Abdominal Sacrocolpopexy: A Comprehensive Review

Nygaard, Ingrid; McCreery, Rebecca; Brubaker, Linda; Connolly, AnnaMarie; Cundiff, Geoffrey W.; Weber, Anne M.; Zyczynski, Halina M.

doi:10.1097/01.aog.0000139514.90897.07

Cited by 828 publications

(495 citation statements)

References 63 publications

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“…Por el momento, las distintas publicaciones relacionadas con la CSPA y la CSPL, no presentan una técnica estandarizada, existiendo series en que sólo reparan el nivel I (5,8), hasta series en las que reparan todos los niveles, así como tampoco se usan mallas ni suturas del mismo tipo (5,12). Además en la evaluación de los resultados tanto objetivos como subjetivos se utilizan distintos parámetros.…”

Section: Discussionunclassified

Colposacropexia abdominal abierta con malla mixta en el prolapso de cúpula vaginal: experiencia en el Hospital de Quilpué, Chile

D¹,

A²,

A³

et al. 2015

Rev. chil. obstet. ginecol.

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Trabajos OriginalesColposacropexia abdominal abierta con malla mixta en el prolapso de cúpula vaginal: experiencia en el Hospital de Quilpué, Chile Francisco Kaplan D. 1 , Hernán Quinchavil A. 1 , Pablo Riera A. 2 , Robinson Flores C. 1 , Oscar Becerra A. 1 , Tiare Hevia G. a , Daniela Bustos R. b , Javiera Opazo B. b 1 Servicio de Obstetricia y Ginecología, 2 Servicio de Urología, Hospital de Quilpué, Chile.a Matrona, Policlínico de Ginecología, Hospital de Quilpué. b Alumnas, Escuela de Medicina, Universidad Andrés Bello. RESUMENIntroducción: La colposacropexia por vía abdominal abierta (CSPA) es el gold standard para el tratamiento del prolapso de la cúpula vaginal (PCV). Objetivo: Mostrar nuestra experiencia, en un Hospital de mediana complejidad, en los primeros siete casos sometidos a un CSPA, reportando las complicaciones intra y post operatorias. Método: Se realizó un estudio prospectivo descriptivo en nuestras siete primeras pacientes portadoras de un prolapso de cúpula vaginal estadio III o IV (POP-Q) sintomáticas, sin incontinencia urinaria y sometidas a una CSPA, con una malla mixta en el Servicio de Obstetricia y Ginecología del Hospital de Quilpué. Resultados: Se reclutaron 7 pacientes. Ninguna de ellas presentaba complicaciones con riesgo vital peri-operatorio, en un período de seguimiento de 33 meses. En el 100% de las pacientes se logró cura objetiva definida como un POP-Q estadio 0 o I, y buena calidad de vida según el Cuestionario de Impacto del Piso Pélvico (PFIQ-7, versión validada en español). Durante el seguimiento, sólo una paciente presentó exposición asintomática de 5 mm de la malla, resuelta con su resección por vía vaginal. Ninguna paciente requirió de una cirugía por prolapso de órganos pélvicos después de la CSPA. Conclusión: Los resultados obtenidos concuerdan con la literatura. La CSPA sigue siendo el gold standard para el tratamiento del PCV, no siendo superada por el momento, por ninguna otra técnica, incluso la colposacropexia laparoscópica. Estimamos que el uso de mallas parcialmente reabsorbibles pueden disminuir la exposición de mallas, sin embargo se requieren de más estudios.PALABRAS CLAVE: Colposacropexia, prolapso de cúpula vaginal, cirugía de prolapso genital SUMMARY Introduction:The abdominal sacral-colpopexy is currently considered the gold standard for the management of (CSPA) vaginal vault prolapse (PCV). Objective: To report our surgical experience at a county hospital with our first seven abdominal sacral-colpopexy cases. Reporting intra and post-operative complications. Methods: We conducted a prospective descriptive study involving our first seven cases of patients with symptomatic vaginal vault prolapse stage III or IV (POP-Q) without urinary incontinence. All patients were undergoing CSPA with a partially absorbable mesh in the Obstetrics and Gynecology Department at the Quilpué Hospital. Results: Seven patients were recruited. None of them presented a life threatening complication during a mean follow up period of 33 months. A hundred percent of patient...

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Section: Discussionunclassified

Colposacropexia abdominal abierta con malla mixta en el prolapso de cúpula vaginal: experiencia en el Hospital de Quilpué, Chile

D¹,

A²,

A³

et al. 2015

Rev. chil. obstet. ginecol.

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“…[1][2][3][4] Gynemesh PS (Ethicon, Sommersville, NJ), one of the most widely implanted polypropylene meshes, has been shown to induce a robust foreign-body response and degenerative changes in the vagina when implanted via sacrocolpopexy including a decrease in smooth muscle contractility and volume, a loss of mechanical integrity, a decrease in matrix structural proteins (collagen and elastin) accompanied by an increase in glycosaminoglycan (GAG) content, and an increase in the amount and activity of matrixdegrading proteases. [5][6][7][8] In theory, these negative effects could be overcome with the use of regenerative biomaterials either in combination with Gynemesh PS as a composite graft or alone with the elimination of permanent materials.…”

Section: Introductionmentioning

confidence: 99%

Extracellular Matrix Regenerative Graft Attenuates the Negative Impact of Polypropylene Prolapse Mesh on Vagina in Rhesus Macaque

Liang

Knight

Barone

et al. 2017

Obstet Gynecol Surv

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BACKGROUND-The use of wide pore lightweight polypropylene mesh to improve anatomical outcomes in the surgical repair of prolapse has been hampered by mesh complications. One of the prototype prolapse meshes has been found to negatively impact the vagina by inducing a decrease in smooth muscle volume and contractility and the degradation of key structural proteins (collagen and elastin), resulting in vaginal degeneration. Recently, bioscaffolds derived from extracellular matrix have been used to mediate tissue regeneration and have been widely adopted in tissue engineering applications.

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“…Laparoscopic sacrocolpopexy has been adopted by many pelvic surgeons as a way to minimize surgical morbidity and quicken patient recovery [3] [4] [5]. Abdominal sacrocolpopexy (ASC) has been shown to have one of the highest long-term anatomic success rates (78% -100%) among procedures for pelvic organ prolapse repair [6] with minimal complications [7]. During ASC identification of the pre-sacral ligament can be difficult, particularly in obese patients.…”

Section: Introductionmentioning

confidence: 99%

“…During ASC identification of the pre-sacral ligament can be difficult, particularly in obese patients. This area is surrounded by critical structures, such as the right ureter, where injuries happen during ASC in 1.0% of the procedures (0.8% -1.9%) [8]. The middle sacral vessels, the left iliac vein and the caval bifurcation are also nearby the area where the mesh needs to be placed.…”

Section: Introductionmentioning

confidence: 99%

“…The middle sacral vessels, the left iliac vein and the caval bifurcation are also nearby the area where the mesh needs to be placed. Bleeding management can be particularly difficult in this area and accidental lesions of these vessels can result in blood loss, which is described in 4.4% of the procedures (0.18% -16.9%) [8]. Awareness of these challenges may discourage the use of ASC, therefore, limiting the access of women with advanced apical prolapse to the most effective surgical strategy available.…”

Section: Introductionmentioning

confidence: 99%

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Robotic Assisted Laparoscopic Apical Suspension. Description of a 4 Points Technique (RALAS-4): First Case Reported

Davila¹,

Bruce²,

Goodman³

et al. 2017

OJOG

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The uterosacral ligaments (UTSL), together with the cardinal ligament (CL), hold the upper vagina and cervix over the levator plate. These 2 ligaments provided 4 points support at the apex. Here we describe our surgical technique of robotic assisted laparoscopic apical suspension (RALAS) using nonabsorbable sutures and describe a new 4 points technique (RALAS-4). 73-year-old Caucasian woman, gravida 5, para 4 had symptomatic pelvic organ prolapse (POP) apical/anterior stage III. At pelvic ultrasound evaluation the uterus was small and normal appearing of adnexa bilaterally. She failed pessaries and was sexually active. The most relevant complaints were vaginal bulging, pressure and urinary incontinence, mainly stress urinary incontinence; she is using 5 -7 pads/day. Robotic assisted laparoscopic hysterectomy, mid-urthral sling and apical suspension was successfully performed in 125 min. Once we finished with hysterectomy, we proceed with RALAS-4, we used V-Loc 3-0, CV-23 (Covidien) sutures (absorbable) on the right and left uterosacral ligaments (2 points) and theses were reinforced with Gore-Tex 2-0, CV-2 (non-absorbable, Gore Medical). On the right/left anterior apical support we used Gore-Tex 2-0 and these provided the 2 point suspension (UTLS = 2 and anterior vagina = 2). The 2 anterior apical support sutures are taken from the vagina to the transversalis fascia and the obliterated umbilical artery on the anterior abdominal wall. The tension of these anterior sutures was maintained with Hem-o-lock (TeleFlex) and LAPRA-TY (Ethicon). In our opinion RALAS-4 may represents an alternative to robotic or laparoscopic sacrocolpopexy. This new approach simulate the natural 4 points support given by uterosacral ligaments and cardinal ligament, with the additional benefit of

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Abdominal Sacrocolpopexy: A Comprehensive Review

Cited by 828 publications

References 63 publications

Colposacropexia abdominal abierta con malla mixta en el prolapso de cúpula vaginal: experiencia en el Hospital de Quilpué, Chile

Colposacropexia abdominal abierta con malla mixta en el prolapso de cúpula vaginal: experiencia en el Hospital de Quilpué, Chile

Extracellular Matrix Regenerative Graft Attenuates the Negative Impact of Polypropylene Prolapse Mesh on Vagina in Rhesus Macaque

Robotic Assisted Laparoscopic Apical Suspension. Description of a 4 Points Technique (RALAS-4): First Case Reported

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