Technique of anterior colporrhaphy: a Dutch evaluation

Lensen, E.J.M.; Stoutjesdijk, Jackie A.; Withagen, Mariëlla I. J.; Kluivers, Kirsten B.; Vierhout, Mark E.

doi:10.1007/s00192-010-1353-4

Cited by 21 publications

(16 citation statements)

References 19 publications

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“…This may be attributed to the large variation in surgical technique of anterior colporrhaphy, though other factors may play a role as well. 36 Compared with the RCT of Dietz et al 17 we found fewer anatomical recurrences of the apical compartment (3.4 versus 21%) after SSHP. The latter number is rather high for SSHP.…”

Section: Main Findingsmentioning

confidence: 47%

Hysteropexy in the treatment of uterine prolapse stage 2 or higher: laparoscopic sacrohysteropexy versus sacrospinous hysteropexy—a multicentre randomised controlled trial (LAVA trial)

IJsselmuiden

Oudheusden

Veen

et al. 2020

BJOG

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Objective To investigate whether laparoscopic sacrohysteropexy (LSH) is non‐inferior to vaginal sacrospinous hysteropexy (SSHP) in the surgical treatment of uterine prolapse. Design Multicentre randomised controlled, non‐blinded non‐inferiority trial. Setting Five non‐university teaching hospitals in the Netherlands, one university hospital in Belgium. Population 126 women with uterine prolapse stage 2 or higher undergoing surgery without previous pelvic floor surgery. Methods Randomisation in a 1:1 ratio to LSH or SSHP, stratified per centre and severity of the uterine prolapse. The predefined inferiority margin was an increase in surgical failure rate of 10%. Main outcome measures Primary outcome was surgical failure, defined as recurrence of uterine prolapse (POP‐Q ≥ 2) with bothersome bulging/protrusion symptoms and/or repeat surgery or pessary at 12 months postoperatively. Secondary outcomes were anatomical recurrence (any compartment), functional outcome and quality of life. Results Laparoscopic sacrohysteropexy was non‐inferior for surgical failure (n = 1, 1.6%) compared with SSHP (n = 2, 3.3%, difference −1.7%, 95% CI: −7.1 to 3.7) 12 months postoperatively. Overall, anatomical recurrences and quality of life did not differ. More bothersome symptoms of overactive bladder (OAB) and faecal incontinence were reported after LSH. Dyspareunia was more frequently reported after SSHP. Conclusion Laparoscopic sacrohysteropexy was non‐inferior to SSHP for surgical failure of the apical compartment at 12 months’ follow up. Following LSH, bothersome OAB and faecal incontinence were more frequent, but dyspareunia was less frequent. Tweetable abstract Laparoscopic sacrohysteropexy and vaginal sacrospinous hysteropexy have equally good short‐term outcomes.

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Section: Main Findingsmentioning

confidence: 47%

Hysteropexy in the treatment of uterine prolapse stage 2 or higher: laparoscopic sacrohysteropexy versus sacrospinous hysteropexy—a multicentre randomised controlled trial (LAVA trial)

IJsselmuiden

Oudheusden

Veen

et al. 2020

BJOG

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“…Within the literature there are descriptions of different techniques, which are categorised under the umbrella term of 'anterior repair' [6][7][8][10][11][12][13][14][15][16]. As with previous questionnaire studies [3,6,8] this study identified that most surgeons dissect in a superficial plane and this was frequently combined with a midline repair of the vaginal muscularis. This technique was first described by Kelly in 1913 for the treatment of stress incontinence [10].…”

Section: Discussionmentioning

confidence: 99%

“…Qualitative methods (video observations and interviews) have allowed categorisation of the entire procedure. The degree of variation seen was greater than had previously been described in the literature when simple questionnaires were used [6][7][8]. The combination of these variable steps results in potentially hundreds of different types of native tissue anterior repair.…”

Section: Main Findingsmentioning

confidence: 93%

Surgical technique used in the UK for native tissue anterior pelvic organ prolapse repair (VaST)

et al. 2019

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Introduction The PROSPECT study found that outcomes for native tissue and mesh prolapse repairs are similar but mesh repairs have a 10% risk of exposure. The current UK surgical mesh pause has led to renewed interest in native tissue surgery. Previous studies of native tissue anterior repair surgical techniques have been limited by the questionnaire study design. The objective of this study was to describe and categorise native tissue anterior repair surgical techniques. Methods This prospective qualitative study used a purposive sampling strategy to recruit surgeons. Data were collected through video-recorded observations of surgery, audio-recorded interviews with surgeons and field notes. The study took place in urogynaecology theatres in 21 UK centres. Thematic analysis was performed using computer-based software and themes of surgical technique were developed. Results Thirty consultant surgeons were recruited. In all steps of the anterior repair procedure, infiltration, dissection, method of fascial repair, type and method of suturing and suture placement, surgical technique varied between surgeons. The filming of surgery followed by immediate validation with the surgeons gave greater insight. Surgeons' terminology to describe techniques varied and the investigators' opinions of the techniques performed were not always consistent with the surgeons' descriptions. The concept of fascia in histological terms was not uniform amongst surgeons. Conclusion VaST has demonstrated significant variation in native tissue anterior repair surgical techniques and inconsistency in the terminology used to describe them. These inconsistencies may prevent future meaningful research of prolapse surgery. The variation in technique could affect surgical outcomes and this should be explored further.

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“…Typically, mesh is placed below the vaginal muscularis (fascia) directly against the rectum or bladder, as described by Muffly and Barber in 2010 [ 10 ]. The traditional plane of dissection is more superficial; the vaginal epithelium is split from the underlying muscularis to enable its plication [ 7 , 11 , 12 ]. Most surgeons in this study continue to use this technique and a past study of Dutch Urogynecologic Society members showed that almost half of the surgeons attempted to “dissect the vaginal mucosa as thin as possible from the bladder” (43%).…”

Section: Discussionmentioning

confidence: 99%

A UK questionnaire survey of current techniques used to perform pelvic organ prolapse repair

et al. 2017

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Introduction and hypothesisEvidence-based medicine should result in better standardisation of practice. This study aims to evaluate whether there remains variation in surgical techniques in native tissue and graft/mesh repairs of pelvic organ prolapse (POP) in UK practice.MethodsA questionnaire survey was conducted to describe current surgical techniques for native tissue and graft/mesh POP repairs performed by a cohort of UK surgeons recruiting to a large multicentre prolapse trial (PROSPECT).ResultsThe questionnaire return rate was 90% (n = 56 out of 62). Substantial variations in surgical techniques were seen at every step of the procedure. Native tissue repair: most surgeons used infiltration, 95% (n = 53 out of 56), but the volume used varied (10–80 ml). All but one surgeon performed a midline incision; this surgeon performed an elliptical incision. The depth of tissue dissection varied, being both above and below the vaginal muscularis (fascia). Fascial repair methods included midline, closure of separate fascial defects, paravaginal repair and rectal/levator plication. Graft/mesh repairs: many different products and manufacturers were used. There was variation in the method of attachment of graft/mesh inserts and their placement in relation to the fascia. For both native tissue and graft/mesh repairs, the method of fascial dissection, suturing methods and suture material varied. Most surgeons inserted a pack, 91% (n = 50 out of 55), soaked in varying substances before use.ConclusionsThere is considerable variation between UK-based surgeons in the surgical techniques used to perform both native tissue and graft/mesh-augmented POP repairs. Further research is required to determine whether these differences influence outcome.

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Technique of anterior colporrhaphy: a Dutch evaluation

Cited by 21 publications

References 19 publications

Hysteropexy in the treatment of uterine prolapse stage 2 or higher: laparoscopic sacrohysteropexy versus sacrospinous hysteropexy—a multicentre randomised controlled trial (LAVA trial)

Hysteropexy in the treatment of uterine prolapse stage 2 or higher: laparoscopic sacrohysteropexy versus sacrospinous hysteropexy—a multicentre randomised controlled trial (LAVA trial)

Surgical technique used in the UK for native tissue anterior pelvic organ prolapse repair (VaST)

A UK questionnaire survey of current techniques used to perform pelvic organ prolapse repair

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