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At least 19 recordsLinked to original sources
PubMed2003

Vaginal evisceration after hysterectomy: the repair by a laparoscopic and vaginal approach with a omental flap.

BACKGROUND: Vaginal evisceration is generally repaired by vaginal or abdominal route. We describe two cases of vaginal evisceration using a combined laparoscopic and vaginal approach employing an omental flap. CASES: Case 1: A radical abdominal hysterectomy was performed in a premenopausal patient for a FIGO IB1 cervical cancer. Four months later, she was found to have a vaginal cuff dehiscence which was repaired by a vaginal approach. Two months later, she had a vaginal cuff evisceration which was repaired using a combined laparoscopic and vaginal approach employing an omental flap with good success. Case 2: A postmenopausal woman who underwent an abdominal hysterectomy and pelvic lymphadenectomy for a FIGO IB endometrial cancer was noted to have a vaginal evisceration two months after primary surgery. This was also successfully repaired using a combined laparoscopic and vaginal approach employing an omental flap. CONCLUSION: The combined laparoscopic and vaginal approach with omental flap is effective for repair of a vaginal cuff dehiscence with bowel evisceration. The addition of laparoscopy provides an opportunity for inspection of the small bowel, the peritoneal toilet, and mobilization of an omental flap.

Adult↗
PubMedDate not supplied

[Treatment of urinary incontinence by vaginal approach].

The vaginal route is routinely used for surgical cure of exersion-induced urinary incontinence. This technique has the advantage of being rapid and easily performed during a short hospital stay. Long-term results however, have been debated. Certain factors have been identified in the literature which would affect long-term failure. These factors indicate that the "ideal" vaginal route should be based on the Burch operation starting at the upper portion and working downwardly. Finally, sphincter failure or detrusor instability must be eliminated before an operation for exertion-induced incontinence can be indicated since such a combination would modify the procedure.

Female↗
PubMed1999

[Interposition of a synthetic mesh by vaginal approach in the cure of genital prolapse].

There are two goals for treatment if vaginal prolapse, restauration of normal function and anatomy and prevention of recurrence. Most operations described for replacement and maintenance of prolapsed organs in the pelvic cavity do not treat the cause of the prolapse which is diastasis of levator muscles and, in most cases, failure of the pelvic fascia. By analogy with the treatment of parietal hernias, the concept of a synthetic graft to reinforce failing fascias and restauration of normal anatomy has been proposed. From June 1994 through March 1999, 46 patients were treated for genital prolapse by a vaginal approach with positioning of a polyester mesh sutured to the vaginal angles. No major complication was observed. One mesh exposure occurred 4 months after treatment of a cystocele with vaginal hysterectomy and was treated by partial resection with good outcome. With a 5-year follow-up (median 26 months), all patients are totally satisfied. No recurrence of prolapse was observed. Sexual function was preserved without dyspareunia. This study demonstrates the feasability and efficacy of using a synthetic graft in the cure via a vaginal approach of genital prolapse. Complementary studies are necessary to evaluate the indications for which the procedure can be proposed and how it should be integrated in to schemes with other procedures.

Female↗
PubMed1989

Management of vaginal vault prolapse: retrospective comparison of abdominal versus vaginal approach.

Twenty-two cases of vaginal vault prolapse were managed by our service over the five-year period ending 12/31/86. Eleven cases were repaired by a transvaginal sacrospinous colpopexy and 11 by a transabdominal suspension. There were no differences in demographic data or preoperative symptoms between these groups. The vaginal procedure required less operative time, had less blood loss, averaged fewer hospital days and overall was more economical. The complication rates and follow-up results of the two techniques were comparable. The abdominal procedure is considered preferable for patients with specific indications for an abdominal approach. The vaginal procedure appears to be more appropriate when the abdominal approach is not otherwise indicated. The experience of the surgeon and individualization of the patient are important factors in choosing the best approach for the repair.

Female↗
PubMed1984

[Urethrovesical suspension with autologous fascia tissue by the purely vaginal approach--the short-arm sling operation].

Sling operations are a last result following failures of routine vaginal surgery for stress incontinence. The present paper describes a new operative treatment of stress incontinence by using pre-existing urethral fixing ligaments. The complex reunion of these ligaments after their preparation results in a sling formation with autologous tissue. The ligaments are 1-2 cm long from their origin. The urethra is directly under the insertion of the ligaments. Their presence in all cases permits the treatment of incontinence of all types and degrees with a reliable fixation of the urethra to the symphysis. The regional anatomy must be well observed in all cases. Plication of the remaining vesico-vaginal septum eliminates the always present vaginal descent. The numerous advantages over all other sling operations of this short arm sling operation are described in detail. Only the incorporation of endopelvic fascia into the carrying structures is a reliable indication for postoperative continence. The ideal nutrition of the fixating ligaments permits full activity four weeks after the operation and integration into the working life. Among the 332 cases of stress incontinence which were cured by this method no true recurrence was observed. A few patients had stress incontinence under extreme stress and were considered as failures. The short arm sling operation shows its advantages by reliable long term results, the pure vaginal approach without costly foreign materials and the lack of infection are other advantages.

Fasciotomy↗
PubMed1981

Retropubic urethrocystopexy: vaginal approach.

A modification of the classic Marshall-Marchetti-Krantz (MMK) operation which includes suspending the urethrovesical junction to the pubis by the vaginal approach is presented. This offers the advantages of a shorter operating time, the lack of an abdominal incision, and the concomitant repair of other pelvic anatomic defects through the vagina, with a cure rate at least equal to, if not better than, that associated with the abdominal route. The study group of 25 patients had less morbidity, a 1-day decrease in hospital stay, and 1 1/2 fewer days of catheter drainage compared to a matched control group of MMK operations done abdominally in this preliminary report. A 96% cure and improvement rate of the symptoms of stress incontinence was shown at the 6-week postoperative visit. This compares to a 92% rate in the control series of abdominal MMKs. The permanency of the procedure will have to be evaluated critically as more cases are added and sufficient time elapses to see if these good initial results hold up.

Adult↗
PubMed1995

New and simplified vaginal approach for correction of urinary stress incontinence in women.

Twenty-four patients with urodynamically confirmed urinary stress incontinence were operated upon with a new and simplified vaginal approach. This new technique is a simplification of a previously described transabdominal surgical method, in which a two-component fibrin sealant (Tisseel) was used. The sealant resulted in an excess of fibrin, which induced fibrosis, securing the urethrovesical junction in an elevated position to the retropubic periosteum. In the present study, the sealant was deposited retropubically with a specially designed needle through the anterior vaginal wall. A great advantage with this procedure is that only local anesthesia is used and the patient can leave the outpatient clinic 1 hour after the operation. The minimum duration of the follow-up period was 18 months. The success rate was as high as 63%, and no side effects were observed.

Adult↗
PubMed1999

Five-layer repair of rectovaginal fistula using a vaginal approach. A case report.

We present a case of a rectovaginal fistula which was revealed as an incidental finding at the time of posterior colporrhaphy. We describe a previously unreported 5-layer repair through a vaginal approach in preference to the more frequently reported approaches of endoanal flap or conversion to a fourth degree tear. The diagnosis and management of rectovaginal fistulas is discussed.

Female↗
PubMed1978

Transabdominal repair of cystocele, a 20 year experience, compared with the traditional vaginal approach.

In patients with pelvic floor relaxation and concomitant pelvic pathology indicating the abdominal approach the so-called "combined" operation is not a satisfactory technique. During the course of the total abdominal hysterectomy the cystocele can well be repaired by mobilizing the bladder and excising the relaxed vaginal mucosa. The technique is described and its efficiency in 76 cases is compared to 109 cases repaired by the traditional vaginal approach. Over a 20 year period, 92% of the former as compared to 78% of the latter showed a satisfactory result. Both series revealed that time plus anatomic stress are the major factors in those patients in whom the pelvic floor relaxation recurred.

Abdomen↗
PubMed1984

[Vaginal approach to non-irradiated vesicovaginal fistula].

We herein report our experience in the transvaginal repair of 30 consecutive cases of non-radiated Vesicovaginal Fistulae. The new principles applied include: early surgery as soon as the fistula is recognized, no excision of the fistulous tract to avoid retraction and bleeding of the margins as well as to provide protection of the ureteric orifices, closure of the intact fistula in two layers, rotation and advancement of the vaginal flap to cover the fistula avoiding overlapping of suture lines, and finally assurance of adequate bladder decompression with both a suprapubic tube and an urethral catheter. In the followup period of 6 to 72 months, we experienced a 94% success rate at primary repair with only two failures which are now dry after subsequent trans-vaginal closure. In spite of size, location or proximity to the ureteric orifices, the vaginal approach has proved to be amenable in all cases with minimal discomfort for the patient, a shorter hospital stay and equal or even better results than the more extensive abdominal approach.

Female↗
PubMed1997

[Suburethral sling urethropexy: a vaginal approach].

Considering the poor long term results with the bladder neck suspensions, the poor results with the retropubic approach in obese or intrinsic sphincter deficiency and the complexity of the classical retropubic sling procedure, a simple vaginal sling urethropexy approach was developed. The vaginal mucosa is opened at 12 o'clock under the urethra. Dissection of the endopelvic fascia is undertaken. Polypropylene sutures are placed at the 4 corners of a free 2 x 4 cm rectus abdominis muscle flap which is suspended under the bladder neck transvaginally. Polypropylene sutures are tied at the rectus muscle through a 3 cm suprapubic incision. 25 patients were operated by one single surgeon. 7 had previous uretropexies. Previous hysterectomies: 8. Average age: 57. Average weight: 67.6. Severe stress incontinence was demonstrated in 23 patients. 9 patients had mixed incontinence. Average protective pads per day pre-op: 4.1. OR time: 93.8 min. Blood loss was minimal. 10 patients had transient post op retention (24 days average). 1 bladder perforation. 2 incisional hernias. 6 suprapubic wound infections. Average hospital stay: 5.95 days. The average follow up was 22 months. All patients were either cured (76%) or improved. 73% were satisfied (questionnaire). Despite a longer OR time, and the incidence of transient post op retention, this vaginal sling urethropexy approach is a simple and efficient procedure. It can be useful in previously operated or obese patients. It is easier to perform than the more conventional retropubic or combined (retropubic and vaginal) sling urethropexy.

Dissection↗
PubMed1977

[Short and long-term results of the treatment of vesicovaginal fistula by the vaginal approach (author's transl)].

Gynecologists prefer the vaginal route for closure of vesicovaginal fistulae. Urologists, however, have some doubts as to the long-term results as far as proper function is concerned. The purpose of this investigation was to discover the limits of the vaginal fistula operations with reference to patients at the Department of Gynecology and Obstetrics, University Erlangen-Nürnberg. From 1962 to 1976, 40 women with vesicovaginal, urethrovaginal and vesicocervicovaginal fistulae were treated. Forty-five operations were necessary. In one patient, surgery in two sessions was planned from the beginning. Besides 4 obstetric fistulae, gynecological operations were the original cause of the fistulae in 34 cases. Two women had actinic fistulae (overdosage of intracavitary radium application). Attempts to close the fistulae here failed utterly. The Latzko technique was used in 27 women. Füth's method, in 7. In the remaining cases various vaginal procedures were chosen, for example, interposition of the bulbocavernosus muscle or interposition of the uterus. Three late complecations with recess formation (in 2 cases with concrements) after the Latzko operation could be treated trans-urethrally. Ten years after a Füth's operation one patient had to undergo vaginal surgery for an urethral diverticulum with concrement. The precedure of choice in the typical post-hysterectomy fistula is the Latzko operation. For fistulae patients who still have a uterus, other vaginal procedures are preferable. No attempt should be made to close a radiogenic fistula--usually following inadequate radiation therapy--by a vaginal operation. Details of our indications are fully dealt with in the discussion.

Female↗
PubMed1987

[Fixation of Gore-Tex slings to the pubococcygeal tendons: a simple technic of treating stress urinary incontinence using only the vaginal approach].

A new technique for curing urinary stress incontinence using the vaginal route and a sling of synthetic material, GORE-TEX, is described. The sling is fixed at one end on the junction between the cervix and the urethra in the centre, and at the edges to the tendons of the pubo-coccygeal muscles. The situation is worked out from a urethral profile. Thirty cases have been treated and the results have been satisfactory. If they are confirmed by other operators it will show that a new reliable technique which is very simple and non-aggressive can be used.

Adult↗
PubMed1999

[Artificial sphincter implantation in women with urinary incontinence using a combined abdomino-vaginal approach].

OBJECTIVE: The artificial sphincter has been utilized for urinary incontinence due to intrinsic sphincteric insufficiency, with good fixation of the urethra and a maximum urethral closing pressure of 20-30 cms H2O, or after failed attempts at correction using other techniques. This procedure is difficult to perform since the patients have generally undergone several operations and it is necessity to prepare the cleavage between the urethra and vagina. We propose a modified combined vaginal and suprapubic approach of the technique described by Appell and Abbassian in 1988 for enhanced exposure of the urethra and bladder neck and easy access. METHODS: The modified combined abdominovaginal approach has been utilized in 18 females aged 16-62 years since 1995. RESULTS: 16 patients were continent (88%). One patient (5.5%) required removal of the artificial sphincter due to infection. Another patient (5.5%) has mild incontinence and requires 2 pads a day. Four patients (22%) with detrusor instability are receiving anticholinergics. Three patients (16%) with an underlying neurogenic incontinence require intermittent catheterization. Fourteen patients (77.7%) have type III stress urinary incontinence. We performed the Kelly procedure in 10 patients (55.5%), the Marshall-Marcetti-Kranz in 7 (38.8%), Gittes in 3 (16.6%), and 2 patients (11.1%) had a sling procedure. Two techniques were simultaneously performed in some patients. CONCLUSIONS: Although the number of patients in this series is small, the fact that only one case required removal of the artificial spincter due to infection indicates that this is a useful alternative approach that significantly facilitates implantation of the artificial sphincter in these patients.

Abdomen↗