Correction of pelvic organ prolapse by laparoscopic lateral suspension with mesh: a clinical series (original) (raw)
Related papers
Modified laparoscopic lateral suspension with a five-arm mesh in pelvic organ prolapse surgery
BMC Women's Health
Background Laparoscopic lateral suspension (LLS) is a laparoscopic technique used to treat pelvic organ prolapse (POP) in apical and anterior compartment defect with the use of a synthetic T-shaped mesh graft. The posterior compartment is repaired using a second mesh or a procedure along with LLS, such as posterior colporrhaphy. The aim of this study was to evaluate the clinical results of LLS for POP using a five-arm mesh instead of a T-shaped mesh graft to repair the defect of the posterior compartment in addition to the apical and anterior compartments. Methods Data from 37 patients with a diagnosis of advanced-stage (≥ 3) POP undergoing LLS with the use of a five-arm mesh were retrospectively analysed. Pre-operative and post-operative examinations and, surgical outcomes were determined. The results of measurements and examinations, reoperation rates, erosion rates, lower urinary tract symptoms, and complications were analysed. The Prolapse Quality of Life Questionnaire (P-QOL) w...
World Journal of Surgery, 2020
Background This study aimed to compare ventral mesh rectopexy (VMR) and pelvic organ prolapse suspension surgery (POPS) in management of patients presenting with rectal prolapse. Methods Our study was a prospective cohort trial in which 120 female patients with complete rectal prolapse were included, 60 patients had had VMR and the other 60 had had POPS as a surgical management for complete rectal prolapse. Results had been compared 6 months postoperatively regarding operative time, postoperative pain, hospital stay, complications of surgery including recurrence of the rectal prolapse, the efficacy of each operation in treatment of rectal prolapse and associated symptoms. Results The patients were assessed 6 months postoperatively. There was no significant statistical difference regarding hospital stay and postoperative pain. Operative time was significantly shorter in POPS in comparison with VMR (P value \ 0.05). VMR showed slight improvement regarding constipation and continence scores; however, this was statistically significant. VMR showed less complications compared to POPS. Complications with rectopexy happened only with 4 patients compared to 24 patients in POPS groups, 2 cases of recurrence in rectopexy group compared to 6 cases of recurrence in POPS. Conclusion POPS is comparable to VMR in management of rectal prolapse and in improving the ODS symptoms. Thus, POPS can be used as easier, faster option to treat rectal prolapse in selected patients.
Mini-Laparoscopic Repair of Apical Pelvic Organ Prolapse (POP) by Lateral Suspension with Mesh
Facts, Views & Vision in ObGyn, 2018
Background The aim of the present study is to analyze the feasibility, safety and learning curve of Mini- Laparoscopic Lateral suspension (LLS) for the treatment of apical and anterior defects following pelvic organ prolapse. Methods This is a cohort study on a retrospective series of 35 consecutive patients who underwent Mini-LLS for symptomatic POP between January 2014 and July 2016. All 35 patients were operated at the Gynaecological Unit in S. Chiara Hospital by two senior surgeons (S. Tateo and L. Mereu) and by a team with optimal skills in laparoscopic surgery. Patients were divided in two groups according to two different chronological phases: phase 1 identified the initial 12 cases, phase 2 the last 23 cases. We collected pre-, peri- and post-operative information to analyze the surgical outcomes and learning curve after Mini-LLS procedures. Results The mean LLS-Overall Time (OT) was 107.6 min (range, 185- 63 min). None of the patients had intra-operative complications. No c...
Urogynaecologia, 2022
The use of vaginal mesh in order to correct Pelvic Organ Prolapse (POP) has been banned by the FDA due to the complications associated with them. The objective is to determine efficacy and safety in the short and long term in a sample of women undergoing transvaginal mesh surgery performed by properly trained surgeons, in a referral center and with a protocolized follow-up. We present a longitudinal, descriptive study of a cohort of 53 patients with POP who underwent transvaginal mesh surgery between 2001 and 2015. The efficacy of the treatment is evaluated quantifying both clinical changes and life quality, as well as the rate for prolapse recurrence and the short-and long-term treatment-related complications. A total of 53 patients with average follow-up of 87 months were included. All of them had their surgery performed by three properly-trained surgeons. Indication for mesh placement was assessed in 49.1% of cases due to previous surgery recurrence. Treatment improved urinary in...
International journal of clinical urology, 2018
Objective: We assess the anatomical and functional results of pelvic organ prolapse (POP) repair with application of transvaginal synthetic meshes. Keywords: pelvic organ prolapse, vaginal repair, urogynecology. Methods: We analyzed a cohort of 105 women who underwent transvaginal pelvic floor repair using mesh (Elevate Prolapse Repair System). A gynecological examination, cough test, uroflowmetry and an administration of the overactive bladder Awareness Tool were done. Parametric and nonparametric methods of descriptive statistics, as well as logistic regression were used for data analysis. Results: Prolapse recurrence after vaginal repair was noted in 3.81% (n=4) of patients. The proportion of patients with de novo onset of incontinence after surgery was 8.57% (n=9). In 26.7% (n=28) of women with stress urinary incontinence (SUI), SUI symptoms persisted after surgery. The mean Q max in the patient group was 19.5 ml/s. The mean Q max in patients reporting bladder-emptying problems was 14 ml/s, and the mean post-void residual (PVR) was 50±15.0 ml. After surgery, the mean Q max increased to 27.6 ml/s. The PVR after surgery decreased to 30±5.0 ml. The number of patients with bladder outlet obstruction symptoms decreased to 17 (16.19%). Conclusion: The management of genital prolapse with synthetic prostheses interposed through vaginal approach is an efficient method with good midterm outcomes.
Laparoscopic sacrocolpopexy versus transvaginal mesh for recurrent pelvic organ prolapse
International Urogynecology Journal, 2012
Both expert surgeons agree with the following: (1) Surgical mesh, whether placed laparoscopically or transvaginally, is indicated for pelvic floor reconstruction in cases involving recurrent advanced pelvic organ prolapse. (2) Procedural expertise and experience gained from performing a high volume of cases is fundamentally necessary. Knowledge of outcomes and complications from an individual surgeon's audit of cases is also needed when discussing the risks and benefits of procedures and alternatives. Yet controversy still exists on how best to teach new surgical techniques and optimal ways to efficiently track outcomes, including subjective and objective cure of prolapse as well as perioperative complications. A mesh registry will be useful in providing data needed for surgeons. Cost factors are also a consideration since laparoscopic and especially robotic surgical mesh procedures are generally more costly than transvaginal mesh kits when operative time, extra instrumentation and length of stay are included. Long-term outcomes, particularly for transvaginal mesh procedures, are lacking. In conclusion, all surgery poses risks; however, patients should be made aware of the pros and cons of various routes of surgery as well as the potential risks and benefits of using mesh. Surgeons should provide patients with honest information about their own experience implanting mesh and also their experience dealing with mesh-related complications.
Methods of surgery for pelvic organ prolapse in a nationwide cohort (FINPOP 2015)
Acta Obstetricia et Gynecologica Scandinavica, 2018
Introduction: The management of pelvic organ prolapse (POP) varies significantly between countries. The objective of this study was to describe the methods used for POP surgery in Finland and to identify the factors that affect clinicians' choice to use either a native tissue repair (NTR) or mesh repair method. Material and Methods: This prospective cohort study included 3,535 surgeries covering 83% of all POP operations performed in Finland in 2015. The operative details and patient characteristics, including the Pelvic Floor Distress Inventory (PFDI-20), were compared between three selected surgical methods (NTR, transvaginal mesh (TVM), and abdominal mesh (AM)). The predictive factors for the use of mesh augmentation were also studied with logistic regression analysis. Results: The most common method was NTR (N=2855, 81%), followed by TVM (N=429, 12%) and AM (N=251, 7%). Approximately 92% of patients who underwent primary prolapse surgery underwent NTR, and mesh surgery was used mainly for recurrent prolapse. The strongest predictor of mesh surgery was previous POP surgery for the same vaginal compartment (adjusted odds ratio (OR) = 56, 95% confidence interval (CI) = 38-84 for TVM; adjusted OR = 22, 95% CI = 14-34 for AM). Other predictive factors for mesh surgery were previous hysterectomy, healthcare district, severe bulge symptoms and advanced prolapse. TVM was associated with advanced anterior prolapse and older age. AM surgery was associated with advanced apical and/or posterior compartment prolapse. PFDI-20 scores were the highest in the AM group (108 vs 103 in the TVM group and 98 in the NTR group, p=0.012), which indicates more bothersome symptoms than in the other groups. Conclusions: The Finnish practices follow international guidelines that advocate NTR as the principal surgical method for POP. Synthetic mesh augmentation was mainly used in patients with recurrent and advanced Accepted Article This article is protected by copyright. All rights reserved. prolapse with severe symptoms. The variation in the rates of mesh augmentation for POP surgery in different hospitals implies a lack of sufficient evidence of the most suitable treatment method and indicates a need for national guidelines.
Il Giornale di chirurgia
Pelvic organ prolapse suspension (POPS) is a recent surgical procedure for one-stage treatment of multiorgan female pelvic prolapse. This study evaluates the preliminary results of laparoscopic POPS in 54 women with a mean age of 55.2 and a BMI of 28.3. Patients underwent at the same time stapled transanal rectal resection (STARR) to correct the residual rectal prolapse. We had no relapses and the preliminary results were excellent. We evaluated the patients after 1 year follow-up and we confirmed the validity of our treatment. The technique is simpler than traditional treatments with an important reduction or completely disappearance of the pre-operative symptomatology.