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.

Síndrome Mayer-Rokitansky-Küster-Hauser con prolapso de órganos pélvicos: reporte de un caso / Mayer-Rokitansky-Küster-Hauser syndrome with pelvic organ prolapse: Case report

Resumen ANTECEDENTES: El síndrome de Mayer-Rokitansky-Küster-Hauser aparece en 1 de cada 4500 a 5000 mujeres; se origina por subdesarrollo embrionario de los conductos de Müller que resulta en agenesia vaginal o de útero. El tratamiento consiste en dilataciones vaginales o formación de una neovagina mediante un procedimiento quirúrgico. La falta de estructuras de soporte vaginal es una de las causas del prolapso de la cúpula vaginal, posterior al tratamiento conservador o quirúrgico. CASO CLÍNICO: Paciente de 26 años, con diagnóstico de síndrome de Mayer-Rokitansky-Küster-Hauser; inicio de la vida sexual activa a los 16 años. Acudió a consulta por sensación de cuerpo extraño en los genitales y un "bulto" vaginal de dos años de evolución. En la exploración física ginecológica se encontró un prolapso total vaginal. Se realizó la sacrocolpopexia laparoscópica y se colocó una malla tipo I, con monofilamento, para la corrección del prolapso vaginal. A los tres meses posteriores al procedimiento quirúrgico no volvió a reportar síntomas de sensación de cuerpo extraño en la vagina y reinició la vida sexual activa sin problemas. CONCLUSIONES: La sacrocolpopexia laparoscópica, junto con la colocación de una malla, es una opción de tratamiento con buenos resultados en la restauración de la anatomía, función sexual y satisfacción de la paciente con prolapso de la cúpula, posterior a creación de una neovagina.

Abstract BACKGROUND: The Mayer-Rokitansky-Küster-Hauser syndrome, has an incidence of 1 per 4,500 to 5,000 women, is caused by an embryonic underdevelopment of the müllerian ducts, resulting in agenesis of the vagina or uterus. There is treatment based on dilatations and creation of neovagina by surgery. Prolapse of the vaginal vault in Mayer-Rokitansky-Küster-Hauser syndrome is rare and may occur after conservative or surgical treatments. The lack of vaginal support structures can lead these patients to develop a vaginal vault prolapse CASE: A 26-year-old woman, who started sexual life at 16 years of age. He came to the clinic due to a sensation of a foreign body in the genitals and vaginal bulge of two years of evolution. Physical examination: normal external genitalia without alterations, with presence of total vaginal prolapse. Reflex of the sacral plexus S2-S4 (clitoral, perineal and anal) present and normal. Pelvic organ prolapse quantification (POP Q): 0, 0, +2, 3, 4, 5, -1, -1, x. IP: II, Gossling 2. Laparoscopic sacrocolpopexy was performed and type I mesh with monofilament was used to correct vaginal prolapse. At 3 months after the procedure, she denies vaginal bulge symptom in vagina, satisfactory active sexual, denies dyspareunia. CONCLUSIONS: Laparoscopic sacrocolpopexy with mesh placement is a treatment option with good results in the restoration of the anatomy, sexual function and satisfaction of the patient in a patient with dome prolapse posterior to the neovagina.

Culdoplastía de Mayo o colposacropexia abdominal en la corrección del prolapso de la cúpula vaginal poshisterectomía / Mayo culdoplasty or abdominal colposacropexy in correction of post-hysterectomy vaginal vault prolapse

El objetivo de este estudio fue comparar los resultados de la culdoplastía de Mayo con la colposacropexia abdominal en la corrección del prolapso de la cúpula vaginal poshisterectomía. Se revisaron las historias clínicas de 155 pacientes con prolapso de cúpula vaginal poshisterectomía en las que se procedió a la corrección quirúrgica entre febrero 2013 y noviembre 2017. Se realizó seguimiento para evaluar la satisfacción del paciente y el resultado a largo plazo. La edad promedio de las pacientes al momento de la cirugía fue de 67,1 +/- 5,6 años y 69,0 % de las pacientes tenían antecedentes de haber sido sometidas a histerectomía abdominal. El tiempo medio entre la histerectomía y la cirugía de corrección fue de 16,9 +/- 3,6 años. Ciento diecinueve pacientes se sometieron a abordaje vaginal utilizando la técnica de culdoplastía de Mayo (grupo A) y 36 pacientes se sometieron a colposacropexia abdominal (grupo B). Durante la cirugía se produjeron tres casos (2,5 %) de lesión vesical inadvertida en el grupo A. En el grupo A se observaron 2 casos de recurrencia comparado con un solo caso en las pacientes del grupo B (p = ns). Al analizar la satisfacción de la cirugía, 84,9 % de las pacientes del grupo A y 77,7 % de las pacientes del grupo B se declararon satisfechas con los resultados quirúrgicos. Se concluye que la corrección del prolapso de la cúpula vaginal mediante colposacropexia abdominal y culdoplastía de Mayo son procedimientos seguros y efectivos.

The aim of this study was to compare the results of the Mayo culdoplasty with abdominal colposacropexy in the correction of post-hysterectomy vaginal vault prolapse. Medical records of 155 patients with post-hysterectomy vaginal vault prolapse were reviewed in which the surgical correction was carried out between February 2013 and November 2017. Follow-up was performed to evaluate the patient's satisfaction and the long-term result. The average age of the patients at the time of surgery was 67.1 +/- 5.6 years and 69.0% of the patients had a history of having undergone an abdominal hysterectomy. The mean time between hysterectomy and correction surgery was 16.9 +/- 3.6 years. One hundred and nineteen patients underwent vaginal access using the Mayo culdoplasty technique (group A) and 36 patients underwent abdominal colposacropexy (group B). During surgery there were three cases (2,5 %) of inadvertent bladder injury in group A. In group A, 2 cases of recurrence were observed compared with a single case in patients in group B (p = ns). When analyzing the satisfaction of the surgery, 84,9 % of the patients of group A and 77,7 % of the patients of group B declared themselves satisfied with the surgical results. It is concluded that the correction of vaginal vault prolapse by abdominal colposacropexy and Mayo culdoplasty are safe and effective procedures.

Colpocleisis para el tratamiento del prolapso de cúpula vaginal grave / Colpocleisis for the treatment ofadvanced vaginal vault prolapse

INTRODUCCIÓN: El prolapso de los órganos pélvicos (POP) es una condición cuya prevalencia aumenta con la edad. Es necesario que los cirujanos comprendan las indicaciones, riesgos, limitaciones y resultados de las varias técnicas quirúrgicas disponibles. En este artículo se aborda el tratamiento quirúrgico obliterativo del POP (colpocleisis y colpectomia) en base a la revisión de estudios. TÉCNICA: En la literatura son descritas muchas variaciones de las técnicas obliterativas. Con el objetivo de reglamentar la técnica para futuros estudios, describimos la técnica de LeFort modificada, realizada por los autores. Los métodos obliterativos tienen un tiempo operatório, morbilidad perioperatoria reducida y una tasa baja de recurrencia del prolapso. El índice de calidad de vida y satisfacción de la paciente son altos. CONCLUSIÓN: La literatura existente respecto a la colpocleisis es limitada por la calidad metodológica. Por tanto, no hay nivel de evidencia I o II, en lo que se refiere a la colpocleisis. Sin embargo, esta técnica debe hacer parte del arsenal terapéutico del cirujano en el abordaje de los prolapsos severos en mujeres mayores.

INTRODUCTION. The pelvic organ prolapse (POP) is a condition whose prevalence increases with age. Surgeons need to understand the indications, risks, constraints and results of various surgical techniques. This article is about obliterative surgical treatment of POP (colpocleisis and colpectomia) and it is based on the review of studies is discussed. TECHNICAL. In the literature are many variations of the techniques obliterative. In order to regulate the art for future study, we describe the technique of LeFort modified by the authors. The obliterative methods have operatory time, reduced perioperative morbidity and a low rate of recurrence of prolapse. The index ofquality oflife and patient satisfaction are high. CONCLUSION. The literature regarding the colpocleisis is limited by methodological quality. Therefore no evidence level I or II, in what concerns the colpocleisis. However, this technique should be part of the armamentarium of the surgeon in addressing severe prolapse in elderly women.

Impact of Sacrospinous Colpopexy Associated with Anterior Colporrhaphy for the Treatment of Dome Prolapse on all Three Vaginal Compartments / Resultados da colpofixação sacroespinal associada a colporrafia anterior para o tratamento do prolapso de cúpula vaginal

Objective To evaluate the results of sacrospinous colpopexy surgery associated with anterior colporrhaphy for the treatment of women with post-hysterectomy vaginal vault prolapse. Methods This prospective study included 20women with vault prolapse, PelvicOrgan Prolapse Quantification System (POP-Q) stage≥2, treated between January 2003 and February 2006, and evaluated in a follow-up review (more than one year later). Genital prolapse was evaluated qualitatively in stages and quantitatively in centimeters. Prolapse stage < 2 was considered to be the cure criterion. Statistical analysis was performed using the Wilcoxon test (paired samples) to compare the points and stages of prolapse before and after surgery. Results Evaluation of the vaginal vault after one year revealed that 95% of subjects were in stage zero and that 5% were in stage 1. For cystocele, 50% were in stage 1, 10% were in stage 0 (cured) and 40% were in stage 2. For rectocele, three women were in stage 1 (15%), one was in stage 2 (5%) and 16 had no further prolapse. The most frequent complication was pain in the right buttock, with remission of symptoms in all three cases three months after surgery. Conclusions In this retrospective study, the surgical correction of vault prolapse using a sacrospinous ligament fixation technique associatedwith anterior colporrhaphy proved effective in resolving genital prolapse. Despite the low complication rates, there was a high rate of cystocele, which may be caused by posterior vaginal shifting due to either the technique or an overvaluation by the POP-Q system.

Objetivo Avaliar os resultados da cirurgia de colpofixação sacroespinal associada a colporrafia anterior, para o tratamento de mulheres com prolapso de cúpula vaginal pós-histerectomia. Métodos Estudo prospectivo que incluiu 20 mulheres com prolapso de cúpula em estágio≥2 de acordo com o Sistema de Quantificação do Prolapso Genital (POP-Q) tratadas no período de janeiro de 2003 a fevereiro de 2006 e avaliadas emrevisão tardia (maior que um ano). O prolapso genital foi avaliado qualitativamente em estágios e, quantitativamente, emcentímetros. Como critério de cura, consideramos prolapso em estágio < 2. Para análise estatística, foi utilizado teste de Wilcoxon (amostras pareadas) para comparar os pontos e estágios dos prolapsos antes e depois da cirurgia. Resultados Na cúpula vaginal a avaliação após um ano mostrou 95% em estágio zero e 5% em estágio 1. Cistocele: 50% em estágio 1, 10% em estágio zero (curadas) e 40% emestágio 2. Retocele: trêsmulheres apresentavamestágio 1 (15%), uma emestágio 2 (5%) e dezesseis não apresentavam prolapso posterior. As complicações mais frequentes foramdor no glúteo direito com remissão do sintoma emtodos os três casos após três meses da cirurgia. Conclusões Neste estudo retrospectivo, a cirurgia de correção do prolapso de cúpula pela técnica de fixação no ligamento sacroespinal, associada à colporrafia anterior, se mostrou efetiva na resolução do prolapso genital com baixa taxa de complicações; porém com alta taxa de cistocele - o que pode ter sido decorrente do desvio vaginal posterior pela técnica, ou ainda uma supervalorização pelo sistema POP-Q.

Sacrocolpopexia laparoscópica para el tratamiento del prolapso apical: resultados y seguimiento a largo plazo / Laparoscopic sacrocolpopexy for apical prolapse

Objetivos: Evaluar los resultados subjetivos, anatómicos y funcionales a largo plazo de las pacientes sometidas a sacrocolpopexia laparoscópica para manejo de prolapso apical. Métodos: Estudio observacional con pacientes a quienes se les hizo sacrocolpopexia laparoscópica entre febrero de 2006 y diciembre de 2012, en tres centros. El nivel de soporte del piso pélvico se midió mediante la escala de cuantificación del prolapso de órganos pélvicos (POP-Q). Los resultados funcionales se evaluaron mediante un cuestionario de síntomas intestinales, urinarios, sexuales y de molestias físicas. También se estimó la satisfacción global de las pacientes con una escala de uno a diez. Resultados: Se realizó sacrocolpopexia laparoscópica a 68 pacientes, pero el seguimiento fue posible sólo en 24. Ninguna paciente tuvo prolapso apical postoperatorio. El punto C medio del POP-Q fue -6,8 cm. Se observó mejoría importante con respecto a los síntomas subjetivos de prolapso con reducciones significativas en las puntuaciones del cuestionario en el seguimiento postoperatorio. La satisfacción fue en promedio de 9,1. La incontinencia urinaria preoperatoria se resolvió en el 35 por ciento de las que la reportaron, sin necesidad de cirugía de continencia concomitante. No hubo complicaciones a corto plazo. A largo plazo hubo una hernia incisional en el sitio del trocar y una obstrucción intestinal por la malla. Conclusión: La sacrocolpopexia laparoscópica es un tratamiento quirúrgico seguro y eficaz para el prolapso apical post-histerectomía. Proporciona un excelente soporte apical y buen nivel de satisfacción, con una mejoría general de los síntomas de prolapso.

Objective: To evaluate the long-term subjective, anatomical and functional outcomes after laparoscopic sacrocolpopexy for apical prolapse. Methods: An observational study of women undergoing laparoscopic sacrocolpopexy between February 2006 and December 2012 was undertaken, at three centers. Pelvic organ support was assessed objectively using the pelvic organ prolapse quantification scale (POP-Q). Functional outcomes were assessed using a questionnaire of bowel, urinary, sexual and physical discomfort symptoms postoperatively. Also was assessed the overall satisfaction of surgery with a scale of one to ten. Results: During the period of the study, sacrocolpopexy was done in 68 patients, but follow-up was possible only in 24. At a mean follow up of 34 months, all 24 women had stage 0 vault support with point C of the POP-Q score averaging -6.8 cm. Subjective improvements in prolapse symptoms were observed with significant reductions in the questionnaire scores. The satisfaction measured with visual scale averaged 9.1. Fifteen women reported stress urinary incontinence before sacrocolpopexy, and it was resolved in 35 percent without concomitant continence surgery. New onset incontinence was reported in two women. There were no intraoperative and perioperative complications. The long term complications were an incisional hernia on the trocar port site and bowel obstruction caused by the mesh that needed intestinal resection. Conclusions: Laparoscopic sacrocolpopexy is a safe and effective surgical treatment for post-hysterectomy apical prolapse. It provides excellent apical support and good level of satisfaction, with overall improvement in prolapse symptoms.

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.

The 2 Cases of the Sacrospinous Ligament Fixation for the Massive Eversions of the Vagina after Total Abdominal Hysterectomy / 대한산부인과학회잡지

Massive eversion of the vagina is one of the most disturbing disorders confronting a woman. It is a complex disorder that always surgical, and all defects. The managements is always surgical, and all defects must be repaired concomitantly. Current surgical practice relies primarily on the strength of the endopelvic fascia and certain ligaments. Massive eversion of the vagina can be treated by a variety of transvaginal and transamdominal surgical technique. In most instances a transvaginal approach is useful. If strong cadinal and uteroscral support in not available fiocation of the vginal vault to the sacrospinous ligment is useful. In 1987, Miyazaki introduced his Miya Hook ligature carrier. With this instrume nt, introduction of the needle became safer and easier than with the Deschamp aneurysm needle. We had experienced two cases of massive eversion of vagina after the total abdominl hyst erectomy who were treated succesfully with sacrospinous ligement fixation by using Miya Hook. We report above two cases and review briefly.