Ailar AssambayevaSechenov University, Russian Federation
Title: Median timesh colporrhaphy with transobturator ligature fixation of the vaginal cuff as a method of surgical treatment for post-hysterectomy pelvic hernia
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.
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.