A trial for the hybrid operation of anterior vaginal wall repair with trans-vaginal minimal mesh and posterior vaginal wall repair with dermis harvested from lateroabdominal skin
IUGA Academy. Takeyama M. Jun 30, 2018; 212902
Topic: Pelvic Organ Prolapse
Dr. Masami Takeyama
Dr. Masami Takeyama

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A trial for the hybrid operation of anterior vaginal wall repair with trans-vaginal minimal mesh and posterior vaginal wall repair with dermis harvested from lateroabdominal skin

Takeyama, M1; Kuwata, T1; Kashihara, H1; Kato, C1; Nagao, K2; Miwa, Y3; Hongo, S4

1: First Towakai Hospital; 2: Depertment of urology, Toho University Faculty of Medicine; 3: Depertment of Urology, Gifu redcross Hospital; 4: Depertment of urology, Kindai university

Introduction: Regarding pelvic organ prolapse (POP) repair, posterior vaginal wall repair is controversial. The recurrence rate in the repair with native tissue is rather high. Trans-vaginal mesh for these conditions is in some case a good measure, however, many sergeants currently will not use mesh for posterior vaginal wall repair. So, another new good measure is required.

Objective: Here we will demonstrate a new measure for the posterior vaginal wall prolapse repair, a preliminary report.

Methods: Materials are five POP cases, two with high stage uterine prolapse and remaining three with both cystocele and rectocele. Operative procedures : anterior prolapse was repaired with transvaginal minimal mesh surgery (TVM-A2) and posterior prolapse was repaired with dermis harvested from lateroabdominal skin of the patients (Trans vaginal dermis procedure: TVD). TVD procedure for posterior POP is as follows. (1) Harvest of dermis from the patient’s abdominal skin (Fig.1): Marking of 130x80mm diamond shape on the lateroabdominal skin and multiple parallel shallow epidermal incisions were made, and each epidermal stripe was cut off with scissors. Then only dermis was left in the skin, and the dermis was harvested with scissors. (2) Posterior vaginal wall repair with dermis (Fig.2): After liquid dissection, midline incision was made on the posterior vaginal wall. Then both side pararectal space were dissected to reach the sacrospinous ligaments(SSL). Anchoring sutures were put at the 3 points: uterine cervix, distal end of the posterior vaginal wall and both sides of SSL. The dermis of 13x8cm which had been prepared was sutured to the anchoring points with braided non-absorbable (SSL and cervix) and braided absorbable thread (vaginal wall)(Fig.3). Finally, vaginal wall was closed with monofilament absorbable thread. TVM-A2 procedure was performed with self-cut minimal mesh. The anchoring points are leathered tissue around both side ischial spine and distal part of anterior vaginal wall.

Results: Operating time: average 107min. (74min.-167min.). Blood loss: average 71gr. (25gr.-200gr.). There was no perioperative complication.

Conclusions: Dermis has been used to repair the penis with Peyronie’s disease safely. The flexibility and intensity of the lateroabdominal dermis seems also suitable for the reinforcement of the rectovaginal fascia. The hybrid operation including TVD procedure is still in the preliminary stage, however, seems promising for the POP repair. We are going to accumulate the cases and improve this procedure in the near future.


Work supported by industry: no.

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