Does the method of dissecting in anterior colporraphy lead to a difference in thickness of removed vaginal tissue?

Lensen, E.J.M.; Erp, S.H.M. van den Berg-van; Stoutjesdijk, Jackie A.; Hasaart, T. H. M.; Withagen, Mariëlla I. J.; Kluivers, K.B.; Dietz, Viviane; Vierhout, Mark E.

doi:10.1016/j.ejogrb.2012.12.028

Cited by 8 publications

(4 citation statements)

References 10 publications

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“…This finding may suggest that hydrodissection does not change the actual thickness of the removed vaginal tissue. 31 In contrast, Lensen et al 20 studied the effect of four surgical techniques, two of which included hydrodissection, on the thickness of microscopic layers of the vaginal wall. Although they found that hydrodissection was 'the only independent factor of influence on the total thickness of the removed tissue', the study had several significant limitations.…”

Section: Discussionmentioning

confidence: 99%

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The role of hydrodissection in native tissue repair of anterior vaginal wall defects

Schwarzman

Samueli

Shaco-Levy

et al. 2021

Aust NZ J Obst Gynaeco

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A variety of surgical techniques are available for vaginal prolapse repair, indicating a lack of consensus. A debate regarding the utility of hydrodissection for splitting the surgical plane of the vaginal wall exists. The aim of this study is to evaluate the impact of hydrodissection in anterior colporrhaphy (AC). Materials:Patients undergoing primary AC were randomly assigned to an approach with (study group) versus without (control group) hydrodissection. Five surgeons performed both techniques, and the trimmed vaginal tissue was retrieved for histological analysis. Two pathologists, blinded to the surgical approach, evaluated the presence of a loose connective tissue at the surgical dissection plane (controversially deemed 'fascia', as explained in this article). In addition, we compared the operative time, pain score and haemoglobin levels. After statistical analysis, data were presented using percentile, and statistical significance was tested using the χ 2 and Fisher's exact tests.Results: Forty-six patients underwent primary elective AC, with 23 patients in each, the study and control groups. The groups were comparable regarding age (study group 60.33 ± 11.95 years and control group 59.86 ± 12.04, P = 0.90), menopausal status (study group 17 (73.9%) and control group 15 (68.2%), P = 0.67) and other characteristics. We found no difference in sample characteristics between the two groups. Connective tissue was found in only 13.6% (n = 3) of patients after hydrodissection and in 27.3% (n = 6) of patients without hydrodissection (P = 0.46). The hydrodissection group had significantly less bleeding than the control group (ΔHB 0.66 ± 0.66 vs 1.21 ± 0.84, P = 0.05). Conclusions:After hydrodissection, less bleeding was noted without compromise the surgical planes.

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Section: Discussionmentioning

confidence: 99%

“…According to the current literature, no major differences in outcome nor complication rates were noted between the various techniques; however, it should be noted that these were small series. 20,21 We aimed to evaluate the influence of hydrodissection on the quality of surgical planes during AC.…”

Section: Introductionmentioning

confidence: 99%

The role of hydrodissection in native tissue repair of anterior vaginal wall defects

Schwarzman

Samueli

Shaco-Levy

et al. 2021

Aust NZ J Obst Gynaeco

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“…Eski cerrahların "Diseksiyonu ne kadar ince yaparsan o kadar iyi olur." önerisi son yapılan çalışmalarda destek görmemiştir (19). Ek olarak en iyi diseksiyon şeklinin nasıl olduğuna dair bilimsel veri de yoktur.…”

Section: Bulgularunclassified

“…Birçok teknik varyasyonunda olduğu gibi hidrodiseksiyon konusundaki pratikler bilimsel destekten yoksundur. Bir çalışmada hidrodiseksiyon ile çıkartılan vajina mukozasının daha kalın olduğu gösterilmiştir (19). Fasya plikasyonun nasıl yapılacağına dair fikir birliği yoktur.…”

Section: Bulgularunclassified

Anterior Colporrhaphy Technique and Approach Choices: Turkey Evaluation

Aydın¹,

Bakar²,

Batmaz³

et al. 2016

Haseki

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ÖzAmaç: Türkiye'de anterior vajinal duvar cerrahisi ile ilgilenen cerrahlar arasındaki anterior kolporafi tekniklerindeki ve yaklaşımlarındaki farklılıkları değerlendirmektir. Yöntemler: Preoperatif muayeneyi, anterior kolporafi tekniğini, operasyon tercihlerini ve postoperatif bakımı değerlendiren anket cerrahlara sunuldu. Direkt olarak, elektronik posta, telefon veya anlık mesajlaşma ile iletişime geçildi. Yirmi sekiz soruluk anketi kullandık. Data analizi yapıldı ve frekanslar hesaplandı. Bulgular: Anketi tamamlayan 116 kişi vardı. Büyük bir kısmını (%87,9) genç jinekologlar oluşturuyordu. Ürologlar çalışma popülasyonunun %9,5'ini oluşturuyordu. Paravajinal defekti değerlendirme oranı %75,9'du ve çoğunlukla rugaların izlenmesi ile değerlendiriliyordu. Transperineal 3D pelvik taban ultrasonografi kullanımı düşüktü (%5,7). Levator ani kas hasarını değerlendirme oranı %46,6 idi. Levator ani kas defekti için transperineal ultrasonografi kullananlar cerrahlar %19'du. Hidrodiseksiyon kullanımı, fasya plikasyonu, fazlalık vajina mukozasının çıkartılması ve sütur tercihleri konusunda farklılıklar mevcuttu. Anterior kolporafi için meş kullanımı nadir (%17,8) olup, çoğunlukla (%12,2) nüks olgularında kullanılıyordu. Paravajinal defekt onarımı yapanlar anketi cevaplayanlar içinde %31,9'du. Üriner kateter genellikle birinci veya ikinci gün çıkartılıyordu. Vajinal tampon genellikle operasyondan 24 saat sonra çıkartılıyordu. Sonuç:Türkiye'deki operatörler arasında anterior vajinal duvar onarımı teknikleri ve yaklaşımları çeşitlilik göstermektedir. Teknikler arasındaki bu farklılıklar en iyi cerrahi teknik konusunda fikir birliği olmadığını düşündürmektedir. Teşhis için kullanılan teknolojinin gelişimi ile birlikte operasyon seçenekleri de değişebilir. Anahtar Sözcükler: Kolporafi anterior, anterior vajinal duvar prolapsusu, sistosel, meş, paravajinal defekt onarımı Aim: To evaluate the diversity in techniques and approaches for anterior colporrhaphy among operators in Turkey. Methods:A survey evaluating the preoperative examination, technique of anterior colporrhaphy, operation choice and postoperative care was presented to surgeons. We contacted via directly, mail or telephone. We used 28 item questionnaire.Results: Majority (87.9%) was composed of young gynecologists. Urologists composed of the 9.5% of the study population. The rate of paravaginal defect evaluation was 75.9% and mostly by inspection the presence of vaginal rugae. The use of transperineal 3D pelvic floor ultrasonography was low (5.7%). The evaluation of levator ani muscle defect was 46.6%. The usage of the transperineal 3D ultrasonography for levator ani muscle defect was 19 percent of operators. There were diversity in use of hydrodissection, fascial plication, excision of vaginal mucosa and suture choice. Usage of mesh for anterior colporrhaphy was limited (17.8%) and mostly in recurrent cases (12.2%). Paravaginal defect repair rate was 31.9%. The urinary catheter was generally removed one or two day after operation. Vaginal pack usually removed 24 hour...

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Pelvic Organ Prolapse

Costantini

Natale²,

Carbone

et al. 2016

Practical Functional Urology

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Pelvic organ prolapse (POP) is one of the most common problems faced by every gynecologist. Understandably, terminology is very important when describing vaginal or uterine descent, for two reasons. First, the physician's notes must represent the clinical problem and be able to communicate it to another colleague exactly as it has been seen. The second reason is quality assurance in research, where exact terminology is needed to accurately describe changes in pelvic organ prolapse and to allow comparisons between institutions and studies.Urogenital prolapse has traditionally been classifi ed according to the degree of anatomical descent, the site of the defect and the presumably involved pelvic viscera. The large number of different grading systems that have been used refl ects the diffi culty in designing an objective, reproducible system for grading prolapse. Intraand interobserver variability is often of importance and may lead to confusion. This makes diffi cult comparing successive examinations over time in the same woman or between different women. The Baden-Walker halfway system is one of the most used for POP classifi cation. It consists of a simple 0-4 grading scale which classifi es prolapse according to the defect site (urethra, bladder, cervix, or cuff, pouch of Douglas, rectum, and perineum) and descent above or below the vaginal introitus. For its simplicity, the Baden-Walker system has maintained considerable popularity among gynecologists in their daily clinical practice.In 1996 Bump et al. published a new classifi cation: the POP-Q system that has been widely accepted and has become the de facto standard in clinical medicine and research.It has been adopted by major organizations including the International Continence Society (ICS), the Society of Gynecologic Surgeons, the American Urogynecologic Society, and the National Institute of Health (NIH) as an accepted method of describing pelvic support and comparing exams over time or before and after interventions. The POP-Q has been shown to have reproducibility in several centers when the exam is conducted in a standardized fashion. The clinical description of pelvic fl oor anatomy is determined during the physical examination of the external genitalia and vaginal canal. It is critical that the examiner sees and describes the maximum protrusion noted by the individual during her daily activities and during physical examination in gynecological position (better on 45° angle) at maximum effort or Valsalva maneuver. The system relies on specifi c measurements of six defi ned points in the midline of the vaginal wall: Aa, Ba, C, D, Ap, Bp, and three other landmarks: GH (genital hiatus), TVL (total vaginal length), and PB (perineal body). Each of the six points is measured in centimeters above or proximal to the hymen (negative number) or in centimeters below or distal to the hymen (positive number) with the plane of the hymen being defi ned as zero (0). The hymen was selected as the reference point rather the introitus because it is more precisely iden...

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Does the method of dissecting in anterior colporraphy lead to a difference in thickness of removed vaginal tissue?

Cited by 8 publications

References 10 publications

The role of hydrodissection in native tissue repair of anterior vaginal wall defects

The role of hydrodissection in native tissue repair of anterior vaginal wall defects

Anterior Colporrhaphy Technique and Approach Choices: Turkey Evaluation

Pelvic Organ Prolapse

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