Objective of the study: To know the efficacy of transvaginal mesh repair augmented by synthetic polypropylene mesh for pelvic organ prolapse with objective and subjective result of the procedure. Material and methods: Evidence was gathered mostly about transvaginal synthetic polypropylene mesh using the search terms Transvaginal mesh, urinary incontinence, Mesh-complication, anterior prolapse, posterior prolapse, pelvic organ prolapse, vault prolapse, and mesh erosion-From April 2008 to March 2013. Online search range: Pub Med, Medline, RCT, Embase, database, Retrospective study and prospective study. Result: In vaginal Prolapse surgery, graft or mesh is used more frequently than traditional repairs, which has high failure rates. Vaginal approach of mesh placement and suspension of the upper part of the vagina is seen to be more appropriate and successful, showing effects similar to that of the invasive abdominal approach. Because of its lower failure rates it is recently supported by Cochrane review as well. To make such kinds of surgeries easier, more standard and least invasive vaginal kits are being upgraded. It is said that every surgeon can perform the procedure with mesh kits easily, but it is not so. It needs advance pelvic surgery skills, a lot to understand and the limitations of the technique as well. This current paper focuses the needs for the development of the kit, how to use it, results and complications till date and the techniques how to overcome the complications. Before recommending the technique for general use in all Prolapse patients, a lot of things like investigation on proper patient selection, continue research on graft composition, techniques that minimize complications of needle passes or mesh placement should be understood thoroughly. Apart from these we still should have more surgical skills to perform the procedures, to reduce complications and increase better results. Conclusion: Transvaginal repair using a synthetic polypropylene transvaginal mesh is a feasible and efficient procedure for the treatment of pelvic organ prolapse with less significant complications. Monofilament macro porous synthetic polypropylene mesh is effective, due to its low risk of infection and foreign body reaction. Proper patient selection is the best way to avoid unnecessary complications.
Background: Skin closure in the abdominal surgeries is an important factor that affects the prognosis of wound in terms of hospital stay as well as overall outcome of the surgery.Objectives: Cesarean section being the commonly performed operation, choice of suture material has the unexceptional role on it. This study has been performed with an objective to look for the merits and demerits of the skin closure by suture (Silk 2-0) and stapler.Methods: Prospective comparative study conducted among the patients admitted in a Maternity Ward of Gandaki Medical College Teaching Hospital for elective and emergency cesarean section. The comparison has been made in terms of time taken during the skin closure, presence or absence of soakage and wound dehiscence, day of suture removal and pain during the suture removal.Results: The average time taken for skin closure for suture group was found to be 5.46 min (±0.97) and the same for stapler group was found to be 1.22 min (±0.15) respectively. Similarly, the mean day of stitch removal in suture and staples were found to be 6.94 (±1.75) and 7.95 (±1.89) respectively. Surgical site infection (SSI) i.e. soakage was present in eight percent of those in suture group and 20% in stapler group. Wound dehiscence was present in two percent among the suture group and five percent among the stapler group. The severity of pain is more in stapler group than that of suture group during its removal.Conclusions: Our study concluded suture being superior to staplers for skin closure during cesarean section. Though time taken for the closure is less in the stapler group, other factors like wound complications, duration of hospital stay, pain during its removal favored for the suture to be used.J-GMC-N | Volume 11 | Issue 01 | January-June 2018, Page: 1-4
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