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Vajinal kaf prolapsusu ve uterus prolapsusu için iki yeni cerrahi teknik

Year 2019, Volume: 3 Issue: 8, 619 - 622, 01.08.2019
https://doi.org/10.28982/josam.605975

Abstract

Pelvik organ prolapsusu ve vajinal kaf prolapsusu kadınların yaşam kalites ini etkileyen ve cerrahi tedavi gerektiren bir klinik durumdur. Bu çalışma ile biz apikal vajinal prolapsus ve uterin desensusun tedavisini sunmayı hedefledik. Klasik sakrospinöz ligament fiksasyon tekniği, vajinal tepenin sadece bir veya iki köşesini sakrospinöz ligamana sabitler, ancak üst ön ve arka vajinal fasyaya herhangi bir destek vermez. Vajina apeksinin yanlarına konan bir sütür ile vajinanın üst kısmını genişlettiğinden, bu durum sadece ön ve arka vajinal duvarların daha büyük karın içi basıncına maruz kalmasına neden olmaz aynı zamanda sistosel ve enterosel gelişimine neden olur, ancak genişlemiş vajinal apeks cinsel sorunlara neden olabilir. Bunun dışında sakrospinöz kolpopeksi sadece bir tarafa yapılırsa, vajinal apeks fiksasyona doğru saparak vajinal anatomiyi bozar. Geliştirdiğimiz yöntemlerle fizyolojik anatomi taklit edilmiş olacaktır. Bu teknikler transapikal sirkuler sakrospinoz ve transservikal apikal sakrospinoz uteropeksi dir. TACSAC; Renkli kalemle bilateral olarak vajinal apeksin yan duvarları medial olarak sağ ve sol iskiyal spinden 2 cm uzunluğunda 2 cm olarak işaretlenir. Vajinal apeks duvarları, sublukoza kadar iki taraflı ve dikey olarak kesilir. Vajinal tepe üzerinde iki dikey insizyonun uçları arasında dik açılı bir kelepçe kullanılarak iki submukozal tünel açılır. Vajinal apeks bu kanallardan TOT meshi ile sabitlenir. TACSU serviks hastalarında da benzer şekilde uygulanır. Bu yöntemler normal anatomiyi daha çok taklit eden, uygulanabilirliği daha kolay ve komplikasyon riski daha düşük yöntemlerdir.

References

  • 1. Zimmerman CW. Pelvic organ prolapse: Basic principles. In: Rock JA, Jone III HW (eds): Te Linde’s Operative Gynecology. Philadelphia: Lippicott Williams and Wilkins. 2008, pp 854-873.
  • 2. Chen HW, Guess MK, Connell KA, Bercik RS. Ischiorectal abscess and ischiorectal-vaginal fistula as delayed complications of posterior intravaginal slingplasty: a case report. J Reprod Med. 2009 Oct;54(10):645-8.
  • 3. Strohbehn K, Richter HE. Operative Management of Pelvic Organ Prolapse. In: Gibbs, RS.; Karlan, BY.; Haney, AF.; Nygaard, IE. (eds): Danforth's Obstetrics and Gynecology, 10th Edition. Philadelphia: Lippincott Williams & Wilkins 2008;840-866.
  • 4. Richter HE, Varner RE. Pelvic Organ Prolapse. In: Berek, JS (eds). Berek & Novak's Gynecology, 14th Edition. Philadelphia: Lippicott Williams and Wilkins. 2007;898-935.
  • 5. Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter PJ. Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol. 2004 Jan;190(1):20-6.
  • 6. Fatton B, Amblard J, Debodinance P, Cosson M, Jacquetin B. Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh(Prolift technique)--a case series multicentric study. Int Urogynecol J Pelvic Floor Dysfunct. 2007 Jul;18(7):743-52.
  • 7. Gadonneix P, Ercoli A, Scambia G, Villet R. The use of laparoscopic sacrocolpopexy in the management of pelvic organ prolapse. Curr Opin Obstet Gynecol.2005;17:376–380.

The two new surgical techniques for vaginal cuff prolapse and uterine prolapse

Year 2019, Volume: 3 Issue: 8, 619 - 622, 01.08.2019
https://doi.org/10.28982/josam.605975

Abstract

Pelvic organ prolapse and vaginal cuff prolapse are clinical conditions that affect women’s quality of life and require surgical treatment. In this study, we aimed to present apical vaginal prolapse and uterine descensus treatment with two new techniques. The classical sacrospinous ligament fixation technique fixes only one or two corners of the vaginal apex to the sacrospinous ligament, but it does not support the upper anterior and posterior vaginal fascia. Since it expands the upper part of the vagina with a suture put on the sides of the vaginal apex, it may not only expose the anterior and posterior vaginal walls to greater intraabdominal pressure and cause cystocele and enterocele development, but lead to sexual problems, as well. Apart from this, if sacrospinous colpopexy is performed to one side only, the vaginal apex is deviated towards the fixation, thus spoiling the vaginal anatomy. With our following methods, we imitate the physiological anatomy: Transapical circular Sacrospinous colpopexy (TACSAC) and Transcervical apical circular Sacrospinous uteropexy (TACSU). TACSAC: Bilateral side walls of the vaginal apex are marked with a color pencil 2 cm medially to the right and left ischial spine and 2 cm in length. Vaginal apex walls are bilaterally and vertically incised until the submucosa layer. Two submucosal tunnels are opened by using a right-angle clamp between the tips of two vertical incisions on the vaginal apex. The vaginal apex is fixed with a TOT mesh through these channels. In TACSU, the same procedure is followed for the cervix. These methods are more likely to mimic normal anatomy, easier to perform, and lower risk of complications.

References

  • 1. Zimmerman CW. Pelvic organ prolapse: Basic principles. In: Rock JA, Jone III HW (eds): Te Linde’s Operative Gynecology. Philadelphia: Lippicott Williams and Wilkins. 2008, pp 854-873.
  • 2. Chen HW, Guess MK, Connell KA, Bercik RS. Ischiorectal abscess and ischiorectal-vaginal fistula as delayed complications of posterior intravaginal slingplasty: a case report. J Reprod Med. 2009 Oct;54(10):645-8.
  • 3. Strohbehn K, Richter HE. Operative Management of Pelvic Organ Prolapse. In: Gibbs, RS.; Karlan, BY.; Haney, AF.; Nygaard, IE. (eds): Danforth's Obstetrics and Gynecology, 10th Edition. Philadelphia: Lippincott Williams & Wilkins 2008;840-866.
  • 4. Richter HE, Varner RE. Pelvic Organ Prolapse. In: Berek, JS (eds). Berek & Novak's Gynecology, 14th Edition. Philadelphia: Lippicott Williams and Wilkins. 2007;898-935.
  • 5. Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter PJ. Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol. 2004 Jan;190(1):20-6.
  • 6. Fatton B, Amblard J, Debodinance P, Cosson M, Jacquetin B. Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh(Prolift technique)--a case series multicentric study. Int Urogynecol J Pelvic Floor Dysfunct. 2007 Jul;18(7):743-52.
  • 7. Gadonneix P, Ercoli A, Scambia G, Villet R. The use of laparoscopic sacrocolpopexy in the management of pelvic organ prolapse. Curr Opin Obstet Gynecol.2005;17:376–380.
There are 7 citations in total.

Details

Primary Language English
Subjects Obstetrics and Gynaecology
Journal Section Review
Authors

Fatma Devran Bıldırcın 0000-0002-2952-4209

Ayşe Özdemir 0000-0003-4232-4794

Pervin Karlı 0000-0003-4907-5890

Arif Kökçü This is me 0000-0001-8745-3667

Publication Date August 1, 2019
Published in Issue Year 2019 Volume: 3 Issue: 8

Cite

APA Bıldırcın, F. D., Özdemir, A., Karlı, P., Kökçü, A. (2019). The two new surgical techniques for vaginal cuff prolapse and uterine prolapse. Journal of Surgery and Medicine, 3(8), 619-622. https://doi.org/10.28982/josam.605975
AMA Bıldırcın FD, Özdemir A, Karlı P, Kökçü A. The two new surgical techniques for vaginal cuff prolapse and uterine prolapse. J Surg Med. August 2019;3(8):619-622. doi:10.28982/josam.605975
Chicago Bıldırcın, Fatma Devran, Ayşe Özdemir, Pervin Karlı, and Arif Kökçü. “The Two New Surgical Techniques for Vaginal Cuff Prolapse and Uterine Prolapse”. Journal of Surgery and Medicine 3, no. 8 (August 2019): 619-22. https://doi.org/10.28982/josam.605975.
EndNote Bıldırcın FD, Özdemir A, Karlı P, Kökçü A (August 1, 2019) The two new surgical techniques for vaginal cuff prolapse and uterine prolapse. Journal of Surgery and Medicine 3 8 619–622.
IEEE F. D. Bıldırcın, A. Özdemir, P. Karlı, and A. Kökçü, “The two new surgical techniques for vaginal cuff prolapse and uterine prolapse”, J Surg Med, vol. 3, no. 8, pp. 619–622, 2019, doi: 10.28982/josam.605975.
ISNAD Bıldırcın, Fatma Devran et al. “The Two New Surgical Techniques for Vaginal Cuff Prolapse and Uterine Prolapse”. Journal of Surgery and Medicine 3/8 (August 2019), 619-622. https://doi.org/10.28982/josam.605975.
JAMA Bıldırcın FD, Özdemir A, Karlı P, Kökçü A. The two new surgical techniques for vaginal cuff prolapse and uterine prolapse. J Surg Med. 2019;3:619–622.
MLA Bıldırcın, Fatma Devran et al. “The Two New Surgical Techniques for Vaginal Cuff Prolapse and Uterine Prolapse”. Journal of Surgery and Medicine, vol. 3, no. 8, 2019, pp. 619-22, doi:10.28982/josam.605975.
Vancouver Bıldırcın FD, Özdemir A, Karlı P, Kökçü A. The two new surgical techniques for vaginal cuff prolapse and uterine prolapse. J Surg Med. 2019;3(8):619-22.