Aim. To estimate and compare the features and efficacy of different surgical methods of pelvic organ prolapse correction. Methods. 120 patients with stage 4 of pelvis organ prolapse were included in the study. The different types of surgical procedures were performed («Manchester» surgery, vaginal hysterectomy, sacropexy, laparoscopic ventrosuspension). Surgical method was selected accounting the patient’s age, desire to save the uterus, presence of uterine or adnexal pathology and concomitant diseases. For long-term outcomes evaluation, patients were followed up for 6-36 month after surgery. Results. The long-term outcomes of the different types of surgeries performed in patients with stage 4 of pelvis organ prolapse were comparable. Minimal surgery time, blood loss and the hospital stay were registered in patients, in whom laparoscopic ventrosuspension combined with colpoperineorrhaphy and levatorplasty was performed, compared to «Manchester» surgery, vaginal hysterectomy and sacropexy with colpoperineoplasty. No cases of serious complications were registered. Patients with stress incontinence observed before surgery reported improvement in urination, although 6 patients (10%) still reported rare episodes of incontinence. Conclusion. In elderly patients with stage 4 of pelvis organ prolapse, laparoscopic ventrosuspension of uterus or vaginal stump with further colpoperineorrhaphy and levatorplasty could be performed; this type of surgery is technically simple, not time-consuming, and it’s results are comparable with the effectiveness of sacropexia. Thus, it could be recommended to under-trained young surgeons.
Long-term outcomes of progestin plus metformin as a fertility-sparing treatment for atypical endometrial hyperplasia and endometrial cancer patients