Ailar Assambayeva
Sechenov University, Russian FederationTitle: Median timesh colporrhaphy with transobturator ligature fixation of the vaginal cuff as a method of surgical treatment for post-hysterectomy pelvic hernia
Abstract
Pelvic organ prolapse is a common pathology, the prevalence of which
increases towards pre- and postmenopausal period. Based on an overview of the
literature, the disease is diagnosed in 41% of women aged 50 to 79 years. One
of the important predisposing factors is hysterectomy, the frequency of which
does not tend to diminish.
Despite the development and
use of numerous methods of conservative and surgical treatment including the application
of own and alloplastic materials, the number of relapses of the disease remains
significant and ranges from 33 to 40%, which indicates the extreme complexity
of the problem and unacceptability of a single standard approach to its
solution.
We have developed an original method for surgical correction of
post-hysterectomy pelvic hernia using a combination of titanium mesh implants
and transobturator ligature fixation of the vaginal cuff during median
colporrhaphy. The analysis of clinical observation and dynamic follow-up for
3-24 months of 26 patients aged 65 to 78 years with post-hysterectomy pelvic
hernia, who were operated according to the developed four-stage surgical
program by transvaginal approach, showed the absence of pelvic organ prolapse
during gynecological examination, Valsalva maneuver, and transperineal
ultrasound. The questionnaire survey of patients showed their satisfaction with
the results of surgery and improvement of their quality of life.
Conclusion: Median Timesh-colporrhaphy with transobturator ligature
fixation of the vaginal cuff in patients of elderly and senile age with
post-hysterectomy pelvic hernia when slightly prolonging the operation duration
contributes to strengthening and firm consolidation of the vaginal walls,
elevation of the vaginal cuff and adjacent organs, improving the condition of
the surgical scar and, therefore, improving patients’ quality of life,
preventing disease recurrence and decrease mesh-associated complications.
Biography
Anatoly Ishchenko, the head the Department of Obstetrics and
Gynecology No. 1 of Sechenov University. Till now, A.I.Ishchenko has 45 year
clinical practice and 21 years of teaching experience in obstetrics and
gynecology. For over 18 years professor A.I.Ishchenko the head the Department
of Obstetrics and Gynecology No. 1 of Sechenov University. Also, he is the
author of over 600 scientific papers in the field of Obstetrics and Gynecology.
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