Glue mesh fixation: Feasibility, tolerance and complication assessment. Results 24months after laparoscopic sacrocolpopexy.

AIM: This study aims to assess short- and mid-term feasibility, strength and tolerance of glue mesh fixation for laparoscopic sacrocolpopexy, as well as postoperative quality of sexual activity. PATIENTS AND METHODS: This original prospective clinical study was carried out in multiple university surgical centres between 2012 and 2013. Data were obtained during immediate postoperative hospitalisation, at 3 and at 24 months postoperatively. For a total of 42 patients subjected to laparoscopic sacrocolpopexy, bladder catheterization and hospitalisation times, pain score, early and late postoperative complications, prolapse staging according to POP-Q classification, and quality of sexual activity were registered. RESULTS: Mean operative time was 120minutes and patients were hospitalised for a mean of 3days. Four complications (9.52%) occurred on the immediate postoperative period, whilst 2 patients (4.76%) complained of pain on day 3 (VAS 1). At the end of the follow-up period (24 months), one patient had a prosthetic exposure, 4 patients (9.52%) complained of stress urinary incontinence (10.81%). Simultaneously, 6 patients (14.29%) experienced dyschezia (2 improved, 1 similar, 1 de novo, 2 worsened), and there was no report of dyspareunia. All anterior and posterior floor prolapses were staged between 0 and 1. All superior floor prolapses were staged between 0 and 2. Concerning sexual impairment, there was no report of dyspareunia, urinary leaks or other problems associated with intercourse, and quality of sexual activity improved. CONCLUSION: Minimally invasive sacrocolpopexy with the use of glue fixation does not lead to increased mid-term morbidity, simultaneously allowing for significant prolapse improvement, and providing global patient satisfaction and overall quality of life.

[Breast reconstruction with pedicled TRAM flap (a retrospective study of 115 consecutive cases)]. / Reconstruction mammaire par lambeau musculocutané unipédiculé de muscle grand droit de l'abdomen (115 cas consécutifs).

PURPOSE OF THE STUDY: The purpose of this study is to analyse the advantages, disadvantages and results of the uni-pedicled TRAM flap. PATIENTS AND METHOD: This retrospective study concerns 115 consecutive uni-pedicled TRAM flaps realised by two surgeons between 1994 and January 2007. These reconstructions were all realised for oncologic pathology and were either immediate or delayed surgery. Concerning the immediate reconstruction, a skin sparing mastectomy has been realised as often as possible for intraductal carcinomas and small invasive carcinomas. For the immediate reconstruction the study takes into account complications and oncologic recurrences with an average backward of 45 months. RESULTS: The uni-pedicled TRAM flap offers a good reliability and the esthetics results are stable at long-term for immediate breast reconstruction and delayed breast reconstruction. The major complications are flap necrosis (12,2%) and parietal complications (6%). The recurrence rate after mastectomy and uni-pedicled TRAM flap is equivalent of the recurrence rate expected for mastectomy alone. There were never late diagnostic for recurrence after uni-pedicled TRAM flap. The esthetic improvement by surgery concerns the opposite breast for 31,3%, it was a mastopexy or reduction. The esthetic improvement of the TRAM flap concerns 14 patients (12,1%). The improvement of inframammary crease was the most frequent improvement (9/115-8%). CONCLUSION: The TRAM flap uni-pedicled allows a delayed, immediate breast reconstruction or bilateral synchronised breast reconstruction. The long-term disadvantages are the abdominal complications and the impossibility to realise the same technique for a later contralateral reconstruction.