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2.
Article in Chinese | WPRIM | ID: wpr-942990

ABSTRACT

Objective: To compare the morbidity of perineum-related complication between biological mesh and primary closure in closing pelvic floor defects following extralevator abdominoperineal excision (ELAPE). Methods: A literature search was performed in PubMed, Embase, Cochrane Library, Web of Science, Wanfang database, Chinese National Knowledge Infrastructure, VIP database, and China Biological Medicine database for published clinical researches on perineum-related complications following ELAPE between January 2007 and August 2020. Literature inclusion criteria: (1) study subjects: patients undergoing ELAPE with rectal cancers confirmed by colonoscopy pathological biopsy or surgical pathology; (2) study types: randomized controlled studies or observational studies comparing the postoperative perineum-related complications between the two groups (primary perineal closure and reconstruction with a biological mesh) following ELAPE; (3) intervention measures: biological mesh reconstruction used as the treatment group, and primary closure used as the control group; (4) outcome measures: the included literatures should at least include one of the following postoperative perineal complications: overall perineal wound complications, perineal wound infection, perineal wound dehiscence, perineal hernia, chronic sinus, chronic perineal pain (postoperative 12-month), urinary dysfunction and sexual dysfunction. Literature exclusion criteria: (1) data published repeatedly; (2) study with incomplete or wrong original data and unable to obtain original data. Two reviewers independently performed screening, data extraction and assessment on the quality of included studies. Review Manager 5.3 software was used for meta-analysis. The mobidities of perineum-related complications, including overall perineal wound (infection, dehiscence, hernia, chronic sinus) and perineal chronic pain (postoperative 12-month), were compared between the two pelvic floor reconstruction methods. Finally, publication bias was assessed, and sensitivity analysis was used to evaluate the stability of the results. Results: A total of five studies, including two randomized controlled studies and three observational controlled studies, with 650 patients (399 cases in the biological mesh group and 251 cases in primary closure group) were finally included. Compared with primary closure, biological mesh reconstruction had significantly lower ratio of perineal hernia (RR=0.37, 95%CI: 0.21-0.64, P<0.001). No significant differences in ratios of overall perineal wound complication, perineal wound infection, perineal wound dehiscence, perineal chronic sinus and perineal chronic pain (postoperative 12-month) were found between the two groups (all P>0.05). Conclusion: Compared with primary closure, pelvic floor reconstruction following ELAPE with biological mesh has the advantage of a lower incidence of perineal hernia.


Subject(s)
Humans , Pelvic Floor/surgery , Perineum/surgery , Proctectomy , Rectum/surgery , Surgical Mesh
3.
Chinese Medical Journal ; (24): 200-205, 2021.
Article in English | WPRIM | ID: wpr-878027

ABSTRACT

BACKGROUND@#It has been a global trend that increasing complications related to pelvic floor surgeries have been reported over time. The current study aimed to outline the development of Chinese pelvic floor surgeries related to pelvic organ prolapse (POP) over the past 14 years and investigate the potential influence of enhanced monitoring conducted by the Chinese Association of Urogynecology since 2011.@*METHODS@#A total of 44,594 women with POP who underwent pelvic floor surgeries between October 1, 2004 and September 30, 2018 were included from 22 tertiary academic medical centers. The data were reported voluntarily and obtained from a database. We compared the proportion of each procedure in the 7 years before and 7 years after September 30, 2011. The data were analyzed by performing Z test (one-sided).@*RESULTS@#The number of different procedures during October 1, 2011-September 30, 2018 was more than twice that during October 1, 2004-September 30, 2011. Regarding pelvic floor surgeries related to POP, the rate of synthetic mesh procedures increased from 38.1% (5298/13,906) during October 1, 2004-September 30, 2011 to 46.0% (14,107/30,688) during October 1, 2011-September 30, 2018, whereas the rate of non-mesh procedures decreased from 61.9% (8608/13,906) to 54.0% (16,581/30,688) (Z = 15.53, P < 0.001). Regarding synthetic mesh surgeries related to POP, the rates of transvaginal placement of surgical mesh (TVM) procedures decreased from 94.1% (4983/5298) to 82.2% (11,603/14,107) (Z = 20.79, P < 0.001), but the rate of laparoscopic sacrocolpopexy (LSC) procedures increased from 5.9% (315/5298) to 17.8% (2504/14,107).@*CONCLUSIONS@#The rate of synthetic mesh procedures increased while that of non-mesh procedures decreased significantly. The rate of TVM procedures decreased while the rate of LSC procedures increased significantly.@*TRIAL REGISTRATION NUMBER@#NCT03620565, https://register.clinicaltrials.gov.


Subject(s)
Female , Humans , China , Gynecologic Surgical Procedures/adverse effects , Pelvic Floor/surgery , Pelvic Organ Prolapse/surgery , Surgical Mesh/adverse effects , Treatment Outcome , Vagina
4.
Medisan ; 24(5) ilus
Article in Spanish | LILACS, CUMED | ID: biblio-1135211

ABSTRACT

Se presenta el caso clínico de una anciana de 86 años de edad con evisceración del intestino delgado a través del periné. Se efectuó la exploración quirúrgica urgente del abdomen y se observó la perforación del fondo del saco de Douglas y la salida de 50 cm de intestino delgado estrangulado, de manera que se realizó la resección intestinal de todo el segmento afectado y anastomosis termino-terminal. Luego se reparó el defecto del fondo del saco de Douglas con una plastia perineal, para lo cual se utilizó una malla de polipropileno. Este proceder es una buena alternativa para el tratamiento quirúrgico en quienes presentan hernias perineales, pues permite un cierre mejor, disecar el saco herniario y reducirlo adecuadamente.


The case report of a 86 years elderly is presented with evisceration of the small bowel through the perineum. The urgent surgical exploration of the abdomen was carried out and it was observed the perforation of the Douglas pouch and the 50 cm prominence of impacted small bowel, so that the bowel resection of the whole affected segment and end to end anastomosis was carried out. Then the Douglas pouch defect was repaired with a perineal plasty, for which a polypropylene mesh was used. This procedure is a good alternative for the surgical treatment in those who present perineal hernias, because it allows a better closing, to dissect the hernial sack and to reduce it appropriately.


Subject(s)
Pelvic Floor/surgery , Douglas' Pouch/surgery , Intestine, Small/surgery , Perineum/surgery , Aged , Douglas' Pouch/injuries , Intestine, Small/injuries
5.
Arq. bras. med. vet. zootec. (Online) ; 72(2): 323-331, Mar./Apr. 2020. ilus, tab
Article in Portuguese | LILACS, VETINDEX | ID: biblio-1128176

ABSTRACT

A túnica vaginal possui características ideais para enxertia e já foi empregada na reparação de diversos tecidos, inclusive do diafragma pélvico. Objetivou-se avaliar a aplicabilidade da túnica vaginal como enxerto autógeno livre, em dupla camada, para a reparação do diafragma pélvico em 14 cães portadores de hérnia perineal, das quais, nove eram unilaterais e cinco, bilaterais. Após a orquiectomia, as túnicas de ambos os testículos foram coletadas, sobrepostas e fixadas entre si por meio de quatro pontos de reparo. Foi realizada abordagem ao saco herniário, inspeção, redução do conteúdo herniário, desbridamento muscular e síntese primária mediante sutura. O enxerto foi fixado à musculatura remanescente por meio de pontos simples separados e, posteriormente, encoberto pela sutura intradérmica e por síntese cutânea. Observações transoperatórias e, posteriormente, avaliações clínicas e ultrassonográficas, por período de um ano, permitiram sugerir que a túnica vaginal possui atributos ideais para a reparação do diafragma pélvico. Conclui-se que o enxerto autógeno livre de túnica vaginal, em dupla camada, é exequível e aplicável para o reparo do diafragma pélvico no tratamento da hérnia perineal em cães.(AU)


The tunica vaginalis has ideal characteristics for grafting and has already been used to repair several tissues, including the pelvic diaphragm. The aim of this study was to evaluate the applicability of the tunica vaginalis as a free double-layer autogenous graft to repair the pelvic diaphragm in 14 dogs with perineal hernia, of which, nine were unilateral and five, bilateral. After orchiectomy, the tunics of both testicles were collected, overlapped and fixed to each other by four repair points. The hernial sac was approached, followed by inspection, reduction of the hernia content, muscle debridement and primary synthesis through suture. The graft was attached to the remaining musculature by simple interrupted stitches and later hidden by intradermal suture and cutaneous synthesis. Intraoperative observations and, later, clinical and sonographic evaluations over a one-year period, allow to suggest that the tunica vaginalis has ideal attributes for the pelvic diaphragm repair. It is concluded that the autogenous graft-free of tunica vaginalis in double layer is feasible and applicable in order to repair the pelvic diaphragm in the perineal hernia treatment in dogs.(AU)


Subject(s)
Animals , Dogs , Peritoneum/transplantation , Pelvic Floor/surgery , Hernia/veterinary , Herniorrhaphy/veterinary
7.
Int. braz. j. urol ; 42(3): 507-513, tab, graf
Article in English | LILACS | ID: lil-785724

ABSTRACT

ABSTRACT Objectives To evaluate the feasibility, safety and surgical results of skeletonized mesh implants to form a pelvic harness for pelvic floor reconstruction surgery. Study design Patients with advanced pelvic floor prolapse were enrolled to this study. Study model was a kit mesh, reduced to 75% of the original surface area by cutting out mesh material from the central mesh body. Patients were evaluated at the end of the 1st and 6th post-operative months and interviewed at the study conclusion. Results Ninety-five women with advanced pelvic floor prolapse had this implant. Mean follow-up duration was 9 months (6-12 months). The POP-Q point’s measurements showed marked and statistically significant improvements. Bladder over-activity symptoms, fecal incontinence, pelvic pain and constipation rates were all reduced as well. No adverse effects related to the dissection or mesh implantation were marked. The first and sixth post-operative month follow-up records as well as the study conclusion interview findings were satisfactory in terms of subjective and objective cure and adverse effects occurrence. Conclusion This study data proposes that skeletonizing meshes might be safely and successfully implanted for potentially improved pelvic floor reconstruction.


Subject(s)
Humans , Female , Adult , Aged , Surgical Mesh , Pelvic Floor/surgery , Plastic Surgery Procedures/methods , Pelvic Organ Prolapse/surgery , Pelvic Floor Disorders/surgery , Postoperative Complications , Prolapse , Time Factors , Feasibility Studies , Prospective Studies , Surveys and Questionnaires , Reproducibility of Results , Follow-Up Studies , Treatment Outcome , Statistics, Nonparametric , Equipment Design , Middle Aged
8.
Rev. Hosp. Clin. Univ. Chile ; 26(3): 215-221, 2015. tab, ilus
Article in Spanish | LILACS | ID: lil-786574

ABSTRACT

Pelvic floor dysfunctions are highly prevalent in our population significantly affecting the quality of life of women. Pregnancy and childbirth are well recognized risk factors. It has recently become clear that pelvic floor trauma encompass more than perineal trauma or “what one could see in the delivery room.” The levator ani muscle may be affected at birth with the loss of the integral structure of the pelvic floor support, secondarily triggering the descent of the pelvic organs. The overdistension of the urogenital hiatus and anal sphincter injuries can also be consequences of a vaginal birth. An episiotomy is an intervention that seeks to facilitate the expulsion of the fetus expanding the perineum preventing tissue distension and perineal tear. However, this claim raised by its developer has no scientific basis. Today the restrictive practice of this procedure is recommended, given the potential complications that may arise when it is systematically performe. Despite this recommendation, there are no conclusive studies that explore the role that episiotomy has in obstetric pelvic floor trauma...


Subject(s)
Humans , Female , Pelvic Floor/surgery , Pelvic Floor/physiopathology , Pelvic Floor/injuries , Episiotomy
9.
Rev. argent. coloproctología ; 23(4): 207-211, Dic. 2012.
Article in Spanish | LILACS | ID: lil-714968

ABSTRACT

INTRODUCCION: entre las técnicas descriptas para corregir defectos del piso pelviano, el uso de suturas mecánicas circulares se plantea como una opción con fundamentos anatómicos y funcionales, con bajos índices de complicaciones. OBJETIVO: analizar las indicaciones y técnicas utilizando suturas mecánicas circulares por vía Endoanal, su factibilidad y resultados inmediatos. DISEÑO: estudio prospectivo, consecutivo, no randomizado. MATERIAL Y METODO: entre Junio de 2007 y Diciembre de 2010 se utilizaron los dispositivos PPH 03 y PPH 01 en 62 pacientes. Se analizan: indicaciones, técnica, tiempo operatorio, morbilidad, internación y resultados funcionales inmediatos. RESULTADOS: con el procedimiento PPH fueron intervenidos 40 pacientes. Con la técnica STARR fueron operadas 22 mujeres. Para el procedimiento PPH el tiempo operatorio promedio fue de 30 minutos y la morbilidad 15%. Para STARR el tiempo operatorio promedio fue de 40 minutos y la morbilidad 4,5%. Con la técnica PPH se obtuvo 100% de corrección de prolapso. Con STARR se observó disminución del ODS Score en todos los casos. Internación promedio: 1 día. CONCLUSIONES: el uso de los dispositivos de sutura mecánica circular por vía endoanal es factible y seguro. Utilizados por coloproctólogos con experiencia ofrecen una alternativa válida en los pacientes que cumplan los requisitos para indicarlos.


BACKGROUND: several techniques have been described for the treatment of pelvic floor diseases. The circular stapler devices are advocated as a safety and effectiveness option, with anatomical and physiological basis. OBJECTIVE: The aim of this study was to demonstrate the feasibility, effectiveness and reliability of the circular staplers devices for endoanal techniques. DESIGN: non-randomized, prospective study. MATERIAL AND METHODS: since June 2007 up to December 2010 we have applied the PPH 03 and PPH 01 devices to 60 patients. We analyzed indications, surgical techniques mean operative time, complications, mean length of stay and immediate functional results. RESULTS: we have applied the PPH procedure to 40 patients and the STARR procedure to 22 female patients. To PPH procedure the mean duration of the operation was 30 minutes and we registered a rate of complications to 15%. To STARR procedure the mean operative time was 40 minutes and the morbidity was 4,5%. Mean length of stay was 1 day. CONCLUSIONS: the circular stapler devices trough endoanal techniques are feasible, safe and effective with low morbidity. Colorectal surgeons might implement them in the use of them in order to optimize results. Further investigation is required to optimize patient selection and reduce potential complications.


Subject(s)
Humans , Male , Female , Adult , Middle Aged , Aged, 80 and over , Colorectal Surgery/instrumentation , Suture Techniques/instrumentation , Colorectal Surgery/methods , Pelvic Floor/surgery , Pelvic Floor/injuries , Pain, Postoperative , Rectal Diseases/surgery , Surgical Staplers , Hemorrhoids/surgery , Rectal Prolapse/surgery
10.
Clinics ; 67(8): 871-875, Aug. 2012. graf, tab
Article in English | LILACS | ID: lil-647788

ABSTRACT

OBJECTIVE: The aim of this study was to compare female sexual function after surgical treatment of anterior vaginal prolapse with either small intestine submucosa grafting or traditional colporrhaphy. METHODS: Subjects were randomly assigned, preoperatively, to the small intestine submucosa graft (n = 29) or traditional colporrhaphy (n = 27) treatment group. Postoperative outcomes were analyzed at 12 months. The Female Sexual Function Index questionnaire was used to assess sexual function. Data were compared with independent samples or a paired Student's t-test. RESULTS: In the small intestine submucosa group, the total mean Female Sexual Function Index score increased from 15.5±7.2 to 24.4±7.5 (p<0.001). In the traditional colporrhaphy group, the total mean Female Sexual Function Index score increased from 15.3±6.8 to 24.2±7.0 (p<0.001). Improvements were noted in the domains of desire, arousal, lubrication, orgasm, satisfaction, and pain. There were no differences between the two groups at the 12-month follow-up. CONCLUSIONS: Small intestine submucosa repair and traditional colporrhaphy both improved sexual function postoperatively. However, no differences were observed between the two techniques.


Subject(s)
Female , Humans , Middle Aged , Intestine, Small/transplantation , Sexual Dysfunction, Physiological , Sexual Behavior/physiology , Uterine Prolapse/surgery , Vagina/surgery , Gynecologic Surgical Procedures/methods , Postoperative Complications , Postoperative Period , Pelvic Floor/surgery , Quality of Life , Statistics, Nonparametric , Surveys and Questionnaires , Sexual Dysfunction, Physiological/etiology , Sexual Dysfunction, Physiological/psychology , Treatment Outcome
11.
Rev. obstet. ginecol. Venezuela ; 71(4): 246-251, dic. 2011. tab
Article in Spanish | LILACS | ID: lil-659255

ABSTRACT

Evaluar la técnica de cura de incontinencia urinaria de esfuerzo con cincha transobturatriz bajo anestesia local. Estudio descriptivo y prospectivo en 22 pacientes con incontinencia urinaria de esfuerzo de la consulta de piso pélvico del Hospital Universitario de Caracas entre abril y noviembre de 2010, a las que se les colocó cincha transobturatriz con anestesia local y sedación consciente complementaria en la mayoría de los casos. El tiempo quirúrgico promedio fue 9,57 min. Dos pacientes toleraron el procedimiento quirúrgico con anestesia local exclusiva, mientras que las otras 20 (90,9 por ciento) requirieron sedación endovenosa, similar a lo descrito en la literatura. El dolor intraoperatorio en promedio fue de 3,18 puntos en la escala visual análoga. El 100 por ciento de las pacientes estuvo satisfecha con el procedimiento anestésico y el 95,5 por ciento lo recomienda. La anestesia local con sedación consciente constituye una técnica tolerable, segura, y rápida para la cura de incontinencia urinaria de esfuerzo con cincha transobturatriz


To evaluate the transobturator tape procedure for urinary stress incontinence under local anesthesia. Prospective and descriptive study of 22 patients with urinary stress incontinence from the Pelvic Floor Unit of Universitary Hospital of Caracas, between April and November 2010, in whom the transobturator tape procedure was performed under local anesthesia and sedation. Mean surgical time was 9.57 min. Two patients tolerated the surgical procedure with local anesthesia without sedation, while the other 20 (90.9 percent) required intravenous sedation, as described in most publications. Mean intraoperative pain was 3.18 points in the Visual Analogue Scale. One hundred percent of the patients were satisfied with the anesthetic technique, and 95.5 percent would recommend it. Local anesthesia with sedation is a well-tolerated, safe, and fast technique for the surgical treatment of urinary stress incontinence with transobturator tape


Subject(s)
Humans , Female , Anesthesia, Local/methods , Pelvic Floor/surgery , Pelvic Floor/pathology , Urinary Incontinence, Stress/diagnosis , Urinary Incontinence, Stress/therapy , Gynecology
12.
Int. braz. j. urol ; 36(2): 209-217, Mar.-Apr. 2010. ilus, tab
Article in English | LILACS | ID: lil-548382

ABSTRACT

PURPOSE: This prospective study was performed to achieve visualization of the reestablishment of anatomy after reconstructive surgery in the different pelvic compartments with non-absorbable radiopaque meshes, providing valuable anatomic information for surgeons implanting meshes. MATERIALS AND METHODS: A total of 30 female patients with stress urinary incontinence (SUI), anterior and posterior vaginal wall prolapse, or both underwent surgical repair using radiopaque meshes after written informed consent. Patients with SUI underwent five different surgeries. Patients with anterior vaginal prolapse underwent a procedure using a combined pre-pubic and transobturator mesh, and those with posterior vaginal prolapse underwent posterior slingplasty. Three-dimensional reconstruction using helical CT was performed four weeks postoperatively. RESULTS: In all cases, the mesh was clearly visualized. Transobturator slings were shown at the midurethra, and the anchoring tails perforated the obturator foramen at the safety region. Mini-slings were in the proper place, and computed angiography revealed that the anchoring system was away from the obturator vessels. In patients undergoing procedure for anterior vaginal prolapse, both pre-pubic armpit and obturator slings were clearly seen and the mesh was in the proper position, supporting the bladder base and occluding the distal part of the urogenital hiatus. Transcoccygeal sacropexy revealed indirectly a well-supported "neo rectovaginal fascia" and the anchoring tails at the level of ischial spines. CONCLUSION: Three-dimensional helical tomography images of the female pelvis using radiopaque meshes have a potential role in improving our understanding of pelvic floor reconstructive surgeries. These radiopaque meshes might be the basis of a new investigative methodology.


Subject(s)
Female , Humans , Imaging, Three-Dimensional/methods , Pelvic Floor/surgery , Surgical Mesh , Tomography, Spiral Computed/methods , Urinary Incontinence, Stress/surgery , Uterine Prolapse/surgery , Prospective Studies , Pelvic Floor/anatomy & histology , Radiographic Image Interpretation, Computer-Assisted/methods , Suburethral Slings , Treatment Outcome
13.
Femina ; 38(2)fev. 2010. tab
Article in Portuguese | LILACS | ID: lil-545684

ABSTRACT

O prolapso genital é condição comum e importante indicação de cirurgia ginecológica nos dias atuais. A quantificação do prolapso é realizada por meio do POP-Q, uma classificação internacionalmente reconhecida e preconizada pela Sociedade Internacional de Continência (ICS). O suporte dos órgãos pélvicos se dá por um sistema de suspensão, constituído de ligamentos, e outro de sustentação, constituído por fáscias e músculos, especialmente o levantador do ânus, que deve estar íntegro para que possa manter perfeito suporte dos órgãos e o hiato genital fechado. A fraqueza ou defeitos nesse músculo podem levar ao aparecimento de prolapso genital. O tratamento conservador tem ganhado espaço, especialmente em estágios menos avançados do prolapso. Consiste em mudanças nos hábitos de vida diária, tais como redução de peso, diminuição das atividades que aumentam a pressão abdominal, tratamento da constipação intestinal, e intervenções físicas, como o fortalecimento da musculatura do assoalho pélvico. Este estudo constitui um levantamento das evidências científicas acerca do tratamento conservador do prolapso genital, visando proporcionar uma visão mais atual do problema


The pelvic organ prolapse is a common condition and the main cause of gynecologic surgery nowadays. The quantification of genital prolapse is performed by means of POP-Q, an international classification recognized and indicated by the International Continence Society (ICS). The support of the pelvic organs relies on a suspension system, made of ligaments, and a sustentation system, made of fascies or muscles, especially the levator ani, that should be intact in order to give a perfect support for the organs and for close genital gap. The weakness or damages in this muscle can cause genital prolapse. The nonsurgical treatment has been used more frequently, especially in early stages of the prolapse. It consists of changing daily habits, such as reducing weight, decreasing activities that raise abdominal pressure, treating intestinal constipation, and other physical interventions, such as the strengthening of the pelvic floor musculature. This study is a bibliographic evidence-based research about the conservative treatment of the genital prolapse


Subject(s)
Female , Patient Education as Topic , Uterine Prolapse/surgery , Uterine Prolapse/pathology , Uterine Prolapse/therapy , Pelvic Floor/surgery , Pelvic Floor/physiopathology , Exercise Therapy/methods , Weight Loss , Quality of Life
14.
Urol. colomb ; 17(1): 101-108, abr. 2008. ilus
Article in Spanish | LILACS | ID: lil-506193

ABSTRACT

Los desordenes del piso pélvico incluyen la incontinencia urinaria, incontinencia fecal y prolapso de órgano pélvico que son prevalentes en la población femenina y se pueden presentar al mismo tiempo. El manejo de estos desordenes debe ser realizado por Urólogos y Ginecólogos al mismo tiempo y en un mismo momento quirúrgico para mejorar resultados y como beneficio para las pacientes.


Subject(s)
Humans , Fecal Incontinence/surgery , Fecal Incontinence/therapy , Urinary Incontinence/surgery , Pelvic Floor/surgery
15.
Rev. chil. obstet. ginecol ; 73(3): 145-150, 2008. tab
Article in Spanish | LILACS | ID: lil-515866

ABSTRACT

Objetivos: Describir una técnica quirúrgica, novedosa en el medio nacional, de abordaje vaginal, para el tratamiento del prolapso apical: la suspensión transvaginal alta a ligamentos úterosacros (STALUS). Método: Estudio descriptivo longitudinal, de 57 pacientes con defectos apicales, a los cuales se les realizó esa técnica entre Diciembre de 2002 y Octubre 2005. Se realizó estadística descriptiva y test t (2 muestras) para análisis de pronóstico anatómico (POP-Q). Para análisis de potenciales factores pronósticos se utilizó ANOVA, regresión lineal y logística. Resultados: El tiempo operatorio promedio fue de 151 minutos. El resultado anatómico (POP-Q), pre y postoperatorio, resultó favorable y estadísticamente significativo, en los nueve puntos evaluados, 49 de las 54 pacientes fueron seguidas en promedio durante 15 meses. En el compartimiento apical (punto C) obtuvimos curación del 89 por ciento y no hubo fracasos. En la pared anterior, 22 por ciento de las pacientes recidivaron. En cuanto a las complicaciones, se produjo una fístula ureterovaginal. Conclusiones: Tomando las precauciones necesarias, es una técnica segura y reproducible, con buenas tasa de curación. Asegurar la indemnidad del uréter, siempre será una obligación. La recidiva en pared anterior, aunque sea asintomática, resulta ser extremadamente alta, lo que nos obliga a pensar en nuevas técnicas de abordaje de este compartimiento.


Objective: To describe a novel surgery technique in the national ground, of vaginal approach for the treatment of apical prolapse: the transvaginal high suspension to the uterosacral ligaments (STALUS). Method: It is a longitudinal descriptive study that included 57 patients with apical support defects, in which this technique was performed between December 2002 and October 2005. Descriptive statistics and t test were per-formed for the anatomical outcome (POP-Q). For the potential prognosis factors, ANOVA, lineal regression and logistic, were used. Results: The average surgery time was 151 minutes. The anatomical result (POP-Q), before and after surgery, was favourable and significant in the nine points evaluated. 49 of 54 patients were followed for 15 months in average. In the apical compartment (C point) we got an 89 percent of cure and there were no failure. In the anterior wall, instead, 22 percent of our patients recurred. About complications, there was an ureterovaginal fistula. Conclusions: If all precautions are taking, there is a secure and reproducible technique, with good cure rate. To secure the ureter it is always an obligation. The recurrence in the anterior wall, even been asymptomatic, is too high, that make us think in new techniques in order to manage this compartment.


Subject(s)
Humans , Adult , Aged, 80 and over , Female , Middle Aged , Ligaments/surgery , Gynecologic Surgical Procedures/methods , Uterine Prolapse/surgery , Analysis of Variance , Logistic Models , Longitudinal Studies , Prognosis , Pelvic Floor/surgery , Time Factors , Treatment Outcome , Vagina/surgery
16.
Rev. chil. obstet. ginecol ; 71(5): 364-372, 2006. ilus
Article in Spanish | LILACS | ID: lil-464221

ABSTRACT

La histerectomía constituye la segunda cirugía más efectuada en mujeres en edad fértil. Por esto cada día más ginecólogos se interesan en buscar técnicas de menor invasión. Dentro de este concepto y con el objetivo de preservar la indemnidad del suelo pélvico, muchos hemos propuesto la histerectomía supracervical por laparoscopía, como una de las técnicas quirúrgicas que más auge debiera tener. Se trata de una cirugía con menor número de complicaciones tanto intra como postoperatorias, menor estadía hospitalaria y mejor recuperación. En aquellas pacientes que no cumplen los requisitos para una histerectomía supracervical por laparoscopia, la vía vaginal es la mejor alternativa al compararla con la abdominal. Sin embargo, proponemos que debiera realizarse agregando puntos de McCall para prevenir prolapsos futuros; para asegurar la indemnidad ureteral debemos realizar una cistoscopia intraoperatoria con índigo carmín.


Subject(s)
Female , Adult , Humans , Uterine Diseases/surgery , Hysterectomy/methods , Laparoscopy/methods , Pelvic Floor/surgery , Cervix Uteri/surgery , Hysterectomy , Hysterectomy/history , Minimally Invasive Surgical Procedures/methods
17.
Clinics ; 60(1): 71-74, jan.-fev. 2005. ilus
Article in English | LILACS | ID: lil-393843

ABSTRACT

O desenvolvimento espontâneo de hérnia perineal representa uma condição patológica muito rara.Várias técnicas têm sido descritas para a correção da falha no assoalho muscular pélvico.


Subject(s)
Humans , Female , Aged , Hernia/surgery , Perineum/surgery , Plastic Surgery Procedures/methods , Surgical Mesh , Sigmoid Diseases/surgery , Buttocks/surgery , Pelvic Floor/surgery
18.
Rev. chil. obstet. ginecol ; 69(2): 149-156, 2004. ilus, tab
Article in Spanish | LILACS | ID: lil-387576

ABSTRACT

El tratamiento quirúrgico actual del prolapso genital severo es el resultado de un mejor conocimiento y comprensión del piso pelviano. Se revisan los fundamentos anatómicos y fisiopatológicos implicados en el desarrollo del prolapso genital severo y de la cirugía reconstructiva del piso pélvico.


Subject(s)
Humans , Female , Pelvic Floor/surgery , Uterine Prolapse/surgery , Uterine Prolapse/etiology , Vagina/surgery , Risk Factors , Current Procedural Terminology
19.
Rev. chil. obstet. ginecol ; 69(3): 227-231, 2004. ilus, tab
Article in Spanish | LILACS | ID: lil-400446

ABSTRACT

Trabajo prospectivo que evalúa los resultados de la corrección de la incontinencia de orina de esfuerzo con la técnica de la cinta suburetral libre de tensión realizada en el Servicio de Obstetricia y Ginecología del Hospital de Talca. Fueron tratadas 44 pacientes con incontinencia de orina de esfuerzo severa de al menos dos años de evolución, asociada a otra patología ginecológica susceptible de ser corregida por vía vaginal. La técnica de corrección se basa en la colocación de una cinta de polipropileno, en forma de hamaca en el tercio medio de la uretra. La cinta se coloca por medio de agujas, que se introducen desde abdomen y salen parauretral psilateral al sitio de punción. El tiempo promedio de seguimiento fue 12 meses con 93 por ciento de curación al fin del periodo. No hubo lesiones de vejiga ni de otro órgano durante el procedimiento. La complicación más frecuente fue la infección urinaria y la retención de orina. Conclusión: la técnica presentada es una excelente alternativa para la corrección de la incontinencia de orina de esfuerzo y junto con la corrección de otros defectos asociados del piso pelviano.


Subject(s)
Humans , Female , Adult , Middle Aged , Urinary Incontinence, Stress/surgery , Urinary Incontinence, Stress/epidemiology , Urinary Incontinence, Stress/therapy , Chile/epidemiology , Pelvic Floor/surgery , Urologic Surgical Procedures/instrumentation , Urologic Surgical Procedures/methods
20.
Rev. chil. urol ; 69(2): 104-112, 2004.
Article in Spanish | LILACS | ID: lil-393962

ABSTRACT

Desde la publicación de la teoría integral se han producido significativos cambios en la evaluación y manejo de la incontinencia urinaria. Desde noviembre de 2002 se inicia un protocolo prospectivo aplicando la teoría integral en la evaluación y tratamiento de una serie consecutiva de pacientes con incontinencia urinaria que consultan en los Departamentos de Urología y Ginecología del Hospital Clínico dela Universidad de Chile. En el presente estudio se analizan los resultados y complicaciones a corto plazo(primer año de iniciado el protocolo.


Subject(s)
Humans , Female , Urinary Incontinence/diagnosis , Urinary Incontinence/therapy , Pelvic Floor/abnormalities , Pelvic Floor/surgery , Chile , Prospective Studies , Clinical Protocols
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