Abdominal sling surgery: Artificial sacro-uterine ligament

Abdominal sling surgery is defined as attachment of either the connective tissue graft (fascia lata) or some synthetic material (Mersilene) to the anterior wall of the exposed vaginal vault following total hysterectomy or to the posterior wall of the uterine cervix in total and subtotal uterine prolapse, whereas the other end is attached to the anterior longitudinal ligament extending along the anterior surface of the vertebrae. Our analysis comprised 45 operations: 20 cases of vaginal vault prolapse following vaginal hysterectomy; 7 cases of vaginal vault prolapse following HTA: 2 cases of prolapse following subtotal hysterectomy; 3 cases of nondefined TH 2 cases following Burch operation; 1 following Kocher; 1 following Manchester, 1 following Neugebauer-Le For operation in which HTA was performed 2 times. Abdominal sling operation was associated with the following surgical procedures: sling in 13 cases, sling + douglasorrhaphy in 16 cases, sling + douglasorrhaphy + colpoperineoplastics in 6 cases, sling colpoperineoplastics in 9 cases and sling + Marshall Marcetti in 1 case. Recurrence of enterocele was recorded in 5 patients in whom closure of the douglas pouch had not been performed. This procedure was therefore later included into our approach to the operation. The abdominal sling operation has been a logical and physiologic approach to surgical therapy of genital prolapse, particulary of the vaginal vault prolapse following total hysterectomy. This operation ensures subsequent normal sexual relations.

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Uterine Prolapse: From Antiquity to Today

Obstetrics and Gynecology International ◽

10.1155/2012/649459 ◽

2012 ◽

Vol 2012 ◽

pp. 1-9 ◽

Cited By ~ 13

Author(s):

Keith T. Downing

Keyword(s):

Medical Literature ◽

Uterine Prolapse ◽

Vaginal Vault Prolapse ◽

Vaginal Vault ◽

Vault Prolapse ◽

Female Pelvic Medicine

Uterine prolapse is a condition that has likely affected women for all of time as it is documented in the oldest medical literature. By looking at the watershed moments in its recorded history we are able to appreciate the evolution of urogynecology and to gain perspective on the challenges faced by today's female pelvic medicine and reconstructive surgeons in their attempts to treat uterine and vaginal vault prolapse.

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Vaginal vault reconstruction and apical sling in the treatment of post-hysterectomy prolapsE

Journal of obstetrics and women s diseases ◽

10.17816/jowd66146-55 ◽

2017 ◽

Vol 66 (1) ◽

pp. 46-55

Author(s):

Dmitry D Shkarupa ◽

Alexandr A Bezmenko ◽

Nikita D Kubin ◽

Ekaterina A Shapovalova ◽

Alexey V Pisarev

Keyword(s):

Surgical Treatment ◽

De Novo ◽

Uterine Prolapse ◽

Operation Time ◽

Vaginal Wall ◽

Vaginal Vault Prolapse ◽

Vaginal Vault ◽

Vault Prolapse ◽

Sacrospinous Fixation ◽

Apical Sling

Introduction. Frequency of vaginal vault prolapse (VVP) requiring surgical repair is up to 6-8% and 11.6-45% in patients with prior hysterectomy for uterine prolapse. Reported recurrence rate of VVP following different techniques of surgical correction is up to 10%.Objective: to evaluate the effectiveness of the novel technique: bilateral sacrospinous fixation of reconstructed vaginal wall (neocervix) by monofilament polypropylene apical sling (Urosling 1; Lintex, Saint Petersburg, Russia) in surgical treatment of VVP.Methods. This prospective study involved 61 women suffering from post-hysterectomy prolapse. To evaluate the results of surgical treatment, data of a vaginal examination (POP-Q), uroflowmetry, bladder ultrasound, validated questionnaires were used. All listed parameters were determined before the surgery and at control examinations in 1, 6, 12 months after the treatment.Results. Mean operation time was 35 minutes. No cases of intraoperative damage to the bladder/rectum, as well as clinically significant bleeding were noted. 12-months anatomical cure rate (≤ stage I, POP-Q) was 100%, 94.4% and 100% for apical, anterior and posterior vaginal compartments, respectively. At 1 month of follow-up stress urinary incontinence de novo and urgency de novo were noted in 6.5% and 4.9%, respectively. Statistically significant (p < 0.05) improvement in peak flow rate was observed according to uroflowmetry. Comparison of the scores by the questionnaires revealed a significant improvement in the quality of life in the postoperative period.Conclusion. Bilateral sacrospinous fixation of reconstructed vaginal wall (neocervix) by monofilament polypropylene apical sling appears to be effective and safe method for treatment patients with vaginal vault prolapse.

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