Prevención del prolapso genital en histerectomía abdominal utilizando los ligamentos redondos: experiencia personal / Prevention of genital prolapse in abdominal hysterectomy using the round ligaments: personal experience

Prevenir el prolapso de la cúpula vaginal, empleando una técnica peroperatoria que consiste en fijar la cúpula vaginal a los ligamentos redondos, en el momento de realizar la intervención. Realizada la histerectomía, se procedió al cierre de la cúpula vaginal con puntos separados en número de 6 a 8 con material no absorbible, dependiendo de la amplitud de la vagina. Los cabos distales son utilizados para anudar horizontalmente los ligamentos redondos. La fijación de las dos paredes del extremo superior de la vagina, garantiza mayor estabilidad de la vagina y menor posibilidad de producir el prolapso de la cúpula y/o de las paredes anterior y posterior de la vagina. Servicio de Ginecología, Hospital Universitario de Caracas. Las 124 pacientes histerectomizadas y controladas anualmente en un lapso entre 2 y 27 años, con un promedio de 7 años, ninguna de ellas presentó prolapso de cúpula vaginal. Las histerectomías se realizaron en el ejercicio privado. En centros asistenciales públicos, es muy difícil hacer seguimiento y evaluar las pacientes, por razones múltiples. La histerectomía ocupa el primer lugar de las intervenciones ginecológicas, esto obliga a realizar la suspensión y fijación de la cúpula vaginal y simultáneamente corregir la patología asociada del aparato genital. El procedimiento que hemos empleado tuvo resultados muy favorables. La calidad de vida de las mujeres intervenidas quirúrgicamente no se desmejoró, como suele suceder cuando se produce el prolapso de la cúpula vaginal

To prevent vaginal vault prolapse, using a preoperative technique to fix the vaginal vault to the round ligaments in total abdominal hysterectomy, and identify associated pathology in the genital area. After hysterectomy, we proceed to the closure of the vaginal vault with interrupted sutures with non-absorbable material, in number of 6-8, depending of the amplitude of the vagina, the distal ends are used to tie horizontally bilateral round ligaments. The setting of the two upper walls of the vagina, ensures greater stability of the vagina and lower possibility of occurrence of prolapse of the dome and/or the anterior and posterior vaginal walls. Servicio de Ginecologia, Hospital Universitario de Caracas The 124 patients undergoing hysterectomy, checked annually over a period of time between 2 and 27 years, with an average of 7 years, neither had vaginal prolapse. Histerectomy is the firstone gynecological operation. It requires making the suspension and fixation of the vaginal vault and simultaneously correct the genital tract associated pathology. The procedure we used had very favorable results. We can not compare our results with other techniques, do to scarse national an international references. The quality of life of women surgically intervened did not deteriorated, as usually happens when there is prolapse of the vaginal vault

Integrated health research program for the Thai elderly: prevalence of genital prolapse and effectiveness of pelvic floor exercise to prevent worsening of genital prolapse in elderly women.

BACKGROUND: Genital prolapse is a common health problem in elderly women. It is prevalent among elderly females and affects their quality of life. Those with a severe degree of genital prolapse may need operative treatment which may be risky due to co-morbid conditions such as hypertension, respiratory disease, cardiovascular disease and diabetes mellitus. The aim of this study was to determine the prevalence of genital prolapse and the effectiveness of pelvic floor exercise to prevent worsening of genital prolapse in elderly females. METHOD: The authors conducted a cross sectional study to determine the prevalence of genital prolapse in 682 elderly women (aged > or = 60 years) who lived within a 10-kilometer radius of Siriraj Hospital. 654 subjects were eligible for the controlled trial to determine the effectiveness of pelvic floor exercise to prevent worsening of genital prolapse. There were 324 subjects in the control group and 330 subjects in the experimental group. The experimental group received training in pelvic floor exercise and were asked to perform the exercise 30 times after one meal, every day for 24 months. The subjects were followed-up every 6 months for 24 months to assess worsening of genital prolapse. RESULTS: The prevalence of genital prolapse was 70 per cent. There were 324 subjects in the control group and 330 subjects in the experimental group. After 24 months of pelvic floor exercise, the rate of worsening of genital prolapse was 72.2 per cent in the control group and 27.3 per cent in the experimental group (p = 0.005). The rate of worsening of genital prolapse was not significantly different between the control group and the study group in those who had a mild degree of genital prolapse. CONCLUSION: The prevalence of genital prolapse in elderly Thai women was 70 per cent. A 24 months pelvic floor exercise program was effective to prevent worsening of genital prolapse in the women who had severe genital prolapse.

Histerectomias vaginais: revisäo de 178 casos / Vaginal hysterectomies: review of 178 cases

Para avaliar a eficácia e segurança das histerectomias vaginais realizadas pelo Departamento de Ginecologia e Obstetrícia da Faculdade de Medicina de Ribeirao Preto (FMRP-USP), reunimos 178 casos operados entre 01/01/78 e 31/05/90. A maioria das pacientes eram brancas (84,3 por cento), idosas (média de idade de 61,5 anos), menopausadas (77,5 por cento) e multíparas (média de 6,9 partos por paciente). Todas as pacientes tinham algum grau de prolapso genital. Nao houve nenhum óbito em decorrência da cirurgia, as principais complicaçoes foram a infecçao urinária (7,9 por cento) e o prolapso vaginal (6,2 por cento). O índice de complicaçoes intra-operatórias foi de 6,2 por cento e o índice de complicaçoes pós-operatórias foi de 31 por cento, porém nenhuma destas complicaçoes resultou em morte ou dano permanente para a paciente. Complicaçoes menores incluíram infecçao do trato urinário (7,3 por cento) e prolapso da cúpula vaginal (6,2 por cento). Concluímos que a histerectomia vaginal é um procedimento relativamente seguro para a cura do prolapso genital em pacientes idosas e menopausadas. A inclusao do ligamento útero-sacro na rafia da cúpula vaginal e a correçao de uma enterocele previamente diagnosticada pode ser a manobra mais eficaz na prevençao do prolapso vaginal pós-histerectomia.