Corrección del prolapso de cúpula vaginal mediante colpopexia vía abdominal

Introducción: Las disfunciones del suelo pélvico se consideran un problema de salud en el mundo y constituyen una de las indicaciones de operaciones ginecológicas más comunes. Entre sus variantes está el prolapso de la cúpula vaginal. Objetivos: Evaluar los resultados de la corrección del prolapso de cúpula vaginal por la técnica de colpopexia, mediante fijación con tiras aponeuróticas a la pared abdominal anterior. Métodos: Se realizó un estudio observacional, descriptivo. Las variables utilizadas fueron la edad, presencia de comorbilidades, el número de cirugías previas y el grado de satisfacción subjetivo de las pacientes, luego del procedimiento. Resultados: Hubo predominio de edades avanzadas en la muestra estudiada con 89,5 % de pacientes mayores de 55 años. En la mayoría de las pacientes se encontró una o más comorbilidades que favorecieron la presencia de esta afección. Un total de 8 pacientes habían sido sometidas a una cirugía correctora previa para el prolapso (30,7 %). Al mes de la cirugía el 80,7 % tenía una puntuación de 1-3 de la escala de evaluación PGI-I, valor que fue en ascenso y alcanzó el 96,1 % a los 3 meses, el 100 % a los 6 meses y al año. Conclusiones: La corrección del prolapso de la cúpula vaginal, mediante colpopexia por vía abdominal es una alternativa de tratamiento para las pacientes, fundamentalmente jóvenes o que quieren conservar la funcionalidad vaginal y la vida sexual activa.

Introduction: Pelvic floor dysfunctions are considered a health problem in the world, and constitute one of the most common indications for gynecological surgery. Among its variants is the prolapse of the vaginal vault. Objectives: To evaluate the results of the correction of the vaginal vault prolapse by the colpopexy technique by means of fixation with aponeurotic strips to the anterior abdominal wall. Methods: An observational, descriptive, retrospective study was carried out. The variables used were age, presence of comorbidities, the number of previous surgeries and the degree of subjective satisfaction of the patients after the procedure. Results: There was a predominance of advanced ages in the sample studied with 89.5% of patients older than 55 years. In most of the patients, one or more comorbidities were found that favored the presence of this condition. A total of 8 patients had undergone previous corrective surgery for the prolapse (30.7%). One month after surgery, 80.7% had a score of 1-3 on the evaluation, a value that increased and reached 96.1% at 3 months, and 100% at 6 months, and one year. Conclusions: Vaginal vault prolapse correction by mean of abdominal way colpopexy is therapeutic alternative, mainly young, and those who want to preserve vaginal functionality, and active sexual life.

RECURRENT SINUS ARREST DURING LAPAROSCOPIC SACRAL COLPOPEXY IN PATIENTS WITH SICK SINUS SYNDROME : A CASE REPORT

Sick sinus syndrome (SSS) is a disease in which the SA node fails to perform the function of pacemaking. ECG shows various rhythms including sinus arrest. We report recurrent sinus arrest during laparoscopic sacral colpopexy in a 77-year-old female patient with SSS. The patient was diagnosed with SSS, but as there were no symptoms, the operation was performed without pacemaker implantation. After induction of anesthesia, vital signs were stable, but sinus arrest repeatedly appeared due to elevated vagal tone during uterine traction. After operation, the patient underwent pacemaker implantation, and to this day, she is doing well without any symptoms. The anesthesiologist should pay close attention to the progress of the operation through much communication with operator during the surgery. Also, we recommend to considering temporary pacemaker implantation for patients with SSS who undergo surgery that can increase vagal tone.

Conservative Management of Spondylodiscitis after Laparoscopic Sacral Colpopexy: A Case Report and Review of Literature / Manejo conservador da espondilodiscite após colpopexia sacral laparoscópica: Relato de caso e revisão da literatura

Abstract Sacral colpopexy is one of the standard procedures to treat apical pelvic organ prolapse. In most cases, a synthetic mesh is used to facilitate the colposuspension. Spondylodiscitis is a rare but potentially serious complication that must be promptly diagnosed and treated, despite the lack of consensus in the management of this complication.We report one case of spondylodiscitis after a laparoscopic supracervical hysterectomy and sacral colpopexy treated conservatively. We also present a literature review regarding this rare complication. A conservative approach without mesh removal may be possible in selected patients (stable, with no vaginal lesions, mesh exposure or severe neurologic compromise). Hemocultures and culture of imageguided biopsies should be performed to direct antibiotic therapy. Conservative versus surgical treatment should be regularly weighted depending on clinical and analytical progression. A multidisciplinary team is of paramount importance in the follow-up of these patients.

Resumo A colpopexia sacral é um dos procedimentos padrão para tratar o prolapso de órgãos pélvicos apical. Na maioria dos casos, uma tela sintética é usada para facilitar a colposuspensão. A espondilodiscite é uma complicação rara, mas potencialmente grave, que deve ser prontamente diagnosticada e tratada, apesar da falta de consenso no manejo dessa complicação. Relatamos um caso de espondilodiscite após histerectomia supracervical laparoscópica e colpopexia sacral tratada conservadoramente. Também apresentamos uma revisão da literatura sobre essa complicação rara. Uma abordagem conservadora sem remoção da tela pode ser possível em pacientes selecionadas (estáveis, sem lesões vaginais, exposição da tela ou comprometimento neurológico grave). Hemoculturas e cultura de biópsias guiadas por imagem devemser realizadas para direcionar a antibioticoterapia. O tratamento conservador versus o cirúrgico deve ser avaliado regularmente, dependendo da progressão clínica e analítica. Uma equipe multidisciplinar é de suma importância no acompanhamento desses pacientes.

Comparative analysis of different surgical methods for patients with moderate to severe uterine prolapse without conserving fertility / 中国医师杂志

Objective:To compare the efficacy of three different surgical methods in the treatment of patients with pelvic organ prolapse (POP)-Q grade Ⅱ-Ⅲ uterine prolapse (UP).Methods:The clinical data of 100 patients with pelvic organ prolapse quantitative (POP-Q) grade Ⅱ-Ⅲ UP treated in the First Affiliated Hospital of Medical College of Shihezi University from November 2015 to April 2019 were analyzed retrospectively. According to the operation method, they were divided into vaginal total hysterectomy group (TVH group, n=46), laparoscopic total hysterectomy + vaginal stump Y-patch sacral fixation group (LSC group, n=34) and transabdominal total hysterectomy + vaginal stump abdominal transverse fascia and round ligament suspension group (AFS group, n=20). The age, body mass index, delivery times, operation time and intraoperative bleeding of the three groups were compared. POP-Q scale, visual analogue scale (VAS) and Pelvic Floor Impact Questionnaire (PFIQ-7) were used to evaluate the objective cure, subjective satisfaction, preoperative and postoperative quality of life, and the recurrence rate of postoperative prolapse was compared. Results:Among the three groups, the TVH group had the shortest operation time and the LSC group had the least intraoperative blood loss ( P<0.05). The postoperative PFIQ-7 score improved the quality of life in the AFS group significantly better than the other two groups ( P<0.05). The postoperative POP-Q indicator points of the three groups were significantly improved than before ( P<0.05). Postoperative prolapse recurred in 8 cases (17.4%) in TVH group, 3 cases (8.8%) in LSC group and 1 case (5.0%) in AFS group, with no significant difference in recurrence rate among the three groups ( P>0.05). Conclusions:These three surgical treatments are all safe and effective for the treatment of moderate to severe uterine prolapse. Various factors should be considered comprehensively to develop individualized surgical plans for patients.

Colpopexia al ligamento sacroespinoso con CapioTM; cirugía, resultados y evolución de pacientes / Sacroespinous ligament colpopexy with CapioTM; surgery patient outcomes and evolution

Introducción: El prolapso genital femenino altera significativamente la calidad de vida de la mujer. El prolapso apical es el segundo más frecuente después del defecto de pared anterior y la colposuspensión al ligamento sacroespinoso es una de las técnicas quirúrgicas descritas para su tratamiento. Objetivos: Determinar la factibilidad de la corrección del prolapso apical en pacientes sometidas a la colposuspensión al ligamento sacroespinoso, utilizando el dispositivo de captura de sutura CapioTM. Materiales y métodos: Análisis retrospectivo de pacientes intervenidas desde junio de 2015 a junio de 2016, en la unidad de piso pélvico del Hospital Luis Tisné Brousse, basándose principalmente en la evaluación del punto C del Prolpase Organ Pelvic Quatinfication (POP-Q). Resultados: Se intervinieron 15 pacientes, con edad promedio de 60,7 ± 6,8 años. Todas presentaron prolapso genital estadio III o IV. El seguimiento se realizó entre 3 y 13 meses después de la cirugía. Ninguna presentó complicaciones graves durante ni después de la cirugía y sólo una paciente recidivó. Conclusiones: La colposuspensión al ligamento sacroespinoso con CapioTM, es una técnica factible, segura y eficaz para el tratamiento del prolapso apical, sin embargo, es necesario mayor tiempo de seguimiento y estudios comparativos con otras técnicas de colposuspensión.

Introduction: Female genital prolapse significantly alter the quality of life of women. The apical prolapse is the second common defect after anterior wall and the colposuspension to sacrospinous ligament is one of the described surgical techniques for its treatment. Objective: To determine the feasibility of apical prolapse correction in patients undergoing sacrospinous colposuspension using the suture capture device CapioTM. Methods: Retrospective analysis of patients undergoing this surgery from June 2015 to June 2016, including an objective assessment focused mainly in the C point of Prolapse Organ Pelvic Quatinfication (POP-Q) and a subjective evaluation of the patient. Results: 15 patients, of which only 11 were able to complete follow-up, were included. The mean age of the patients at the time of surgery was 60.7 ± 6.8 years, and all were classified as prolapse stages III or IV. The evaluation was performed in average 6.75 ± 3.39 months after surgery, with a minimum of 3 and a maximum of 13 months. No patient had several complications during or after surgery and only one recurred. Conclusions: The colposuspension to sacrospinous ligament with CapioTM is a safe and effective alternative for the treatment of apical genital prolapse. However, a longer follow-up study is needed, in addition to comparative studies with other colposuspension techniques.

Surgical treatments for vaginal apical prolapse

Pelvic organ prolapse is a common condition, occurring in up to 11% of women in the United States. Often, pelvic organ prolapse recurs after surgery; when it recurs after hysterectomy, it frequently presents as vaginal apical prolapse. There are many different surgical treatments for vaginal apical prolapse; among them, abdominal sacral colpopexy is considered the gold standard. However, recent data reveal that other surgical procedures also result in good outcome. This review discusses the various surgical treatments for vaginal apical prolapse including their risks and benefits.

Colposacropexia abdominal abierta con malla mixta en el prolapso de cúpula vaginal: experiencia en el Hospital de Quilpué, Chile / Open abdominal colposacropexy with mixed mesh in vaginal vault prolapse: experience in the Hospital of Quilpué, Chile

INTRODUCCIÓN: La colposacropexia por vía abdominal abierta (CSPA) es el gold standard para el tratamiento del prolapso de la cúpula vaginal (PCV). OBJETIVO: Mostrar nuestra experiencia, en un Hospital de mediana complejidad, en los primeros siete casos sometidos a un CSPA, reportando las complicaciones intra y post operatorias. MÉTODO: Se realizó un estudio prospectivo descriptivo en nuestras siete primeras pacientes portadoras de un prolapso de cúpula vaginal estadio III o IV (POP-Q) sintomáticas, sin incontinencia urinaria y sometidas a una CSPA, con una malla mixta en el Servicio de Obstetricia y Ginecología del Hospital de Quilpué. RESULTADOS: Se reclutaron 7 pacientes. Ninguna de ellas presentaba complicaciones con riesgo vital peri-operatorio, en un período de seguimiento de 33 meses. En el 100% de las pacientes se logró cura objetiva definida como un POP-Q estadio 0 o I, y buena calidad de vida según el Cuestionario de Impacto del Piso Pélvico (PFIQ-7, versión validada en español). Durante el seguimiento, sólo una paciente presentó exposición asintomática de 5 mm de la malla, resuelta con su resección por vía vaginal. Ninguna paciente requirió de una cirugía por prolapso de órganos pélvicos después de la CSPA. CONCLUSIÓN: Los resultados obtenidos concuerdan con la literatura. La CSPA sigue siendo el gold standard para el tratamiento del PCV, no siendo superada por el momento, por ninguna otra técnica, incluso la colposacropexia laparoscópica. Estimamos que el uso de mallas parcialmente reabsorbibles pueden disminuir la exposición de mallas, sin embargo se requieren de más estudios.

INTRODUCTION: The abdominal sacral-colpopexy is currently considered the gold standard for the management of (CSPA) vaginal vault prolapse (PCV). OBJECTIVE: To report our surgical experience at a county hospital with our first seven abdominal sacral-colpopexy cases. Reporting intra and post-operative complications. METHODS: We conducted a prospective descriptive study involving our first seven cases of patients with symptomatic vaginal vault prolapse stage III or IV (POP-Q) without urinary incontinence. All patients were undergoing CSPA with a partially absorbable mesh in the Obstetrics and Gynecology Department at the Quilpué Hospital. RESULTS: Seven patients were recruited. None of them presented a life threatening complication during a mean follow up period of 33 months. A hundred percent of patients achieved objetive cure defined as POP-Q stage 0 or I and subjective cure defined as a significant improvement in a validated questionnaire (PFIQ-7 spanish version). During patients follow up, only one patient had an asymptomatic 5 mm mesh exposure, resolved with a vaginal resection. None of the patients required surgery for pelvic organ prolapse after the CSPA. CONCLUSION: These results are in agreement with the international literature. The CSPA continues to be the gold standard for the PCV treatment of vaginal vault prolapse and has not been surpassed by either vaginal technique or the laparoscopic sacral-colpopexy. We believe that the use of partially reabsorbable meshes can decrease the rate of mesh exposure, however further studies are required.

Hysterectomy; Is it essential for the correction of uterine prolapse? / 대한산부인과학회지

OBJECTIVE: The aim of this study was to compare the efficacy of sacrospinous colpopexy without hysterectomy and with hysterectomy for symptomatic uterine prolapse. METHODS: A retrospective chart review was performed in the women who underwent sacrospinous ligament suspension between March 1998 and March 2002. A hundred fifty five women with a symptomatic uterine prolapse were treated with either sacrospinous colpopexy without hysterectomy and/or anterior-posterior repair (83 cases=Group A) or sacrospinous colpopexy with hysterectomy and/or anterior-posterior repair (72 cases=Group B). RESULTS: The mean duration of surgery, hemoglobin change, catheter days and inpatient days were shorter in group A compared with group B. (Group A 102.5+/-33.4 min, 2.4+/-0.7 mg/dL, 5.2+/-1.4 days, 7.6+/-2.2 days vs. Group B 135.3+/-33.9 min, 2.9+/-0.8 mg/dL, 6.1+/-2.1 days, 9.4+/-3.7 days, p<0.05 respectively) Recurrent pelvic organ prolapse developed in 14.5% in group A and 12.5% in group B. Six patients (7.2%) in group A and 5 patients (6.9%) in group B required repeat operation for recurrent pelvic organ prolapse. CONCLUSIONS: Sacrospinous colpopexy without hysterectomy and with hysterectomy are equally effective surgical operation for uterine prolapse. This study shows that hysterectomy is not essential for the correction of uterine prolapse.

Safety and Efficacy of Transvaginal Sacrospinous Colpopexy / 대한산부인과학회지

OBJECTIVE: To determine the success rate and complications of transvaginal sacrospinous colpopexy for symptomatic uterine/vault prolapse when performed by one surgeon. METHODS: Between march 1996 and march 2002, 105 women with a symptomatic uterine/vault prolapse were treated with transvaginal sacrospinous ligament colpopexy at samsung cheil hospital. Primary outcome measures were complications (acute and long term) and success rate, with failure defined as any degree of uterine/vault prolapse requiring repeat operation, any degree of symptomatic isolated uterine/vault prolapse, any pelvic organ prolapse at or beyond the introitus. Statistical analysis was performed using simple descriptive technique. RESULTS: During the study period, 105 transvaginal sacrospinous ligament colpopexy were performed: 41 with vaginal hysterectomy, 38 without hysterectomy, 25 for post-hysterectomy vault prolapse and 1 cervical amputation. The mean duration of follow-up was 17.7 months (0-66) There were no acute hemorrhage and no deaths. There were four intraoperative complications - three rectal wall injury and one bladder wall injury. There was a complaints of postoperative right buttock pain in 8 of the 105 procedure (7.6%), with this persisting on a chronic basis in 2 patients (1.9%). Postoperatively, there were 11 patients with uterine/valut prolapse, 4 with a cystocele and 1 with a rectocele. Of these 105, there were 6 failures (5.7%). CONCLUSION: Transvaginal sacrospinous colpopexy for the correction of uterine/vault prolapse, when performed by a surgeon experienced in the procedure, is safe and effective surgical procedure and rare major complications.

Effectiveness of sacrospinous colpopexy in vault prolapse patients / 대한산부인과학회지

OBJECTIVE: To evaluate the effectiveness of sacrospinous colpopexy in vault prolapse patients. METHODS: It is the retrospective study including 10 vault prolapse patients who received sacrospinous colpopexy at St. Paul Hospital, the Catholic University from July 1999 to April 2004. RESULTS: The 10 patients receiving sacrospinous colpopexy had the average age of 58.9 years, and the parity of 3.4. They were moderately overweighted with average BMI of 24.5. The average period from hysterectomy to diagnosis of vault prolapse was 11.1 years. Hypertension was noted on most of patients (70.0%). The average operation time was 68.5 minutes and postoperative hemoglobin decrement was 2.4 on average. During 2-month period of postoperative follow-up, there were no significant complications noted except one case of wound infection associated with diabetes and one case of transfusion due to anemia. After sacrospinous colpopexy, protruding mass out of vagina was resolved on 100% and urologic and other complications were improved over 50% of cases. CONCLUSION: Considering that several underlying medical conditions such as hypertension, obesity are associated with vault prolapse patients, sacrospinous colpopexy in case of vault prolapse is an excellent operative approach with low complication and recurrence rates.

A Case of Vaginal Prolapse after McIndoe Operation Managed by Transvaginal Sacrospinous Colpopexy / 대한산부인과학회잡지

McIndoe procedure using the colonic segment has been used in treatment of patients with Mullerian agenesis. Prolapse of a colonic neovagina is rare condition and its treatment is not yet standardized. We experienced a case of neovaginal prolapse following McIndoe procedure using colonic segment. A 51-year-old woman developed prolapse of a neovagina 17 years after the McIndoe operation. She had been diagnosed to have Mullerian agenesis and was managed by McIndoe operation using colonic segment. The prolapse was successfully managed with transvaginal sacrospinous colpopexy. She has no sign of recurrent prolapse and is satisfied with sexual intercourse. Patients with neovaginal prolapse following McIndoe procedure can be treated successfully with transvaginal sacrospinous colpopexy.

Uterine Prolapse-Need for Hysterectomy? / 대한산부인과학회잡지

OBJECTIVE: To compare the efficacy of transvaginal sacrospinous colpopexy with hysterectomy and without hysterectomy for symptomtic uterine prolapse when performed by one surgeon. METHODS: Between march 1996 and march 2002, 59 women with a symptomatic uterine prolapse were treated with either transvaginal sacrospinous ligament colpopexy with hysterectomy (30 cases=Group A) or transvaginal sacrospinous cervicocolpopexy without hysterectomy (29 cases=Group B). Patients were reviewed at least 12 months after operation. RESULTS: The mean age, parity, prolapse grade, menopausal status, body weight and length of follow-up for two groups were no difference. There were two intraoperative complications-Rectal wall injury one patient in group A and one in group B. The mean duration of surgery, hemoglobin change, inpatient days and catheter days were shorter in group B compared with group A. Recurrent asymptomatic cystocele developed in 2 patients in group A and 2 in group B. One patient in group A and one patient in group B required repeat operation for recurrent pelvic organ prolapse. There was no significant difference between the two groups in postoperative satisfactory result (96.7% vs 98.6%, respectively p=0.51). CONCLUSION: Sacrospinous cervicocolpopexy without hysterectomy and sacrospinous colpopexy with hysterectomy are equally effective surgical operation for uterine prolapse. Sacrospinous cervicocolpopexy without hysterectomy avoids the potential morbidity of vaginal hysterectomy and decreases the operation time, blood loss, inpatient days and catheter days. Vaginal hysterectomy may not be necessary in the correction of uterine prolapse.

A case of abdominal sacral colpopexy with use of GORE-TEX graft for vaginal vault prolapse after total hysterectomy / 대한산부인과학회잡지

Post-hysterectomy vaginal vault prolapse is rare complication. There are many surgical procedures to correct this problem. But abdominal colposacropexy, using Marlex mesh or Gore-Tex graft is standard procedure. We experienced one case who had repair of post-hysterectomy vaginal vault prolapse by transabdominal sacral colpopexy using Gore-Tex graft and report with brief review of literatures.

Five cases of abdominal sacral colpopexy for the vaginal vault prolapse after total hysterectomy / 대한산부인과학회잡지

A rate com;lication of hysterectomy is complete prolapse and inversion of vagina. This can occur whether the hysterectomy was abdominal or vaginal and cystocele and/or enterocele is often associated with this condition. Traditionally, prolapse has been treated by surgery, the types of operation for prolapse are generally but not always, carried out through the vaginal rather than through the abdominal surgical route. We experienced five cases who had repair of posthysterectomy vaginal vault prolapse by transabdominal sacral colpopexy and report with brief review of literatures.