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The novel technique of vaginal vault prolapse repair: apical sling and “neocervix” formation - 2 years' outcomes
IUGA Academy. Shapovalova E. Jun 30, 2018; 212829
Topic: Pelvic Organ Prolapse
Dr. Ekaterina Shapovalova
Dr. Ekaterina Shapovalova

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The novel technique of vaginal vault prolapse repair: apical sling and “neocervix” formation - 2 years’ outcomes

Shkarupa, D1; Kubin, N1; Shapovalova, E1; Staroseltseva, O1; Zaytseva, A1

1: Saint-Petersburg State University Clinic of advanced medical technologies n.a. Nikolay I. Pirogov

Introduction: Sacrocolpopexy is considered the gold standard procedure for vaginal vault prolapse (VVP) correction. Nevertheless, it is associated with long operation time, pneumoperitoneum, Trendelenburg position, and a number of well-known complications. The problem of mesh erosions still remains actual for this method.

Objective: To evaluate the mid-term effectiveness of ? novel hybrid technique: bilateral sacrospinous fixation by a monofilament polypropylene apical sling (UroSling-1, Lintex) combined with “neocervix” formation (purse-string suture laid on the internal surface of vaginal fascia) in surgical treatment of post-hysterectomy vaginal vault prolapse (Fig.1,2). A secondary aim was to estimate the impact of the surgery on urinary function and patient’s quality of life.

Methods: 61 consecutive patients suffering from post-hysterectomy prolapse (stage III-IV, POP-Q) underwent a hybrid repair between September 2014 and April 2015. To evaluate the results of surgical treatment we used data of vaginal examination (POP-Q), uroflowmetry, bladder ultrasound, validated questionnaires (PFDI-20, PFIQ-7, PISQ-12, ICIQ-SF). All listed parameters were determined before the surgery and at control examinations in 1, 6, 12 months after the treatment and then annually.

Results: Mean operation time was 35 ± 13 minutes. There were no cases of intraoperative damage to the bladder or rectum, as well as clinically significant bleeding. The anatomical success rates (£ stage I, POP-Q) after a median 31.5 months (min-24, max-36) of follow-up were 95.0% (38/40), 87.5% (45/40), and 95.0% (38/40) for vaginal apex, anterior and posterior vaginal walls. Only in 2 patients the stage of the prolapse exceeded stage II (POP-Q). Women lost to follow-up didn’t have any complaints during the phone interview. There were no cases of mesh erosions during the follow-up period. There were no statistically significant changes of Q max or PVR in comparison to data of previous control examinations. After 6 months of follow-up stress urinary incontinence de novo was noted in 7.4% (4/54), and this number didn’t increase in time. Most of the patients reported a significant improvement in the quality of life after treatment.

Conclusions: The novel hybrid technique: the apical sling combined with neocervix formation appears to be an effective and safe method for treatment patients with post-hysterectomy prolapse that provides high functional results and improves quality of life. To date, our experience is more than 200 operations.


Fig.1. The novel technique of the vaginal cuff fixation to the mesh – indirect fixation of the apical sling to ? conglomerate of vaginal tissues (“neocervix”) created by a subfascial purse-sting suture laid on the internal surface of the vaginal fascia. Subfascial technique of the suture performing provides additional isolation of the sling from the vaginal mucosa. This picture represents a hybrid principle: mesh-based apical prolapse correction combined with native-tissue reconstruction.


Fig.2. Purse-string suture is tied and “neocervix” is formed. Sling-fixation ligatures that were pinned to the internal surface of the fascia by a purse-string suture will be tied above the tissue conglomerate to provide apical fixation.

Disclosure:

Work supported by industry: no.

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