery. We conclude that the augmented surgery provides better postoperative alignment than the conventional surgery and recommend this augmented surgery in partially accommodative esotropia.