scholarly journals Abdominal sacrocolpopexy in surgical treatment of complete vaginal vault prolapse after hysterectomy

2008 ◽  
Vol 61 (11-12) ◽  
pp. 620-624
Author(s):  
Srdjan Djurdjevic ◽  
Tihomir Vejnovic ◽  
Aleksandar Curcic ◽  
Ljiljana Mladenovic-Segedi ◽  
Marko Maksimovic
Keyword(s):  
Surgical Treatment ◽  
Life Quality ◽  
Vaginal Vault Prolapse ◽  
Vaginal Vault ◽  
Surgical Reconstruction ◽  
Vault Prolapse ◽  
Vaginal Repair ◽  
Abdominal Incision ◽  
Abdominal Sacrocolpopexy ◽  
Gynecology And Obstetrics

Introduction The vaginal vault prolapse after hysterectomy is a complex disorder, which can be associated with the prolapse of anterior or posterior vaginal wall or cystorectocele. The exact incidence is unknown, and is within the range from 1 - 43% of operated patients. In order to achieve the complete surgical reconstruction of the pelvic floor disorder, a surgeon must have good knowledge of normal anatomic relations of pelvic organs. Material and methods Twenty-nine women with the vaginal vault prolapse after hysterectomy were operated at Clinic for Gynecology and Obstetrics in Novi Sad during the period from 1995 - 2007. After standard preoperative procedures, positioning of the patient and inferior medial abdominal incision, the supportive graft made of non-resorptive materials was fixed to the vaginal fornix and sacral periost from the promontory to the level of S 3-4 vertebrae. Results The average age of the patients was 61.4 years. The following supportive materials were used: mersilen mesh (16), allograft made of m. rectus abdominis fascia (5), prolen (4), fascia lata strip (2) and common Silk sutures (2). Additional operations (Moschowitz Douglasoraphy, Kelly-Marion anterior vaginal repair, colpoperineoplasty and Burchcolposuspension) were performed in 20 (68.9%) patients. Discussion There were 7 (23.8%) postoperative complications. The erosion of mersilen mesh was detected in 2 (6.8%) patients, and recurrence of vaginal vault prolaps and cystorectocele in 3 (10.2%) patients. According to other authors, the erosion of synthetic materials occurs in about 3.4%, and recurrence of vaginal vault prolaps in 0-22% of operated patients. Conclusion The complete vaginal vault prolaps after hysterectomy is a complex anatomic disorder which has a great impact on the life quality and significantly disturbs patient's psychosocial sphere. Surgical treatment involves abdominal or vaginal access and is planned individually for each patient.

scholarly journals Sacrocolpopexy in management of vaginal vault prolapse

2016 ◽  
Vol 10 (4) ◽  
Author(s):  
Javed Iqbal ◽  
Fauzia Nausheen ◽  
Fozia Ali Bhatti ◽  
Arif Tajammul Khan ◽  
Shahida Sheikh
Keyword(s):  
Operation Time ◽  
Abdominal Hysterectomy ◽  
Vaginal Vault Prolapse ◽  
Vaginal Vault ◽  
Vault Prolapse ◽  
Abdominal Sacrocolpopexy ◽  
Estimated Blood Loss ◽  
One Year ◽  
Study Setting

Aims & Objectives: To review the efficacy of Sacrocolpopexy in the management of vaginal vault prolapse Study Design: Interventional study. Setting & Population: Department of Obstetrics & Gynaecology, Jinnah Hospital, Lahore. Women with vaginal vault prolapse after hysterectomy. Methods and Main-outcome measures: Abdominal Sacrocolpopexy using proline mesh. Follow-up in these patients were carried out at one week, four weeks, six months, and one year. Results: Sacrocolpopexy was carried out in ten patients for vaginal vault prolapse after vaginal (6) and abdominal hysterectomy (4). The mean age was 49.8 years. Parity was between P3 - P6 (Mean parity 4.3). Mean operation time was 79.3 minutes. Estimated blood loss was less than 200m1. No intra-operative or post-operative complications occurred in any case. Conclusion: Abdominal sacrocolpopexy is effective and safe in the treatment of vaginal vault prolapse. This procedure has high success rate in correcting prolapse without a time dependent decrease in efficacy.

scholarly journals Vaginal Vault Prolapse

2009 ◽  
Vol 2009 ◽  
pp. 1-9 ◽  
Author(s):  
Azubuike Uzoma ◽  
K. A. Farag
Keyword(s):  
Negative Impact ◽  
Surgical Techniques ◽  
Aging Population ◽  
Vaginal Vault Prolapse ◽  
Vaginal Vault ◽  
Clear Understanding ◽  
Vault Prolapse ◽  
Ureteric Injury ◽  
Sacrospinous Fixation ◽  
Abdominal Sacrocolpopexy

Introduction. Vaginal vault prolapse is a common complication following vaginal hysterectomy with negative impact on women's quality of life due to associated urinary, anorectal and sexual dysfunction. A clear understanding of the supporting mechanism for the uterus and vagina is important in making the right choice of corrective procedure. Management should be individualised, taking into consideration the surgeon's experience, patients age, comorbidities, previous surgery and sex life.Result. Preexisting pelvic floor defect prior to hysterectomy is the single most important risk factor for vault prolapse. Various surgical techniques have been advanced at hysterectomy to prevent vault prolapse. Studies have shown the McCall's culdoplasty under direct visualisation to be superior. Vault prolapse repair rely on either the use of patient's tissue or synthetic materials and can be carried out abdominally or vaginally. Sacrospinous fixation and abdominal sacrocolpopexy are the commonly performed procedures, with literature in favour of abdominal sacrocolpopexy over sacrospinous fixation due to its reported higher success rate of about 90%. Other less commonly performed procedures include uterosacral ligament suspension and illiococcygeal fixation, both of which are equally effective, with the former having a high risk of ureteric injury. Colpoclesis will play a greater role in the future as the aging population increases. Mesh procedures are gaining in popularity, and preliminary data from vaginal mesh procedures is encouraging. Laparoscopic techniques require a high level of skill and experience. There are many controversies on the mechanism of prolapse and management techniques, which we have tried to address in this article.Conclusion. As the aging population increases, the incidence of prolapse will also rise, older techniques using native tissue will continue, while new techniques using the mesh needs to be studied further. The later may well be the way forward in future.

scholarly journals Surgical treatment of vaginal vault prolapse

1970 ◽  
Vol 2 (2) ◽  
pp. 3-8
Author(s):  
MIJ Withagen ◽  
RMF Van der Weiden ◽  
ME Vierhout
Keyword(s):  
Surgical Treatment ◽  
Social Functioning ◽  
Elderly Women ◽  
Surgical Techniques ◽  
Vaginal Vault Prolapse ◽  
Vaginal Vault ◽  
Prolapse Surgery ◽  
Laparoscopic Sacrocolpopexy ◽  
Vault Prolapse ◽  
Tension Free

Vaginal vault prolapse can cause limitations in physical and social functioning. This problem will enhance with the increasing age in women. New surgical techniques, like tension free vaginal mesh and laparoscopic sacrocolpopexy reduce surgical strain in patients and make prolapse surgery achievable in elderly women. doi:10.3126/njog.v2i2.1446 N. J. Obstet. Gynaecol 2007 Nov-Dec; 2 (2): 3 - 8

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

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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