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.

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.

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.