Pectopexy ?? The treatment of vaginal apical prolapse

Background: Uterovaginal prolapse is a common problem seen in Indian women affecting women in both young as well as old age. It may also occur in post hysterectomy cases. Laparoscopic pectopexy is a proposed new technique of apical prolapse repair. There are no Indian studies being done on this latest technique till date. Objective: To present a case series of laparoscopic pectopexy, a new technique of apical prolapse repair in Indian patients a new techniqueincentre and to assess its efficacy. Materials and Methods: Twelve patients of apical prolapse either uterovaginal or vault prolapse were included in study. Laparoscopic cervico-or colpopectopexy was done using iliopectineal ligaments on both sides of pelvic side walls. The perioperative and short term results were observed and recorded. Results: Laparoscopic pectopexy was done in our twelve cases which included 8 uterovaginal and 4 vault prolapse. The mean effective blood loss was less than 10 ml and average operative time was around 96 minutes. There were no intraoperative complications in any of our patients. In no case conversion to laparotomy was neededN. In follow up there were no major gastrointestinal, urinary complications with no de novo cystoceles or recurrence or stress urinary incontinence with excellent patient satisfaction. Conclusion: Laparoscopic pectopexy is a new technique in a surgeon's armamentarium that can be used more safely, effectively and easily as compared to sacrocolpopexy in management of apical prolapse. Introduction Pelvic organ prolapse is a common health problem affecting about 30% of women between 20-59 years of age and more than half of this are over 50 years of age which may lead to unnecessary increase in hysterectomies [1, 2, 3] Pelvic organ prolapse may seriously influence the physical, psychological and social well-being of affected women. This condition may present with symptoms of pelvic heaviness, protrusion of vagina or dyspareunia. Women may also have associated altered bowel and bladder symptoms like constipation, urinary incontinence or retention. Incidence in Indian women is underreported because of hesitancy in discussing problems like urinary incontinence and prolapse uterus by our women. Surgery is the definitive treatment for symptomatic apical prolapse. The goals for surgical management of apical prolapse are to relieve all symptoms and restore normal functional anatomy with no recurrence. Sacrocolpopexy either done abdominally or laparoscopically is being considered the gold standard technique for repair of apical prolapse for both uterovaginal and vault prolapse till now [4, 5]. Laparoscopic route is definitely better as it provides advantage of minimal invasion, less blood loss and rapid postoperative recovery. In sacrocolpopexy a mesh is placed between the sacrum and vagina or cervix which narrows the pelvis due to post op adhesions. Many studies have clearly mentioned that sacropexy is associated with defecation disorders, constipation, small bowel obstruction [5, 6]. Pelvic organ prolapse is more common in obese patients in which this technique may be less feasible due to restricted accessibility in posterior compartment [7]. Moreover technically this technique require high surgical expertise as it require dissection close to vital structures leading to injury of right ureter and sometimes life threatening bleeding from presacral vessels [8, 9]. In 2007, Guntner Noe introduced a new technique of pectopexy which uses iliopectineal ligaments which are being used over a long time for Burch operation and the iliopectineal ligament is considered stronger than anterior longitudinal ligament [10, 11] .

International braz j urol : official journal of the Brazilian Society of Urology, 2017

To share our first experience with laparoscopic pectopexy, a new technique for apical prolapse surgery, and to evaluate the feasibility of this technique. Seven patients with apical prolapse underwent surgery with laparoscopic pectopexy. The lateral parts of the iliopectineal ligament were used for a bilateral mesh fixation of the descended structures. The medical records of the patients were reviewed, and the short-term clinical outcomes were analyzed. The laparoscopic pectopexy procedures were successfully performed, without intraoperative and postoperative complications. De novo apical prolapse, de novo urgency, de novo constipation, stress urinary incontinence, anterior and lateral defect cystoceles, and rectoceles did not occur in any of the patients during a 6-month follow-up period. Although laparoscopic sacrocolpopexy has shown excellent anatomical and functional long-term results, laparoscopic pectopexy offers a feasible, safe, and comfortable alternative for apical prolaps...

International Urogynecology Journal, 2021

Introduction and hypothesis In addition to laparoscopic sacrocolpopexy (LS), laparoscopic pectopexy (LP) is a novel surgical method for correcting apical prolapse. The descended cervix or vaginal vault is suspended with a synthetic mesh by fixing the bilateral mesh ends to the pectineal ligaments. This study was aimed at developing a learning curve for LP and to compare it with results with LS. Methods We started laparoscopic/robotic pectopexy in our department in August 2019. This retrospective study included the initial 18 consecutive women with apical prolapse receiving LP and another group undergoing LS (21 cases) performed by the same surgeon. The medical and video records were reviewed. Results The age was older in the LP group than in the LS group (65.2 vs 53.1 years). The operation time of LP group was significantly shorter than that of the LS group (182.9 ± 27.2 vs 256.2 ± 45.5 min, p < 0.001). The turning point of the LP learning curve was observed at the 12th case. No ...

Prague medical report, 2021

It has been stated that the effectiveness of pectopexy method for the treatment of pelvic organ prolapse (POP) is similar to sacrocolpopexy. We aimed to search the effects of pectopexy method to the quality of life, sexual function and urinary incontinence. Thirty-one patients who were operated for POP with the technique of laparoscopic pectouteropexy/pectocolpopexy between January 2016 and November 2017 were included the study. Exclusion criteria were pelvic inflammatory disease, suspect of malignancy, pregnancy, prior POP or continence surgery. Quality of life inventories were (P-QOL, PISQ-12, UDI-6, IIQ-7) recorded preoperatively and at the postoperative third month. Results were compared statistically. The percentage of patients with menopause was 67.7% (n=21) and with reproductive term was 32.3% (n=10). Mean prolapse related quality of life inventory (P-QOL) score was 83.45 ± 8.7 (64-98) preoperatively and 8.61 ± 6.4 (0-23) postoperatively (p<0.05). The preoperative and post...

2018

The vaginal prolapse after hysterectomy (removal of the uterus) is often associated with the prolapse of the vaginal vault, rectum, bladder, urethra or small bowel. Minimally invasive surgery such as laparoscopic sacrocolpopexy and pectopexy are widely performed for the treatment of the vaginal prolapse with weakly supported vaginal vault after hysterectomy using prosthetic mesh implants to support (or strengthen) lax apical ligaments. Implants of different shape, size and polymers are selected depending on the patient’s anatomy and the surgeon’s preference. In this computational study on pectopexy, DynaMesh®-PRP soft, GYNECARE GYNEMESH® PS Nonabsorbable PROLENE® soft and Ultrapro® are tested in a 3D finite element model of the female pelvic floor. The mesh model is implanted into the extraperitoneal space and sutured to the vaginal stump with a bilateral fixation to the iliopectineal ligament at both sides. Numerical simulations are conducted at rest, after surgery and during Valsa...

Chirurgia

Neurourology and Urodynamics, 2019

Aims: Apical defect is a pelvic organ prolapse disorder, with 5%-15% prevalence. The aim of the study was to investigate methods of laparoscopic repair of apical defect and compare them with other techniques (open, vaginal, and robotic). Methods: A systematic search of the literature was conducted in MEDLINE/ PubMed and ClinicalTrials.gov databases using the following key words: apical prolapse and treatment procedures. The search was limited by using the humans filters. Only articles published in English between 2010 and 2018 were considered. Two independent authors reviewed the publications for inclusion on the basis of the following criteria: (a) use of laparoscopic techniques, and (b) apical support loss as indication for surgery. Results: A total of 1002 papers were initially identified; 24 studies fulfilled the inclusion criteria. Four main laparoscopic procedures were found. The reported anatomical success rate (POP-Q < II stage) was 77%-100%, with patient satisfaction for pectopexy, laparoscopic sacropexy (LS), lateral ligament suspension and laparoscopic uterosacral ligament suspension (LUSLS) of 96.4%-97.6%, 71.0%-100%, 66.7%-87.8%, and 95%-95.5%, respectively. Major complications included hemorrhage, bladder, ureter, and/or bowel injuries were rare. Prolapse recurrences after LUSLS and LS were reported in 13.2% and 10.4% of patients, respectively; with reoperation rate for LS 2.2%-12.8%. Conclusions: Most studies reported anatomical and subjective outcomes, with follow-up ranging from 1 month to >7 years. Success rates for laparoscopic and abdominal corrections of apical defect were similar; laparoscopy was superior in terms of perioperative blood loss, length of hospital stay, and recovery. K E Y W O R D S apical prolapse, laparoscopic lateral suspension, laparoscopic uterosacral ligament suspension, minimally invasive surgery, pectopexy, pelvic organ prolapse, sacropexy 1 | INTRODUCTION Pelvic organ prolapse (POP) is a worldwide health problem, the prevalence of which ranges from 10% in younger women to 50% in postmenopausal women. 1-6 Apical defect, the least frequent of all POP types, has been reported in 5%-15% of women. 7 DeLancey established three levels of support for proper position of the pelvic organs:

2003

Introduction The basic elements in the biblical account of origins are summarized in the opening verse of the Bible, Gen 1:1: I. ÒIn the beginningÓÑthe ÒwhenÓ of origins; II. ÒGodÓÑthe ÒWhoÓ of origins; III. ÒcreatedÓÑthe ÒhowÓ of origins; IV. Òthe heavens and the earthÓÑthe ÒwhatÓ of origins. In this paper we will take up each of these elements in turn, with special emphasis upon the ÒwhenÓ1 and aspects of the other elements that impinge upon the relationship between Scripture and science.

A Inquisição descobre a Bahia Holandeses no Brasil Rio de Janeiro Paulistas e bandeirantes na guerra contra as missões e a Inquisição de Lima Minas Gerais: o ouro e diamantes Criptojudeus na Paraíba e no Maranhão e os hereges do Grão-Pará A perseguição dos portugueses na América espanhola PARTE IV A "INTELLIGENTSIA" BRASILEIRA