High uterosacral vaginal vault suspension with fascial reconstruction for vaginal repair of enterocele and vaginal vault prolapse

Karram, Mickey M.; Goldwasser, Steve; Kleeman, Steven D.; Steele, Andrew; Vassallo, Brett J.; Walsh, Peggy

doi:10.1067/mob.2001.119077

Cited by 154 publications

(64 citation statements)

References 13 publications

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“…The recently published OPTIMAL trial reported that there were no significant differences in outcomes 2 years after transvaginal uterosacral colpopexy compared to sacrospinous ligament colpopexy. 7 While there are a number of studies reporting on subjective and objective efficacy after uterosacral colpopexy, 6,[8][9][10] there are few large studies that specifically address the perioperative and postoperative adverse events of this procedure. Therefore, the primary objective of this study was to describe perioperative and postoperative adverse events associated with uterosacral colpopexy in a large cohort of women undergoing this procedure at a tertiary care center.…”

mentioning

confidence: 99%

Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse

Unger

Walters

Ridgeway

et al. 2015

American Journal of Obstetrics and Gynecology

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OBJECTIVE:We sought to describe perioperative and postoperative adverse events associated with uterosacral colpopexy, to describe the rate of recurrent pelvic organ prolapse (POP) associated with uterosacral colpopexy, and to determine whether surgeon technique and suture choice are associated with these rates. STUDY DESIGN:This was a retrospective chart review of women who underwent uterosacral colpopexy for POP from January 2006 through December 2011 at a single tertiary care center. The electronic medical record was queried for demographic, intraoperative, and postoperative data. Strict definitions were used for all clinically relevant adverse events. Recurrent POP was defined as the following: symptomatic vaginal bulge, prolapse to or beyond the hymen, or any retreatment for POP. RESULTS:In all, 983 subjects met study inclusion criteria. The overall adverse event rate was 31.2% (95% confidence interval [CI], 29.2e38.6), which included 20.3% (95% CI, 17.9e23.6) of subjects with postoperative urinary tract infections. Of all adverse events, 3.4% were attributed to a preexisting medical condition, while all other events were ascribed to the surgical intervention. Vaginal hysterectomy, age, and operative time were not significantly associated with any adverse event. The intraoperative bladder injury rate was 1% (95% CI, 0.6e1.9) and there were no intraoperative ureteral injuries; 4.5% (95% CI, 3.4e6.0) of cases were complicated by ureteral kinking requiring suture removal. The rates of pulmonary and cardiac complications were 2.3% (95% CI, 1.6e3.5) and 0.8% (95% CI, 0.4e1.6); and the rates of postoperative ileus and small bowel obstruction were 0.1% (95% CI, 0.02e0.6) and 0.8% (95% CI, 0.4e1.6). The composite recurrent POP rate was 14.4% (95% CI, 12.4e16.8): 10.6% (95% CI, 8.8e12.7) of patients experienced vaginal bulge symptoms, 11% (95% CI, 9.2e13.1) presented with prolapse to or beyond the hymen, and 3.4% (95% CI, 2.4e4.7) required retreatment. Number and type of suture used were not associated with a higher rate of recurrence. Of the subjects who required unilateral removal of sutures to resolve ureteral kinking, 63.6% did not undergo suture replacement; this was not associated with a higher rate of POP recurrence. CONCLUSION:Perioperative and postoperative complication rates associated with severe morbidity after uterosacral colpopexy appear to be low. Uterosacral colpopexy remains a safe option for the treatment of vaginal vault prolapse. P elvic organ prolapse (POP) is a common problem in women and is associated with considerable morbidity and a decreased quality of life. In the United States, the prevalence of POP is approximately 2.9% 1 and nearly 300,000 women undergo surgery annually for prolapse. 2 As a result, the estimated direct cost of POP surgery is >$1 billion per year. 3,4 Transvaginal and abdominal procedures exist to treat symptomatic POP. Uterosacral colpopexy is a common transvaginal procedure for vaginal prolapse and can be performed at the time of vaginal hysterectomy or for posthysterec...

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mentioning

confidence: 99%

Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse

Unger

Walters

Ridgeway

et al. 2015

American Journal of Obstetrics and Gynecology

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“…Nuestros resultados son comparables con las pocas series que existen publicadas en la literatura internacional, las cuales muestran tasas de éxito que van del 81 al 100% (3,(6)(7)(8)(9)(10). Tomando las precauciones necesarias, es una técnica segura y reproducible.…”

Section: Variables N=54unclassified

Suspensión Transvaginal Alta a Ligamentos Uterosacros Para El Tratamiento De Defectos Apicales (Stalus): Descripción De La Técnica Y Resultados Anatómicos a Mediano Plazo

et al. 2008

Rev. chil. obstet. ginecol.

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RESUMENObjetivos: Describir una técnica quirúrgica, novedosa en el medio nacional, de abordaje vaginal, para el tratamiento del prolapso apical: la suspensión transvaginal alta a ligamentos úterosacros (STALUS). Méto-do: Estudio descriptivo longitudinal, de 57 pacientes con defectos apicales, a los cuales se les realizó esa técnica entre Diciembre de 2002 y Octubre 2005. Se realizó estadística descriptiva y test t (2 muestras) para análisis de pronóstico anatómico (POP-Q). Para análisis de potenciales factores pronósticos se utilizó ANO-VA, regresión lineal y logística. Resultados: El tiempo operatorio promedio fue de 151 minutos. El resultado anatómico (POP-Q), pre y postoperatorio, resultó favorable y estadísticamente significativo, en los nueve puntos evaluados, 49 de las 54 pacientes fueron seguidas en promedio durante 15 meses. En el compartimiento apical (punto C) obtuvimos curación del 89% y no hubo fracasos. En la pared anterior, 22% de las pacientes recidivaron. En cuanto a las complicaciones, se produjo una fístula ureterovaginal. Conclusiones: Tomando las precauciones necesarias, es una técnica segura y reproducible, con buenas tasa de curación. Asegurar la indemnidad del uréter, siempre será una obligación. La recidiva en pared anterior, aunque sea asintomática, resulta ser extremadamente alta, lo que nos obliga a pensar en nuevas técnicas de abordaje de este compartimiento.PALABRAS CLAVE: Prolapso genital, prolapso apical, defecto apical, abordaje vaginal, ligamentos úterosacros SUMMARYObjective: To describe a novel surgery technique in the national ground, of vaginal approach for the treatment of apical prolapse: the transvaginal high suspension to the uterosacral ligaments (STALUS OBSTET GINECOL 2008; 73(3): 145 -150

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“…Vaginally, Shull described the use of permanent braided sutures extraluminal to the vaginal canal [19]. Subsequent modifications of Shull's technique have incorporated variations on the use of permanent and absorbable sutures for apical support [21,[25][26][27]28•]. Kasturi et al (2011) retrospectively compared apical support outcomes from mostly vaginal uterosacral suspensions using either permanent or delayed-absorbable suture.…”

Section: Laparoscopic Uterosacral Colpopexy (Native Tissue Repair)mentioning

confidence: 99%

Minimally Invasive Pelvic Reconstructive Surgery: A Literature Review of Laparoscopic Surgery for Pelvic Organ Prolapse

Takase-Sanchez

Hale

2013

Curr Obstet Gynecol Rep

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Pelvic reconstructive surgery for pelvic organ prolapse includes transvaginal, open, laparoscopic, and roboticassisted approaches. Laparoscopy has established a significant role in minimally invasive surgery across surgical disciplines. In pelvic surgery, although the vaginal approach may offer the most native route to a minimally invasive technique, advances in gynecologic laparoscopy have reported advantages over traditional routes maintaining safety, efficacy, and high patient satisfaction. Majority of current data is limited to descriptive case series and retrospective data that nonetheless continue to support the laparoscopic approach as a reasonably safe alternative to open and vaginal approaches. Few prospective, clinical trials have compared the safety, efficacy, and costeffectiveness of various approaches and surgical techniques highlighting challenges in the utility of robotic-assistance and vaginal graft placement. This literature review provides a summary of important historical and current data in regards to surgical technique and clinical outcomes of advanced pelvic laparoscopy for pelvic organ prolapse.

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High uterosacral vaginal vault suspension with fascial reconstruction for vaginal repair of enterocele and vaginal vault prolapse

Cited by 154 publications

References 13 publications

Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse

Incidence of adverse events after uterosacral colpopexy for uterovaginal and posthysterectomy vault prolapse

Suspensión Transvaginal Alta a Ligamentos Uterosacros Para El Tratamiento De Defectos Apicales (Stalus): Descripción De La Técnica Y Resultados Anatómicos a Mediano Plazo

Minimally Invasive Pelvic Reconstructive Surgery: A Literature Review of Laparoscopic Surgery for Pelvic Organ Prolapse

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