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Hysteropexy with single-incision vaginal support system associated with a modified culdoplasty for enterocele prevention.
J Obstet Gynaecol 2019; :1-6JO

Abstract

Our study assessed the safety and clinical outcomes of hysteropexy with a single-incision mesh associated with a modified culdoplasty, for the surgical management or prevention of enterocele, in women with pelvic organ prolapse (POP). We carried out a 1-year prospective single-cohort study, including 51 women with symptomatic, multi-compartmental POP. Anatomical outcome was assessed with a POP-Q system and the subjective outcomes were assessed using ICSQ-SF and PGI-I. One-year follow-up data were available for 48 out of 51 patients. The POP-Q cure rate was 91%, 83% of patients were satisfied or very satisfied (PGI-I ≤ 2). No major complications occurred; the most common minor complications were mesh erosion (6%) and pelvic pain (8%). Lower urinary tract dysfunctions arose in 16% of the patients. Anatomical prolapse recurrence (POP-Q stage ≥2) in anterior or apical compartments occurred in four patients (8%). No case of de novo prolapse occurred in the posterior compartment. None of the patients required further surgery for recurrent prolapse. This standardised procedure provided satisfactory 'restitutio ad integrum' of the vaginal anatomy and symptom relief. Impact statement What is already known on this subject? The post-surgical evidence of de novo prolapse in untreated compartments is well-known, especially in prosthetic surgery. The insertion of polypropylene mesh causes a vigorous support, consequently the forces on the pelvic floor are transmitted to the least consolidated vaginal compartment. A lack of simultaneous repair of all the segments involved in the POP increases the risk of surgical recurrence even in those areas that did not appear to be pre-operatively affected by the uterine descensus. What the results of this study add? Our prospective study showed that hysteropexy with a single-incision vaginal support system plus a modified culdoplasty was able to prevent the enterocele and the occurrence of prolapse in the posterior compartment, by closing the Douglas pouch and restoring the connection of the rectovaginal septum with the apical support. What the implications are of these findings for clinical practice and/or further research? This study may be relevant for clinicians in selecting the technique for pelvic floor surgery, and it may be of interest for researchers investigating the reasons for de novo occurrence of posterior segment prolapse.

Authors+Show Affiliations

a Women and Children's Department, Unit of Obstetrics and Gynaecology, ARNAS 'Garibaldi-Nesima' , Catania , Italy.a Women and Children's Department, Unit of Obstetrics and Gynaecology, ARNAS 'Garibaldi-Nesima' , Catania , Italy.a Women and Children's Department, Unit of Obstetrics and Gynaecology, ARNAS 'Garibaldi-Nesima' , Catania , Italy.b Azienda Ospedaliero-Universitaria Policlinico-Vittorio Emanuele , Catania , Italy.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

31390918

Citation

Ettore, Giuseppe, et al. "Hysteropexy With Single-incision Vaginal Support System Associated With a Modified Culdoplasty for Enterocele Prevention." Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology, 2019, pp. 1-6.
Ettore G, Torrisi G, Ettore C, et al. Hysteropexy with single-incision vaginal support system associated with a modified culdoplasty for enterocele prevention. J Obstet Gynaecol. 2019.
Ettore, G., Torrisi, G., Ettore, C., & Guardabasso, V. (2019). Hysteropexy with single-incision vaginal support system associated with a modified culdoplasty for enterocele prevention. Journal of Obstetrics and Gynaecology : the Journal of the Institute of Obstetrics and Gynaecology, pp. 1-6. doi:10.1080/01443615.2019.1617256.
Ettore G, et al. Hysteropexy With Single-incision Vaginal Support System Associated With a Modified Culdoplasty for Enterocele Prevention. J Obstet Gynaecol. 2019 Aug 8;1-6. PubMed PMID: 31390918.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hysteropexy with single-incision vaginal support system associated with a modified culdoplasty for enterocele prevention. AU - Ettore,Giuseppe, AU - Torrisi,Gabriella, AU - Ettore,Carla, AU - Guardabasso,Vincenzo, Y1 - 2019/08/08/ PY - 2019/8/9/entrez PY - 2019/8/9/pubmed PY - 2019/8/9/medline KW - prolapse KW - Hysteropexy KW - enterocele KW - mesh KW - pelvic organ prolapse SP - 1 EP - 6 JF - Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology JO - J Obstet Gynaecol N2 - Our study assessed the safety and clinical outcomes of hysteropexy with a single-incision mesh associated with a modified culdoplasty, for the surgical management or prevention of enterocele, in women with pelvic organ prolapse (POP). We carried out a 1-year prospective single-cohort study, including 51 women with symptomatic, multi-compartmental POP. Anatomical outcome was assessed with a POP-Q system and the subjective outcomes were assessed using ICSQ-SF and PGI-I. One-year follow-up data were available for 48 out of 51 patients. The POP-Q cure rate was 91%, 83% of patients were satisfied or very satisfied (PGI-I ≤ 2). No major complications occurred; the most common minor complications were mesh erosion (6%) and pelvic pain (8%). Lower urinary tract dysfunctions arose in 16% of the patients. Anatomical prolapse recurrence (POP-Q stage ≥2) in anterior or apical compartments occurred in four patients (8%). No case of de novo prolapse occurred in the posterior compartment. None of the patients required further surgery for recurrent prolapse. This standardised procedure provided satisfactory 'restitutio ad integrum' of the vaginal anatomy and symptom relief. Impact statement What is already known on this subject? The post-surgical evidence of de novo prolapse in untreated compartments is well-known, especially in prosthetic surgery. The insertion of polypropylene mesh causes a vigorous support, consequently the forces on the pelvic floor are transmitted to the least consolidated vaginal compartment. A lack of simultaneous repair of all the segments involved in the POP increases the risk of surgical recurrence even in those areas that did not appear to be pre-operatively affected by the uterine descensus. What the results of this study add? Our prospective study showed that hysteropexy with a single-incision vaginal support system plus a modified culdoplasty was able to prevent the enterocele and the occurrence of prolapse in the posterior compartment, by closing the Douglas pouch and restoring the connection of the rectovaginal septum with the apical support. What the implications are of these findings for clinical practice and/or further research? This study may be relevant for clinicians in selecting the technique for pelvic floor surgery, and it may be of interest for researchers investigating the reasons for de novo occurrence of posterior segment prolapse. SN - 1364-6893 UR - https://www.unboundmedicine.com/medline/citation/31390918/Hysteropexy_with_single-incision_vaginal_support_system_associated_with_a_modified_culdoplasty_for_enterocele_prevention L2 - http://www.tandfonline.com/doi/full/10.1080/01443615.2019.1617256 DB - PRIME DP - Unbound Medicine ER -