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At least 217 records · Page 12Linked to original sources
PubMed1995

Vaginal reconstructive surgery for female incontinence and anterior vaginal-wall prolapse.

The surgical procedure of choice to correct stress urinary incontinence using a vaginal approach depends not only on the anatomic origin of the incontinence (hypermobility or intrinsic sphincter dysfunction) but also on the degree of coexistent anterior vaginal wall prolapse. The grade of coexistent cystocele and the finding of a central or lateral defect are important observations that help the surgeon plan the optimum surgical approach. Grade 4 cystocele with central and lateral defects represents the most severe form of anterior vaginal wall prolapse. In this case, the surgical goals are to correct both central and lateral defects, as well as hypermobility related to the mid-urethra and bladder neck.

Female↗
PubMed1982

Complications of abdominal and vaginal hysterectomy among women of reproductive age in the United States. The Collaborative Review of Sterilization.

Although hysterectomy was the most frequently performed major surgical procedure among women of reproductive age during the past decade, few recent studies have been conducted to determine the risk of complications. We examined data from the Collaborative Review of Sterilization, a prospective, multicenter, observational study coordinated by the Centers for Disease Control, to assess the comparative risks of complications among women undergoing hysterectomy by the abdominal and vaginal approaches. Between September, 1978, and August, 1981, 1,851 women from nine institutions were included in the study. Women who underwent vaginal hysterectomy experienced significantly fewer complications than women who had undergone abdominal hysterectomy. The difference was probably attributable to the prevalence and efficacy of prophylactic antibiotic use among the former group. Vaginal hysterectomy was associated with more unintended major surgical procedures but less febrile morbidity, bleeding requiring transfusion, hospitalization, and convalescence than abdominal hysterectomy. Vaginal hysterectomy with prophylactic antibiotics should be strongly considered for those women of reproductive age for whom either surgical approach is clinically appropriate.

Adolescent↗
PubMed2002

[Cystocele repair by the vaginal route with a tension-free sub-bladder prosthesis].

OBJECTIVE: To describe a new vaginal approach for the repair of cystoceles, reinforced with a tension-free polypropylene mesh. METHODS: The vaginal procedure consisted of a complete dissection of the cystocele and a thorough entry from the vesicovaginal space under the inferior pubic ramus into the retropubic space. The polypropylene mesh (GyneMesh(TM), Gynecare, Ethicon France) was placed from the retropubic space to the inferior part of the bladder in a tension-free fashion. RESULTS: Forty-eight consecutive women with grade 3-4 cystoceles underwent this procedure between October 1999 and September 2001. Mean age was 63.9 years (41-85). Mean follow-up is 18 months (8-32). The success rate was 97.9%. There were a total of four vaginal erosions of the mesh (8.3%). There were no postoperative infections of the mesh. CONCLUSION: The vaginal repair of severe cystocele reinforced with a tension-free polypropylene mesh is a simple and reproducible technique, with high success rate and low morbidity.

Adult↗
PubMed2001

[Surgical treatment of stress incontinence using a new vaginal tissue sling: short-term feasibility and complications].

OBJECTIVE: Many operative techniques have been proposed for urinary stress incontinence, a common finding in women. The goal of operating solely via a vaginal approach using autologous material has led to the development of a sling technique using a band of vaginal tissue. METHODS: We described the operative technique and analyzed outcome in the first 35 patients operated with the new vaginal tissue sling technique. RESULTS: Mean duration of the procedure was 35 minutes. The procedure was performed in two cases and thus could be used for prolapsus cure. We had no peroperative complications. Postoperative complications were mainly urine retention (50%) lasting a mean 4.4 days. Transfixation of the bladder was observed late in one case with resection of an intravesicular suture. At mean follow-up of 16.9 months, the success rate was 80% with 68.5% of the patients free of urine leakage. In case of sphincter insufficiency, the success rate was 85.7% (64.3% of the patients were free of leakage). Three of the four patients who had undergone prior Burch colpopexy were cured. DISCUSSION: Our series demonstrated the feasibility of the new vaginal tissue sling technique. It appears to be an adapted procedure for urinary stress incontinence with sphincter insufficiency and particularly well adapted for low closure pressures and after failure of surgical cure. The final assessment of this technique will require longer follow-up and comparative studies with other methods.

Adult↗
PubMed1994

[Rectovaginal fistulas in adults].

Recto-vaginal fistulas have multiple causes and a wide range of clinical and anatomical features. Simple fistulas, defined by a low situation, a traumatic origin, and a small size are accessible to simple means of cure. They can be operated from a vaginal approach, with conversion into a third degree perineal tear followed by repair of the perineal body, and the anal canal; they can be managed from a transanal approach, using endorectal flap advancement technique. Complex fistulas, defined by the etiology (IBD, radiation enteritis, cancer, postoperative), a high situation, or a large size, require larger and more sophisticated operations such as a combined abdomino-perineal approach or a muscle flap technique. Among the numerous techniques described for the cure of recto-vaginal fistulas, the authors emphasize those currently used by the most experienced teams of colo-rectal or gynecological surgeons.

Adult↗
PubMed1995

[The significance of laparoscopically-assisted vaginal hysterectomy--LAVH].

The truly minimal invasive surgeon should always act to the benefit of the patient. Since most of the operative steps of hysterectomy can be performed faster and often better via the vaginal approach than through trocars, minimal invasive surgery does not necessarily mean the employment of endoscopic techniques. Simple vaginal hysterectomy continues to be the least invasive method and 60% of all uteri can be removed this way. If vaginal hysterectomy is not feasible, LAVH should be applied since of all variations of endoscopic hysterectomy. LAVH is the one with the least complications, it is not time-consuming and it is easy to learn. The most effective strategy during the laparoscopic part of LAVH is: As much as necessary--as little as possible. This means, if endoscopic operative steps do not prove to be inevitable during diagnostic laparoscopy, they should be renounced in favour of vaginal hysterectomy (LAVH type I). LAVH type I is the method of choice for about 10% of all uteri. 70% of all uteri can be removed by exclusively vaginal operation if vaginal hysterectomy and LAVH type I are taken together. If operative laparoscopy is unavoidable, is should be limited to those steps which can not be accomplished transvaginally. Another 20% of all uteri can be removed without laparotomy if LAVH type II--LAVH with operative laparoscopy--is employed. If this concept is pursued consequently, only less than 10% of all benign hysterectomies have to be performed via laparotomy.

Adult↗
PubMed1994

Surgical repair of stress urinary incontinence.

Genuine SUI is defined as that associated with hypermobility of the urethra and bladder neck. Accurate history-taking and physical examination allows for proper diagnoses and subsequent therapy in the majority of cases. Patients in whom bladder instability or intrinsic sphincteric deficiency are suspected may benefit from urodynamic testing. Regardless of method, all surgical procedures used to treat genuine SUI aim at supporting the bladder within the pelvic cavity. This allows for adequate compression of the urethra by those intra-abdominal forces that would otherwise only act to expel urine through a compromised outlet. The operation of choice should be determined by its ability to provide this proper positioning over the long-term with the least morbid approach. Comparison of the various procedures is hampered by the lack of objective long-term data. For a vaginal approach, we prefer either the modified Pereyra as developed by Raz, or the placement of a sling beneath the bladder neck to provide firm, long-term support. For those patients who have not had prior abdominal surgery, the laparoscopic approach is an exciting method to obtain accurate dissection and fixation of the bladder neck and urethra. With careful evaluation and performance of these multiple techniques, therapy can be individualized for patients with excellent results.

Evaluation Studies as Topic↗
PubMed1998

[Developments in surgical gynecology].

This farewell lecture presents an overview of the development of operative gynecology on the basis of oncological surgery, removal of the uterus with or without pelvic floor reconstruction as well as corrective surgery of the uterovaginal canal. Without doubt the significance of endoscopic surgery, especially involving the adnexa and the cavum uteri, has increased. Uterus extirpation should remain in the domain of the vaginal approach. An experienced 'vaginalist' has has hardly any need for parasocpic assistance which should influence the renaissa lance of the vaginal method. Emphasis should be put on vaginal reconstruction of the affected pelvic floor in the course of incontinence surgery. Thanks to new diagnostic means malformations of the uterus can be detected more frequently, and it appears essential to develop and improve these methods further if one is to prevent laparoscopic polypragmatism. The author's opinion about the insufficient surgical experience and training in medical specialist education will be discussed.

Animals↗
PubMed2003

"Schauta sine utero": technique and results of laparoscopic-vaginal radical parametrectomy.

OBJECTIVES: Radical parametrectomy or radical cervical stump exstirpation is indicated in selected oncologic situations. We evaluated whether radical parametrectomy without or with cervical stump exstirpation can be performed by a combined laparoscopic-vaginal approach. METHODS: Between November 2001 and Dezember 2002 six patients with unexpected cervical cancer (n = 3) after simple hysterectomy, histologically confirmed vaginal recurrence of endometrial cancer (n = 1), or cervical stump recurrence of endometrial cancer after supracervical hysterectomy (n = 2) underwent radical parametrectomy. After cystoscopic placement of bilateral ureteral stents laparoscopic paraaortic and pelvic lymphadenectomy was performed. The vascular part of the cardinal ligament and the bladder pillar were transsected laparoscopically. According to a LARVH type III procedure vaginal vault or cervical stump with parametrial and paravaginal structures was removed transvaginally. RESULTS: In all patients R0 resection could be achieved (n = 4) or no residual tumor was detected (n = 2). There were no intraoperative complications. One patient developed acute kidney failure on postoperative day 1, with spontaneous recovery after 12 days. The median drop of hemoglobin on postoperative day 5 was 2.15 mmol/L (1.3-3.2) and no patient needed transfusion. Restitution of bladder function took 4.3 days on average. The mean operation time was 424 min (385-452). CONCLUSIONS: Radical parametrectomy can be performed by a combined laparoscopic-vaginal technique without complications. Together with laparoscopic paraaortic and pelvic lymphadenectomy, it is a valid alternative to open surgery in selected oncologic patients.

Adnexa Uteri↗
PubMed1998

Pelvic prolapse: diagnosing and treating uterine and vaginal vault prolapse.

Uterine prolapse is often associated with a concomitant rectocele, cystocele, and/or an enterocele. Moderate degrees of prolapse are often associated with a feeling of pelvic heaviness or fullness or low back pain. The symptoms usually worsen with exertion and ease with bed rest. In severe prolapse, the cervix may descend outside the vaginal introitus, and patients may complain that a "mass" is protruding from the vagina. Bleeding from mucosal ulcerations or from the cervical os may occur due to rubbing of the prolapsed tissue against the patient's clothing. The commonly associated problems of cystoceles and rectoceles may lead the patient to complain of difficulty voiding, recurrent urinary infections, and/or "splinting" to defecate. Mild cases of uterine prolapse do not require therapy unless the patient is symptomatic; in most cases of second- or third-degree prolapse, however, patients may be quite uncomfortable and desire therapy. Nonsurgical options, such as a pessary, are usually tried first if the patient desires conservative therapy. Operative repair for uterine prolapse is usually approached vaginally if the uterus is small. An abdominal approach may be preferred if the uterus is large or if the woman has had multiple previous pelvic procedures or has extensive endometriosis or other processes that may obliterate the cul-de-sac. In either approach, the uterosacral and cardinal ligaments must be carefully ligated and tied together, and the cul-de-sac must be obliterated to reduce the risk of subsequent enterocele and to properly suspend the vaginal vault.

Female↗
PubMed2000

Laparoscopic-assisted vaginal myomectomy.

STUDY OBJECTIVE: To evaluate the safety and efficacy of combined laparoscopic and vaginal approach in dealing with uterine myomas. DESIGN: Retrospective case study (Canadian Task Force classification II-2). SETTING: Tertiary care major teaching hospital. PATIENTS: Thirty-one women with symptomatic fundal and/or posterior wall uterine myomas. INTERVENTION: Laparoscopic-assisted vaginal myomectomy performed by one of the authors from July 1996 to December 1998. MEASUREMENTS AND MAIN RESULTS: Mean +/- SD operating time, blood loss, and length of hospital stay were 79.19+/-18.31 minutes, 150.00+/- 103.28 ml, and 3.10+/-0.75 days, respectively. No patients developed serious complications, and only two minor complications occurred. CONCLUSION: After laparoscopic inspection and location of uterine myomas, dealing with posterior and fundal uterine myomas by the vaginal route makes hemostasis and uterine repair easier than by purely laparoscopic approach.

Adult↗
PubMed2005

ACOG Committee Opinion. Number 311, April 2005. Appropriate use of laparoscopically assisted vaginal hysterectomy.

The technique used for hysterectomy should be dictated by the indication for the surgery, patient characteristics, and patient preference. Most patients requiring hysterectomy should be offered the vaginal approach when technically feasible and medically appropriate. If specific additional procedures that can be completed laparoscopically are anticipated before surgery, laparoscopically assisted vaginal hysterectomy may be an appropriate alternative to abdominal hysterectomy. The benefits of laparoscopically assisted vaginal hysterectomy must be weighed against the potentially increased risk and expense of two distinct operative procedures, laparoscopy and vaginal hysterectomy.

Female↗
PubMed1996

[Comparative prospective study of laparoscopic hysterectomy and abdominal hysterectomy].

Based on assembled findings, the authors assume that laparoscopically assisted vaginal hysterectomy is a real alternative of abdominal hysterectomy and extends the spectrum of indications to overcome contraindications of the vaginal approach in the treatment of benign diseases of organs of the lesser pelvis. In the investigated group of patients the advantages of the minimally invasive approach when evaluating convalescence parameters were confirmed. Introduction of LH had also a favourable impact on the interest in and extension of vaginal operations. It is essential to implement extensive prospective investigations which will evaluate objectively the contribution of endoscopic surgery and their effect on somatic, psychic, social and economic parameters.

Female↗
PubMed1995

Laparo-vaginal treatment of uterine procidentia.

The following is a description of a combined vaginal and laparoscopic repair of vaginal eversion with uterine prolapse (procidentia). There are few procedures that seek to correct the condition while preserving vaginal function. Among them are (1) vaginal approach for sacrospinous fixation, (2) abdominal sling procedures, and (3) abdominal and laparoscopic approaches for promontorial fixation. We are presenting a technical report of a modified sling procedure done via laparoscopy. This technique achieves the functional vaginal reconstruction and avoids the potentially dangerous bleeding associated with the sacral fixation. It has also been our experience that the sacrospinous fixation technique affords limited visual exposure, and henceforth the laparoscopic vaginal sling procedure may be a better alternative.

Female↗
PubMed2001

Management of ovarian dermoids without laparoscopy or laparotomy.

OBJECTIVE: To report experience of managing ovarian dermoids via the vaginal route. STUDY DESIGN: A series of 26 cases managed this way either with or without hysterectomy and for comparison 10 women managed by laparotomy and 6 who underwent laparoscopic ovarian cystectomy or oophorectomy were considered. RESULTS: The vaginal approach was successful in all patients, without need for laparoscopic assistance or a switch over to laparotomy. Spill was minimal or absent in the vaginal group and recovery significantly faster in the vaginal and laparoscopic groups compared to the laparotomy group. Hospital stay was slightly shorter in the vaginal than the laparoscopic group. No disposable material or equipment was used in the vaginal or laparotomy group. CONCLUSION: For mobile, benign ovarian teratoma, the vaginal route should be strongly considered to minimise invasive surgery, particularly when the operator is an experienced vaginal surgeon or laparoscopic equipment or laparoscopic surgeons are not easily available. Reduced spillage and speedier recovery are important advantages.

Adult↗
PubMed1996

Laparoscopically assisted vaginal hysterectomy. Single-surgeon technique with minimal assistance.

OBJECTIVE: To prospectively evaluate parameters of surgical outcome of a novel technique of laparoscopically assisted vaginal hysterectomy performed by a single surgeon with minimal surgical help from an inexperienced assistant. STUDY DESIGN: Four women who had indications for hysterectomy but relative contraindications to the strictly vaginal approach were consecutively entered into the study. The hysterectomy was accomplished with the Endo GIA 30, O'Connor-O'Sullivan self-retaining vaginal retractor, the ligature vaginal hysterectomy technique and one surgical assistant. RESULTS: The average operative time was 133 minutes (range, 105-167). Blood loss averaged 288 mL (range, 150-350). The average length of hospitalization was 62 hours (range, 36-72). The average time of convalescence was two weeks (range, one to three). CONCLUSION: Preliminary results from a series of four patients suggest that this procedure may be a viable and safe alternative for the single surgeon.

Adult↗
PubMed2004

Surgical management of pelvic organ prolapse in women.

BACKGROUND: Pelvic organ prolapse may occur in up to 50% of parous women. A variety of urinary, bowel and sexual symptoms may be associated with prolapse. OBJECTIVES: To determine the effects of surgery in the management of pelvic organ prolapse. SEARCH STRATEGY: We searched the Cochrane Incontinence Group trials register (8 June 2004) and reference lists of relevant articles. We also contacted researchers in the field. SELECTION CRITERIA: Randomised or quasi-randomised controlled trials that included surgical operations for pelvic organ prolapse. DATA COLLECTION AND ANALYSIS: Trials were assessed and data extracted independently by at least two reviewers. Four investigators were contacted for additional information with two responding. MAIN RESULTS: Fourteen randomised controlled trials were identified evaluating 1004 women. Abdominal sacral colpopexy was better than vaginal sacrospinous colpopexy in terms of a lower rate of recurrent vault prolapse (RR 0.23, 95% CI 0.07 to 0.77) and less dyspareunia (RR 0.39, 95% CI 0.18 to 0.86), but the trend towards a lower re-operation rate for prolapse following abdominal sacrocolpopexy was not statistically significant (RR 0.46, 95% CI 0.19 to 1.11). However, the vaginal sacrospinous colpopexy was quicker and cheaper to perform and women had an earlier return to activities of daily living. The data were to evaluate other clinical outcomes and adverse events. For the anterior vaginal wall prolapse, standard anterior repair was associated with more recurrent cystoceles than when supplemented by Vicryl mesh overlay (RR 1.39, 95% CI 1.02 to 1.90) but data on morbidity and other clinical outcomes were too few for reliable comparisons. For posterior vaginal wall prolapse, the vaginal approach was associated with a lower rate of recurrent rectocele and/or enterocele than the transanal approach (RR 0.24, 95% CI 0.09 to 0.64), although there was a higher blood loss and postoperative narcotic use. However, data on the effect of surgery on bowel symptoms and the use of polyglactin mesh overlay on the risk of recurrent rectocele were insufficient for meta-analysis.Meta-analysis on the impact of pelvic organ prolapse surgery on continence issues was limited and inconclusive, although about 10% of women developed new symptoms after surgery. However, more women with occult stress urinary incontinence developed postoperative stress urinary incontinence after endopelvic fascia plication alone than after endopelvic fascia plication and tension-free vaginal tape (RR 5.5, 95% CI 1.36 to 22.32). REVIEWERS' CONCLUSIONS: Abdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse and dyspareunia than the vaginal sacrospinous colpopexy. These benefits must be balanced against a longer operating time, longer time to return to activities of daily living and increased cost of the abdominal approach. The use of a polyglactin mesh overlay at the time of anterior vaginal wall repair may reduce the risk of recurrent cystocele. Posterior vaginal wall repair may be better than transanal repair in the management of rectoceles in terms of recurrence of prolapse. Adequately powered randomised controlled clinical trials are urgently needed.

Female↗
PubMed1996

[Association of Bologna-type cervicocystopexy and Richter-type sacro-spinal fixation in low approach treatment of genital prolapse. Apropos of 18 cases].

We report our experience with Richter spinofixation in association with Bologna cervicocystopexy. Eighteen patients underwent surgery for voluminous prolapse. Spinofixation did not lead to complications. This technique allows a vaginal approach in cases where only an abdominal operation was possible before. Incontinence results were similar to those with the Bologna procedure alone with the additional improvement of allowing a permeable vagina. Currently mean follow-up is 13 months, but these encouraging results suggest that this association should be continued in the future.

Aged↗