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PubMed2006

Posterior vaginal sling experience in elderly patients yields poor results.

OBJECTIVE: The objective of the study was to evaluate our experience with the posterior vaginal sling in an elderly population. STUDY DESIGN: Elderly patients with significant vaginal prolapse underwent a posterior vaginal sling using the IVS Tunneller device (Tyco Healthcare, United States Surgical, Norwalk, CT). Primary failure was defined as a postoperative pelvic organ prolapse quantitative point C (the apex of the vagina) within 2 cm of the preoperative value. Secondary failure was defined as any portion of the anterior or posterior vaginal walls protruding to or beyond the hymeneal ring (pelvic organ prolapse quantitative points Aa or Ap equal to or greater than 0). RESULTS: Twenty-one patients underwent the procedure; 19 were seen for follow up. The average age was 70 years (range 60-78). Twelve patients had primary or secondary failures (12 of 19, 63%). There were 5 primary failures (5 of 19, 26%) and 7 secondary failures (7 of 19, 37%). The mean time to failure was 7 weeks (range 1-18). CONCLUSION: In our elderly population, the posterior vaginal sling has a high failure rate, occurring early in the postoperative period.

Aged↗

PubMed2004

Infected abdominal sacrocolpopexies: diagnosis and treatment.

The abdominal sacrocolpopexy is an excellent procedure to surgically treat vaginal vault prolapse. A synthetic graft is often used to support the vaginal apex, but has the potential to become infected or erode, requiring its removal or revision. The purpose of this paper is to report our experience in the management of patients with infected synthetic grafts after abdominal sacrocolpopexy. A review of the patient databases from three specialty gynecology centers was performed from March 1996 to June 2002. Only patients with an infected graft after an abdominal sacrocolpopexy were included in the study; patients with either suture or graft erosion responding to conservative treatment were excluded. Twenty-two women, ages 37-73 years, developed infection of the synthetic graft after an abdominal sacrocolpopexy (1-60 months after their initial surgery, mean 8.8 months). The infected materials included polytetrafluoroethylene (PTFE, Goretex, n =15) and polypropylene (n=7). Nine of the 15 PTFE meshes and four of the seven polypropylene meshes were placed at the time of a contaminated case (abdominal hysterectomy [n=12], colon resection [n=1]). Eighteen (82%) of the infected grafts involved braided permanent suture to attach the graft to the vaginal wall, monofilament/non-braided permanent suture was used in three patients, and suture type could not be determined in one. All graft removals were attempted vaginally, and this was successful in 16 cases (73%). Two patients experienced significant bleeding: the first patient required an emergency laparotomy and the second patient's bleeding was controlled with packing. A rectovaginal fistula occurred 3 weeks postoperatively in one patient. Synthetic graft infection should be considered as the differential diagnosis in a patient who has undergone an abdominal sacrocolpopexy. Transvaginal removal is preferred, but is fraught with potentially serious complications. The use of braided permanent sutures to affix the graft to the vagina may be associated with mesh infections.

Adult↗

PubMed2002

Dumbing down.

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Female↗