- Email: [email protected]
Laparoscopic approach for severe pelvic vault prolapse
August ] 996, Vok 3, No. 4 Supplement The Journal of the American Association of Gynecologic Laparoscopists
! to 5 on a linear analog scale, described wound appearance, and reported their ultimate satisfaction. The operating surgeons also assessed the wound outcome at the 4-week follow-up visit, although they did not know the material used for wound closure.
present, these were also repaired laparoscopically. All patients had a quality of life questionnaire, 24-hour urolog, transperineal ultrasound, cystourethroscopy, cough stress test, and multichannel urodynamics. At 6 weeks they all had a negative ultrasound, cough stress test, and cystometrogram. At 1 year the complete evaluation was repeated. Five women were lost to follow-up. Four of 41 patients had recurrent GSI. One patient had a grade 1 cystocoele with no other signs of pelvic vault prolapse. These are cure rates of 91% and 98% for GSI and pelvic vault prolapse, respectively. The urodynamic studies appear to be comparable with those reported in laparotomy Burch repairs. These findings are encouraging for laparoscopic procedures, but they are short term and it is essential that the patients be followed for 5 years for the data to be clinically relevant.
Laparoscopic Approach for Severe Pelvic Vault Prolapse JW Ross. Center for Reproductive Medicine and Laparoscopic Surgery, Department of Obstetrics and Gynecology, Salinas Valley Memorial Hospital, Salinas, CA.
Laparoscopic repair of grade 1 to 4 pelvic vault prolapse was performed in 103 patients. All women filled in quality of life questionnaires, and had standing vault examination, transperineal ultrasound examination, and cough stress test. Laparoscopic Burch, paravaginal repair, central pubovesical repair, culdoplasty, sacral colpopexy, and posterior vaginal repair were performed after the type and extent of the prolapse were determined. The majority of the procedures were done as day surgery. Almost all women were able to void spontaneously. At 6 weeks all patients had repeat questionnaires, vault examination, transperineal ultrasound, and cough stress test. No recurrences of vault prolapse or of genuine stress incontinence (GSI) were found at that time. Eighty-nine women were reexamined at 1 one year with the questionnaires, ultrasound vault examination, cough stress, and urodynamics. Of the 89 with GSI, 83 (93%) were objectively dry. Five (6%) of the 89 had recurrent vault prolapse. The laparoscopic cure rate of GSI is comparable with that of open repairs.
Routine Pelvic Support Procedures for Laparoscopic Vaginal Hysterectomies JW Ross. Center for Reproductive Medicine and Laparoscopic Surgery, Salinas Valley Memorial Hospital, Salinas, CA.
Multichannel Urodynamics for Laparoscopic Burch and Pelvic Vault Repairs JW Ross. Center for Reproductive Medicine and Laparoscopic Surgery, Salinas Valley Memorial Hospital, Salinas, CA.
This is a 1-year preliminary report of a 5-year study. Forty-six women with genuine stress incontinence (GSI) were evaluated with multichannel urodynamics before laparoscopic Burch repair and 1 year postoperatively. Reports conclude that as many as 18% of patients develop enteroceles or rectoceles in the first 5 years after Burch repair. To see if prophylactic posterior suspension could prevent this delayed complication, all women had at least a modified culdoplasty. If paravaginal defects, rectoceles, or enteroceles were
$43
Prophylactic pelvic support procedures were performed with laparoscopic-assisted vaginal hysterectomies (LAVH) in 91 women to see if the frequency of future pelvic vault prolapse could be reduced. The patients were divided into two groups. In group 1,43 women were treated with simple LAVH using a suture bipolar technique. In group 2, 48 women had LAVH and prophylactic modified culdoplasties for vault support. Indications for hysterectomy were routine, excluding only patients with significant pelvic relaxation. The work-up included quality of life questionnaire, pelvic ultrasound, standing vault examination, and cough stress test. The study design required follow-up at 6 weeks and 1 year. At 6 weeks all patients were asymptomatic. At 1 year, in group 1, 6 of 40 women had findings of pelvic prolapse and 3 had mild stress incontinence. In group 2, two patients had positive fmdings and one had stress incontinence. The occurrence rates of 15% and 4% are not statistically significant. It might well represent a trend of increased pelvic prolapse in women who do not have adequate concomitant pelvic support procedures. It will be necessary to follow these patients for 5 years to prove or disprove this concept.
! to 5 on a linear analog scale, described wound appearance, and reported their ultimate satisfaction. The operating surgeons also assessed the wound outcome at the 4-week follow-up visit, although they did not know the material used for wound closure.
present, these were also repaired laparoscopically. All patients had a quality of life questionnaire, 24-hour urolog, transperineal ultrasound, cystourethroscopy, cough stress test, and multichannel urodynamics. At 6 weeks they all had a negative ultrasound, cough stress test, and cystometrogram. At 1 year the complete evaluation was repeated. Five women were lost to follow-up. Four of 41 patients had recurrent GSI. One patient had a grade 1 cystocoele with no other signs of pelvic vault prolapse. These are cure rates of 91% and 98% for GSI and pelvic vault prolapse, respectively. The urodynamic studies appear to be comparable with those reported in laparotomy Burch repairs. These findings are encouraging for laparoscopic procedures, but they are short term and it is essential that the patients be followed for 5 years for the data to be clinically relevant.
Laparoscopic Approach for Severe Pelvic Vault Prolapse JW Ross. Center for Reproductive Medicine and Laparoscopic Surgery, Department of Obstetrics and Gynecology, Salinas Valley Memorial Hospital, Salinas, CA.
Laparoscopic repair of grade 1 to 4 pelvic vault prolapse was performed in 103 patients. All women filled in quality of life questionnaires, and had standing vault examination, transperineal ultrasound examination, and cough stress test. Laparoscopic Burch, paravaginal repair, central pubovesical repair, culdoplasty, sacral colpopexy, and posterior vaginal repair were performed after the type and extent of the prolapse were determined. The majority of the procedures were done as day surgery. Almost all women were able to void spontaneously. At 6 weeks all patients had repeat questionnaires, vault examination, transperineal ultrasound, and cough stress test. No recurrences of vault prolapse or of genuine stress incontinence (GSI) were found at that time. Eighty-nine women were reexamined at 1 one year with the questionnaires, ultrasound vault examination, cough stress, and urodynamics. Of the 89 with GSI, 83 (93%) were objectively dry. Five (6%) of the 89 had recurrent vault prolapse. The laparoscopic cure rate of GSI is comparable with that of open repairs.
Routine Pelvic Support Procedures for Laparoscopic Vaginal Hysterectomies JW Ross. Center for Reproductive Medicine and Laparoscopic Surgery, Salinas Valley Memorial Hospital, Salinas, CA.
Multichannel Urodynamics for Laparoscopic Burch and Pelvic Vault Repairs JW Ross. Center for Reproductive Medicine and Laparoscopic Surgery, Salinas Valley Memorial Hospital, Salinas, CA.
This is a 1-year preliminary report of a 5-year study. Forty-six women with genuine stress incontinence (GSI) were evaluated with multichannel urodynamics before laparoscopic Burch repair and 1 year postoperatively. Reports conclude that as many as 18% of patients develop enteroceles or rectoceles in the first 5 years after Burch repair. To see if prophylactic posterior suspension could prevent this delayed complication, all women had at least a modified culdoplasty. If paravaginal defects, rectoceles, or enteroceles were
$43
Prophylactic pelvic support procedures were performed with laparoscopic-assisted vaginal hysterectomies (LAVH) in 91 women to see if the frequency of future pelvic vault prolapse could be reduced. The patients were divided into two groups. In group 1,43 women were treated with simple LAVH using a suture bipolar technique. In group 2, 48 women had LAVH and prophylactic modified culdoplasties for vault support. Indications for hysterectomy were routine, excluding only patients with significant pelvic relaxation. The work-up included quality of life questionnaire, pelvic ultrasound, standing vault examination, and cough stress test. The study design required follow-up at 6 weeks and 1 year. At 6 weeks all patients were asymptomatic. At 1 year, in group 1, 6 of 40 women had findings of pelvic prolapse and 3 had mild stress incontinence. In group 2, two patients had positive fmdings and one had stress incontinence. The occurrence rates of 15% and 4% are not statistically significant. It might well represent a trend of increased pelvic prolapse in women who do not have adequate concomitant pelvic support procedures. It will be necessary to follow these patients for 5 years to prove or disprove this concept.