scholarly journals Pelvic organ prolapse surgical training program in Bangladesh and Nepal improves objective patient outcomes

2020 ◽  
Author(s):  
Barbara Hall ◽  
Judith Goh ◽  
Maqsudul Islam ◽  
Anubha Rawat
Keyword(s):  
Pelvic Organ Prolapse ◽  
Training Program ◽  
Patient Outcomes ◽  
Surgical Training ◽  
Pelvic Organ ◽  
Vaginal Repair ◽  
Low Resource ◽  
Prolapse Recurrence ◽  
Surgical Training Program

Abstract Introduction and hypothesis The DAK Foundation (Sydney) has facilitated pelvic organ prolapse (POP) repairs performed by local gynecologists for underprivileged women in Bangladesh and Nepal since 2014. Initially, there was no long-term patient follow-up. When 156 patients were examined at least 6 months after their surgery, an unacceptably high rate of prolapse recurrence and shortened vaginas was identified. This demonstrated the need for surgical up-skilling in both countries. Our hypothesis is that the introduction of a surgical training program in low-resource countries can significantly improve patient outcomes after pelvic floor surgery. Methods One-on-one surgical re-training was undertaken to up-skill the gynecologists in fascial vaginal repair and vaginal apical reconstruction utilizing sacrospinous fixation (SSF). Following the surgical up-skilling, a further 289 women (between 6 and 18 months post-operatively) were examined to determine patient outcomes. Outcome measures were: Prolapse recurrence: POPQ (pelvic organ prolapse quantification [1]) ≥ stage 2 Vaginal length < 4 cm Results Prior to implementation of the surgical training program, 76% of patients had recurrent prolapse ≥ stage 2, and 56% had a vagina < 4 cm in length. Following the training program, prolapse recurrence was reduced to 45% with significant reductions in the apical, anterior and posterior compartments. The incidence of unacceptable vaginal shortening was 4%. We could not rely on patient symptoms to determine whether they had recurrences. Conclusion Clinical patient follow-up to determine surgical outcome is essential in low-resource settings. We have demonstrated that surgical up-skilling in vaginal hysterectomy, vaginal repair and introduction of SSF were necessary to achieve acceptable prolapse recurrence rates in our programs in Bangladesh and Nepal.

scholarly journals Serious complications and recurrences after pelvic organ prolapse surgery for 2309 women in the VIGI-MESH registry

2021 ◽  
Author(s):  
Xavier Fritel ◽  
Renaud de Tayrac ◽  
Joe de Keizer ◽  
Sandrine Campagne-Loiseau ◽  
Michel Cosson ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Pelvic Organ ◽  
Transvaginal Mesh ◽  
Vaginal Repair ◽  
Mesh Placement ◽  
Native Tissue ◽  
Prolapse Recurrence ◽  
Pop Surgery ◽  
Laparoscopic Sacropexy ◽  
One Year

Objective: To assess the incidence of serious complications and reoperations for recurrence after pelvic organ prolapse (POP) surgery and compare the three most common types of repair. Design: Prospective cohort study using a registry. Setting: 19 surgical centres in France. Population: 2309 women participated between 2017 and 2019. Methods: a multivariate analysis including an inverse probability of treatment weighting approach was used to obtain three comparable groups. Main outcome measures: Serious complications and subsequent reoperations for POP recurrence Results: Mean follow-up was 16.6 months. Surgeries included in the analysis were native tissue vaginal repair (N=504), transvaginal mesh placement (692), and laparoscopic sacropexy with mesh (1113). Serious complications occurred among 52 women (2.3%), and reoperation for recurrence was required for 32 (1.4%). At one year, the cumulative weighted incidence of serious complications was 1.8% for native tissue vaginal repair (95% confidence interval 0-3.9), 3.9% for transvaginal mesh (2.0-5.9), and 2.2% for sacropexy (1.1-2.6). Compared with the native tissue vaginal repair group, the risk of serious complications was higher in the transvaginal mesh group (weighted-HR 3.84, 2.43-6.08), and the sacropexy group (2.48, 1.45-4.23), while the risk of reoperation for prolapse recurrence was reduced in both groups (transvaginal mesh [0.22, 0.13-0.39] and sacropexy [0.29, 0.18-0.47]). Conclusions: Laparoscopic sacropexy with mesh appears to have a better risk profile (few serious complications and few reoperations for recurrence) than transvaginal mesh placement (more serious complications) and native tissue vaginal repair (more reoperations for recurrence). These results are useful for informing women and for shared decision making.

scholarly journals Competency-Based Education in Low Resource Settings: Development of a Novel Surgical Training Program

2017 ◽  
Vol 42 (3) ◽  
pp. 646-651 ◽  
Author(s):  
Meghan McCullough ◽  
Alex Campbell ◽  
Armando Siu ◽  
Libby Durnwald ◽  
Shubha Kumar ◽  
...  
Keyword(s):  
Training Program ◽  
Surgical Training ◽  
Low Resource Settings ◽  
Low Resource ◽  
Competency Based Education ◽  
Surgical Training Program ◽  
Competency Based

Designing a Contextually Appropriate Surgical Training Program in Low-resource Settings: The Botswana Experience

2012 ◽  
Vol 37 (7) ◽  
pp. 1486-1491 ◽  
Author(s):  
Dorotea Mutabdzic ◽  
Alemayehu G. Bedada ◽  
Balisi Bakanisi ◽  
Joseph Motsumi ◽  
Georges Azzie
Keyword(s):  
Training Program ◽  
Surgical Training ◽  
Low Resource Settings ◽  
Low Resource ◽  
Surgical Training Program

Assessing pelvic organ prolapse recurrence after minimally invasive sacrocolpopexy: does mesh weight matter?

2021 ◽  
Author(s):  
Lauren E. Giugale ◽  
Molly M. Hansbarger ◽  
Amy L. Askew ◽  
Anthony G. Visco ◽  
Jonathan P. Shepherd ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Minimally Invasive ◽  
Pelvic Organ ◽  
Prolapse Recurrence

scholarly journals Pelvic organ prolapse surgery and health-related quality of life: a follow-up study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Tadesse Belayneh ◽  
Abebaw Gebeyehu ◽  
Mulat Adefris ◽  
Guri Rortveit ◽  
Janne Lillelid Gjerde ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Pelvic Organ Prolapse ◽  
Pelvic Organ ◽  
Prolapse Surgery ◽  
Stage Iii ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related

Abstract Background Symptomatic prolapse impairs quality of life. Health-related quality of life (HRQoL) is considered an important outcome of pelvic organ prolapse (POP) surgery. However, it is rarely reported, and measures are inadequately used. Thus, studies reporting patient-reported surgical outcomes in low-income contexts are needed. This study aims to evaluate the effect of prolapse surgery on patient HRQoL and determine the predictive factors for change in HRQoL. Methods A total of 215 patients who had prolapse stage III or IV were enrolled. Patients underwent vaginal native tissue repair, and their HRQoL was evaluated at baseline, 3 and 6 months postoperatively. Effect of surgery on subjective outcomes were measured using validated Prolapse Quality of Life (P-QoL-20), Prolapse Symptom Score (POP-SS), Body Image in Prolapse (BIPOP), Patient Health Questionnaire (PHQ-9), and Patient Global Index of Improvement (PGI-I) tools. A linear mixed-effect model was used to compare pre- and postoperative P-QoL scores and investigate potential predictors of the changes in P-QoL scores. Results In total, 193 (89.7%) patients were eligible for analysis at 3 months, and 185 (86.0%) at 6 months. Participant’s mean age was 49.3 ± 9.4 years. The majority of patients had prolapse stage III (81.9%) and underwent vaginal hysterectomy (55.3%). All domains of P-QoL improved significantly after surgery. Altogether more than 72% of patients reported clinically meaningful improvement in condition-specific quality of life measured with P-QoL-20 at 6 months. An improvement in POP-SS, BIPOP, and the PHQ-9 scores were also observed during both follow-up assessments. At 6 months after surgery, only 2.7% of patients reported the presence of bulge symptoms. A total of 97.8% of patients had reported improvement in comparison to the preoperative state, according to PGI-I. The change in P-QoL score after surgery was associated with the change in POP-SS, PHQ, BIPOP scores and marital status (p < 0.001). However, age, type of surgery, and prolapse stage were not associated with the improvement of P-QoL scores. Conclusions Surgical repair for prolapse effectively improves patient’s HRQoL, and patient satisfaction is high. The result could be useful for patient counselling on the expected HRQoL outcomes of surgical treatment. Surgical service should be accessible for patients suffering from POP to improve HRQoL.

scholarly journals EXPERIENCE OF USING SYNTHETIC PROSTHESES PROLIFT ® (GYNECARE) FOR CORRECTION OF GENITAL PROLAPSE

2010 ◽  
Vol 1 (3) ◽  
pp. 32-37
Author(s):  
S A Levakov ◽  
N S Wanke ◽  
O R Shablovskiy ◽  
A G Kedrova ◽  
V N Shirshov ◽  
...  
Keyword(s):  
Pelvic Organ Prolapse ◽  
Prospective Observational Study ◽  
Vaginal Surgery ◽  
Genital Prolapse ◽  
Pelvic Organ ◽  
Safe Procedure ◽  
Prolapse Repair ◽  
Specific Outcome ◽  
One Year

The aim was to evaluated anatomical and symptom specific outcome measures of prolapse repair with PROLIFT ® (Gynecare). In this longitudinal prospective observational study we collected data on a total of 85 women with pelvic organ prolapse stage 2 or more. Objective success rate was 85.9% at 6 months respectively. Patients required a blood more 500 ml - 7,1% and need transfusion. The mesh erosion rate or the displacement of the mesh were 3,5%. Vaginal surgery with prolift mesh® is an effective and safe procedure to correct pelvic organ prolapse over one year follow up.

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