Laparoscopic correction of combined forms of genital prolapse

Cover Page


Cite item

Full Text

Open Access Open Access
Restricted Access Access granted
Restricted Access Subscription or Fee Access

Abstract

BACKGROUND: The significance of pelvic organ prolapse is determined by the absence of a downward trend in its frequency and severity and by the steadily high number of recurrences in every third woman who underwent surgery. According to most authors, surgical correction is the primary treatment for genital prolapse. Therefore, the search for an effective and safe surgical treatment of this pathology is important. Currently, various minimally invasive surgical interventions have been performed via laparoscopic access, which reduces the risk of tissue or adjacent organ damage, possible intraoperative bleeding, and potential complications.

AIM: This study aimed to assess the efficiency and safety of laparoscopic techniques for the correction of genital prolapse.

MATERIALS AND METHODS: The study included 12 patients with pelvic organ prolapse quantification system grades II–IV who underwent surgical correction using a combined laparoscopic approach. The inclusion criterion was the presence of prolapse, including recurrent forms. At the outpatient stage, the patients’ medical history was collected, and complaints, and degree of pelvic organ prolapse were assessed. Genital prolapse was diagnosed based on medical history, clinical data, and additional methods of examination.

RESULTS: With this surgical intervention technique, intraoperative bleeding was avoided, the number of possible postoperative complications was reduced, and disease recurrence was prevented. The criteria for assessing the surgical intervention included improvement of the pelvic floor anatomy, elimination of symptoms, patient’s satisfaction with treatment results and quality of life, and reduced risk of recurrence of complications. Mesh-associated complications were excluded by avoiding contact of the synthetic implanted material with the vaginal mucosa.

CONCLUSIONS: Through laparoscopic access, the length of hospital stay was reduced, and compared with abdominal access, a better cosmetic effect was achieved. A comprehensive system considering the assessment of the anatomical outcome, functional status of the pelvic floor, and patient’s quality of life may become the most objective tool to evaluate the success of surgical treatment of genital prolapse.

Full Text

Restricted Access

About the authors

Dmitrii V. Bryunin

I.M. Sechenov First Moscow State Medical University

Email: bryun777@mail.ru
ORCID iD: 0000-0002-5969-4217

MD, Dr. Sci. (Med.), Professor

Russian Federation, 8, building 2, Trubetskaya str. Moscow, 119991

Yurii V. Chushkov

I.M. Sechenov First Moscow State Medical University

Email: obstetrics-gynecology@list.ru
ORCID iD: 0000-0001-8125-1829

MD, Cand. Sci. (Med.), assistant professor

Russian Federation, 8, building 2, Trubetskaya str. Moscow, 119991

Alina N. Pyatkina

I.M. Sechenov First Moscow State Medical University

Author for correspondence.
Email: patkinaalina@gmail.com
ORCID iD: 0000-0002-4260-9661

post-graduate student

Russian Federation, 8, building 2, Trubetskaya str. Moscow, 119991

References

  1. Abhyankar P, Uny I, Semple K, et al. Women’s experiences of receiving care for pelvic organ prolapse: a qualitative study. BMC Women’s Health. 2019;19(1):45. doi: 10.1186/s12905-019-0741-2
  2. Kulakov VI, Adamyan LV, Mynbaev OA, Sashin BE, Blinova MA. Khirurgicheskoye lecheniye opushcheniya i vypadeniya vlagalishcha i matki. In: Kulakov VI, Adamyan LV, Mynbaev OA, editors. Operativnaya ginekologiya — khirurgicheskiye energii. Moscow: Antidor; 2000. P:741–760. (In Russ).
  3. Lukyanova DM, Smolnova TYu, Adamyan LV. Modern molecular genetic and biochemical predictors of genital prolapse (a review). Russian Journal of Human Reproduction. 2016;22(4):812. (In Russ). doi: 10.17116/repro20162248-12
  4. Gaivoronsky IV, Niauri DA, Bessonov NYu, et al. Morphological features of the small pelvis structure, as prerequisites for developing genital prolapse. Kursk Scientific and Practical Bulletin “Man and His Health”. 2018;(2):86–93. (In Russ). doi: 10.21626/vestnik/2018-2/14
  5. Krasnopol’skiy VI, Buyanova SN, Shchukina NA, Popov AA. Operative gynecology. Moscow: MEDpress-inform; 2017. (In Russ).
  6. De Tayrac R, Sentilhes L. Complications of pelvic organ prolapse surgery and methods of prevention. Int Urogynecol J. 2013;24(11):1859–1872. doi: 10.1007/s00192-013-2177-9
  7. Parshikov VV, Mironov AA, Anikina EA, et al. Prosthetic repair of the abdominal wall using light and ultra-light synthetic and titan-containing materials in high bacterial contamination (experimental study). Modern Technologies in Medicine. 2015;(4):64–71. doi: 10.17691/stm2015.7.4.08
  8. Sung VW, Rardin CR, Raker CA, et al. Porcine subintestinal submucosal graft augmentation for rectocele repair: a randomized controlled trial. Obstet Gynecol. 2012;119(1):125–133.doi: 10.1097/AOG.0b013e31823d407e
  9. Radzinskiy VE, ed. Perineology. Moscow: Peoples’ Friendship University of Russia; 2010. 372 p. (In Russ).
  10. Krasnopol’skaia IV, Popov AA, Tiurina SS, et al. Analysis of transvaginal sacrospinous fixation versus laparoscopic sacrocolpopexy used in the treatment of patients with genital prolapse. Russian Bulletin of Obstetrician-Gynecologist. 2014;14(5):6670. (In Russ).
  11. Veit-Rubin N, Dubuisson JB, Gayet-Ageron A, et al. Patient satisfaction after laparoscopic lateral suspension with mesh for pelvic organ prolapse: outcome report of a continuous series of 417 patients. Int Urogynecol J. 2017;28(11):1685–1693.doi: 10.1007/s00192-017-3327-2
  12. Maher C, Feiner B, Baessler K, Schmid C. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev. 2013;(4):CD004014. doi: 10.1002/14651858.CD004014.pub5
  13. Granese R, Candiani M, Perino A, et al. Laparoscopic sacrocolpopexy in the treatment of vaginal vault prolapse: 8 years experience. Eur J Obstet Gynecol Reprod Biol. 2009;146(2):227–231.doi: 10.1016/j.ejogrb.2009.06.013
  14. Popov AA, Manannikova TN, Ramazanov MR, et al. Laparoskopicheskaya sakrokol’popeksiya i operatsiya Prolift v khirurgii genital’nogo prolapsa Journal of Obstetrics and Women’s Diseases. 2009;LVIII(5):M39–M40. (In Russ).
  15. Vasin RV, Filimonov VB, Vasina IV. Genital prolapse: contemporary aspects of surgical treatment (literature review). Experimental and Clinical Urology. 2017;(1):104–115. (In Russ).
  16. Krot IF, Zakharenkova TN. Ethiopathogenetic aspects of pelvic organ prolapse. Optimization of surgical treatment. Problems of Health and Ecology. 2013;(1):16–22. (In Russ).
  17. Dietz HP. Pelvic floor ultrasound in prolapse: what’s in it for the surgeon? Int Urogynecol J. 2011;22(10):1221–1232.doi: 10.1007/s00192-011-1459-3
  18. Gyhagen M, Bullarbo M, Nielsen TF, Milsom I. Prevalence and risk factors for pelvic organ prolapse 20 years after childbirth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. Br J Obstet Gynaecol. 2013;120(2):152–160.doi: 10.1111/1471-0528.12020
  19. Korshunov MYu. Prolaps tazovykh organov u zhenshchin: personalizirovannyi podkhod k diagnostike, khirurgicheskoi korrektsii i otsenke rezul’tatov lecheniya [dissertation]. Saint Petersburg; 2017. Available from: https://www.dissercat.com/content/prolaps-tazovykh-organov-u-zhenshchin-personalizirovannyi-podkhod-k-diagnostike-khirurgiches?ysclid=leenoh6t9j835517255 (In Russ).
  20. Korshunov MYu, Sazykina EI. PD-QL questionnaire ― validated instrument for symptoms and quality of life assessment in patients with pelvic organ prolapsed. Journal of Obstetrics and Women’s Diseases. 2008;57(3):86–93. (In Russ).

Supplementary files

Supplementary Files
Action
1. JATS XML
2. Fig. 1. The first longitudinal-shaped implant with protrusions is placed longitudinally with a wide base into the rectovaginal space.

Download (105KB)
3. Fig. 2. The first implant is fixed with separate sutures with a non-absorbable thread to the bundles of muscles that raise the anus on both sides.

Download (95KB)
4. Fig. 3. The second transverse implant is fixed with the ends to the comb ligaments by separate sutures with a non-absorbable thread.

Download (87KB)
5. Fig. 4. The transverse implant is fixed with the central part also to the stump of the vagina or cervix, and the ends to the comb ligaments with separate sutures with a non-absorbable thread.

Download (151KB)
6. Fig. 5. The design of connected implants, with fixation in the central area, forms a reliable structure, and each of them performs its function of supporting the pelvic organs, both along (1st implant), in the area of the longitudinal axis of the sagittal plane, and across (2nd implant), in the area of the transverse axis.

Download (252KB)

Copyright (c) 2023 Eco-Vector



СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ:
ПИ № ФС 77 - 86335 от 11.12.2023 г.  
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ:
ЭЛ № ФС 77 - 80633 от 15.03.2021 г.



This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies