Study on application of modified anterior pelvic floor functional reconstruction operation in pelvic organ prolapse / 重庆医学

Objective To analyze the application value of modified anterior pelvic floor reconstruction operation in pelvic organ prolapse.Methods A retrospective analysis was adopted.A total of 141 patients with pelvic floor reconstruction surgery in the obstetrics and gynecology department of Chongqing Municipal Ma-ternal and Child Health Care Hospital from January 2020 to December 2021 were included.The patients were divided into the observation group(modified anterior pelvic floor reconstruction operation,n=78)and control group(classic anterior pelvic floor reconstruction operation,n=63)according to the operation methods.The perioperative indicators,pelvic organ prolapse quantitation(POP-Q)score before and after operation,objective cure rate after operation,recurrence situation and pelvic floor quality of life score before and after operation were compared between the two groups.Results There was no significant difference in the surgical time,bleeding volume,duration of antibacteriakl drug use,and length of hospital stay between the two groups(P＞0.05).The POP-Q scores after surgerynin the two groups were signbificantly increase compared with before operation,and the objective cure rate in postoperative 12 months in the observation group was significantly higher than that in the control group at 12 months after surgery(91％.0 vs.81.0％,P＜0.05).There was no recurrence in the observation group after one year follow-up,while there were two cases of recurrence in the control group.The scores of the pelvic floor distress inventory short form 20(PFDI-20),pelvic floor impact questionnake,short form 7(PFIQ-7),and pelvic organ prolapse/incontinence sexual function questionnaire-12(PISQ-12)in 1 month after surgery in the two groups had statisticallyu significant differences compared with those before surgery(P＜0.05).After one year of follow-up,the patient global impression of improvement(PGI-I)score in the observation group was significantly lower than that in the control group(P＜0.05).Con-clusion The modified anterior pelvic floor reconstruction operation can effectively improve the quality of life in the patients,moreover the patients are not easy to relapse,so which is a new type of operation worthy of promotion.

Biological mesh versus primary closure for pelvic floor reconstruction following extralevator abdominoperineal excision: a meta-analysis / 中华胃肠外科杂志

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.

Modified transvaginal non-mesh repair surgery based on the "double hammock" pelvic floor support theory:clinical analysis of 72 cases / 中国实用妇科与产科杂志

OBJECTIVE: To report a modified transvaginal non-mesh repair surgery based on "double hammock" pelvic floor support theory,and to observe the perioperative characteristics and short-term follow-up effect.METHODS: We collected 72 patients who underwent modified transvaginal non-mesh repair surgery from October 2017 to July 2018 in the First People's Hospital of Yunnan Province.Data of perioperative,3-month,6-month and 12 month follow-up were analyzed.RESULTS: The procedures were performed successfully in 72 patients,the average operation time was(119±31)min,and the mean blood loss was(47.75±30.55)mL.No traumatic compliacations were found during the operation.The objective response rate evaluated postoperatively by POP-Q stage in short-term follow-up were 100%,and no subjective symptoms of recurrence were observed.CONCLUSION: Modified vaginal non-mesh pelvic floor repair based on the "double-layer hammock" pelvic floor support theory has the advantages of simple surgical procedure, fewer complications and good effect in the short-term. Further observation is needed to determine its long-term effectiveness.

A Comparison of Different Pelvic Reconstruction Surgeries Using Mesh for Pelvic Organ Prolapse Patients

This study was carried out in order to compare the effects in different surgeries using mesh in pelvic organ prolapse patients whose leading points were C. Thirty-nine patients were categorized into 3 groups: group A pelvic reconstruction with hysterectomy; group B hysterectomy prior to pelvic reconstruction; and group C pelvic reconstruction with uterus preserved. At first visit, POP-Q stage was determined, and age, BMI, admission days, operation time, post-operative stage and complications were observed and results were analyzed and compared. All patients who were operated upon converted to stage one month following the operation, and no further change was observed except in one patient. Group admission days were not significantly different, but tended to be lower in group C. Group average operation times between 'group A and B' and 'group A and C' were statistically different. No significant difference was observed in post-operative complications between the groups, but 3 members of group A developed erosion, whereas no erosion occurred in groups B and C. Pelvic reconstruction using mesh is a highly efficient method of treating pelvic organ prolapse. Improvements in stage and post-operative complications were not significantly different in the groups. However, uteropexy showed a shorter operation time, fewer admission days, and less erosion due to mesh than conventional pelvic reconstruction with hysterectomy.