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The novel three-compartment hybrid repair of advanced vaginal vault prolapse
IUGA Academy. Kubin N. Jun 30, 2018; 213245; 261 Topic: Pelvic Organ Prolapse
Nikita Kubin
Nikita Kubin

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261

The novel three-compartment hybrid repair of advanced vaginal vault prolapse

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: Vaginal vault prolapse (VVP) is a difficult challenge for the surgeon. To date there is no standard procedure for this condition. Advanced VVP is often associated with multi-compartment defect: cystocele, rectocele, enterocele [1]. This fact indicates the need of vaginal fascia reconstruction in addition to a durable fixation of the apex. Moreover, thin mucosa of the vaginal cuff limits the use of synthetic materials in pelvic floor restoration.

Objective: To increase the efficiency of surgical correction of advanced stages of vaginal vault prolapse.

Methods: To achieve the aim of VVP surgery improvement the hybrid technique was developed. It consists of three elements: 1) bilateral sacrospinous fixation of vaginal cuff by a monofilament polypropylene apical sling; 2) reconstruction of the vaginal fascia by a purse-string suture laid on the internal surface of it - “neocervix” formation; 3) indirect fixation of the sling to the vaginal tissue with ligatures pinned to the internal surface of the fascia and tied above the “neocervix”. For restoration of advanced VVP this technique was supplemented with reconstruction of the vaginal fascia in anterior and/or posterior compartments by a subfascial colporrhaphy suture (according to Halsted). The obligatory step was binding of a colporrhaphy suture to the sling-fixing ligatures, thereby fixing reconstructed fascia to the inserted sling. So, three-compartment hybrid vaginal vault prolapse repair was created.

Results: 15 consecutive patients suffering from advanced VVP (stage III-IV, POP-Q) were operated in accordance with the proposed method. In six (40%) women reconstruction of the vaginal fascia was performed in two compartments (apical and anterior/posterior), in all other cases the technique was three-compartment. Mean surgery duration was 52± 11 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 12 months of follow-up were 100% (15/15), 93%(14/15) and 100% (15/15) for vaginal apex, anterior and posterior vaginal walls. There were no cases of mesh erosion. Eight women (53%) returned to a sexual life. All patients reported a significant improvement in the quality of life after treatment.

Conclusions: The novel three-compartment hybrid technique is an effective and promising method for reconstruction of advanced vaginal vault prolapse.

Fig.1 Fig.2 Fig.3 Fig.4 Fig.5 Fig.6

Fig.1. Restoration of the central compartment: apical sling is installed, two fixing ligatures are conducted through it and pinned to the internal surface of vaginal fascia by subfascial purse-string suture. Fig.2. “Neocervix” is formed. Fig.3-4. Repair of the anterior compartment – subfascial colporrhaphy (Halsted) with binding of the thread with one of the sling-fixing ligatures (posterior compartment is restored similarly). Fig.5. Closing the vagina. Fig.6. The final view.

1.Coolen A.W.M., Bui B.N., Dietz V., Wang R., van Montfoort A.P.A., Mol B.W.J., Roovers J.W.R., Bongers M.Y. The treatment ofpost-hysterectomyvaginal vaultprolapse: a systematic review and meta-analysis. Int Urogynecol J. 2017; 28(12):1767-1783.

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Work supported by industry: no.

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