BACKGROUND: Numerous surgical techniques have been described for the treatment of vaginal vault prolapses. In 1997, a new minimally invasive procedure was introduced by Petros: the infracoccygeal sacropexy, also known as Intravaginal Slingplasty (IVS). This technique is used to place a mesh in the recto-vaginal fascia and to reinforce the uterosacral ligament by placing a polypropylene tape between the perineum and the vaginal vault. Since July 2002, we have changed our approach to the treatment of vaginal vault prolapses and now perform IVS. The aim of this study was to report our early experience and short-term results with IVS. METHODS: Prospective single-institution non-randomized trial of patients who underwent IVS. Indications, intra- and post-operative complications were recorded as well as early post-operative results. RESULTS: 34 patients with a mean age of 60+/-13 years, were operated during a 12-month period. Surgical indications included rectoceles (n = 27), enteroceles (n = 26), cystoceles (n = 15) and hysteroceles (n = 9). 85% of the patients (n = 29) had more than one prolapse. Mean operative time was 63+/-19 minutes, with a 0% intra-operative complication rate. Post-operative complication rate was 2.9%: bleeding from an internal haemorrhoid required surgical haemostasis. Median post-operative stay was 3 days (range: 2-7 days). There was also one post operative complication (2.9%, a mesh erosion). Recurrence rate was 8.8% (two cystoceles and one rectocele recurred after surgery). CONCLUSION: Posterior IVS provides a safe and efficacious treatment for posterior vaginal vault prolapses. Long-term results are required to assess the functional results and recurrence rate of the technique.

Adult↗

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[Gallbladder volvulus].

We report two new cases of gallbladder volvulus. This rare condition principally affects elderly patients but is due to a congenital malformation related to the presence of a long mesocyst. Various factors such as kyphoscoliosis, multiparity and peristalsis of neighbouring organs favorise the occurrence of volvulus, the role of lithiasis is debatable. The diagnosis may be suggested on ultrasound but is most often confirmed at laparotomy. Diagnosis should be made rapidly in order to avoid progression towards a potentially fatal secondary peritonitis. Certain clinical elements such as the presence of a "floating mass" on palpation may suggest the diagnosis.

Aged↗

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