Anterior vaginal duvar prolapsusunda meş cerrahisi ve ön onarım sonuçlarının karşılaştırılması

Year 2018, Volume: 43 Number: Supplement 1, 248 - 253, 29.12.2018

Gökmen Sukgen , Aşkı Ellibeş Kaya

Abstract

Amaç: Bu çalışmanın amacı anterior vaginal duvar prolapsusunda klasik ön onarım ile meş cerrahisi onarımın 12 aylık takip sonuçlarını karşılaştırmaktır.

Gereç ve Yöntem: Bu retrospektif çalışma; Pelvik Organ Prolapsusu Sınıflandırma Sistemi’ne (POP-Q) göre Grade II veya üzerinde anterior vaginal kompartman defekti olan 69 semptomatik hasta ile yapıldı. Otuz-altı hastaya klasik ön onarım uygulandı (Grup 1), otuz-üç hastaya meş cerrahisi ile ön kompartman onarımı yapıldı (Grup 2). Operasyon şekli, süresi, 6. ve 12. aylarda hasta memnuniyetleri, objektif ve subjektif kür oranları, operasyon sonrası ağrı skorları görsel analog skala (VAS) kullanılarak kaydedildi.

Bulgular: Hasta memnuniyeti Grup 2’de istatistiksel olarak anlamlı oranda fazlaydı. Cerrahi sonrası 12.aydaki objektif kür oranları Grup 2’de %87.8 ve Grup 1’de %61.1 bulundu. Fark istatistiksel olarak anlamlıydı. 12.aydaki subjektif kür oranları Grup 2’de %90.9 ve Grup 1’de %69.4 bulundu. Operasyon süresinin Grup 1’de istatistiksel olarak anlamlı oranda uzun olduğu saptandı. Gruplar arası ameliyatın ilk günü ve birinci yılı VAS ağrı skorlarında fark izlenmedi.

Sonuç: Meş cerrahisi ile ön kompartman onarımı yüksek objektif kür oranları ve yüksek hasta memnuniyeti nedeniyle avantajlı görünmektedir.

Keywords

Pelvik organ prolapsusu, meş, meş onarımı, ön onarım, ön vaginal duvar, ön vaginal prolapsus

Comparison of anterior colporrhaphy and repair with mesh for anterior vaginal wall prolapse

Abstract

Purpose: The aim of this study was to compare anterior colporrhaphy versus mesh repair as surgical management of anterior vaginal prolapse at the 12-months follow-up.

Materials and Methods: This retrospective study was performed on 69 patients who were diagnosed with symptomatic anterior vaginal compartment defect (Grade II or higher) according to the Pelvic Organ Prolapse Quantification (POP-Q) system. Thirty-six of these patients underwent conventional colporrhaphy anterior (Group 1), thirty-three patients (Group 2) were treated with anterior repair via mesh application. Operation type and duration, patient satisfaction and objective and subjective cure rates, postoperative pain score using visual analog scale (VAS) scores were recorded at 6-months and 12-months.

Results: Patient satisfaction was significantly higher in Group 2. Objective cure rates at 12-months after surgery were found 87.8% in Group 2 and 61.1% in Group 1; the difference was statistically significant. Subjective cure rates were determined as 90.9% in group 2 and 69.4% in Group 1. The duration of operation was confirmed to be significantly longer in the mesh group than Group 1. No significant differences were found between one day after and one year after surgery, in comparisons of our groups regarding VAS score for pelvic pain.

Conclusion: The anterior repair with mesh procedure seems to be advantageous due to the higher objective cure rate and patient satisfaction for the treatment of anterior compartment defects. 

Keywords

Pelvic organ prolapse, mesh, mesh repair, anterior colporrhaphy, anterior vaginal wall, anterior vaginal prolapse

References

• 1. Doaee M, Moradi-Lakeh M, Nourmohammadi A, Razavi-Ratki SK, Nojomi M. Management of pelvic organ prolapse and quality of life: a systematic review and meta-analysis. Int Urogynecol J. 2014;25(2):153–63.
• 2. Swift S, Woodman P, O’Boyle A, Kahn M, Valley M, Bland D, et al. Pelvic Organ Support Study (POSST): The distribution, clinical definition, and epidemiologic condition of pelvic organ support defects. In: American Journal of Obstetrics and Gynecology. 2005; 192:795–806
• 3. Gunasekera P, Sazaki J, Walker G. Pelvic organ prolapse: don’t forget developing countries. Lancet. 2007; 369, 1789–1790.
• 4. Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997; 89(4), 501–506.
• 5. Weber AM, Walters MD, Piedmonte MR, Ballard LA. Anterior colporrhaphy: A randomized trial of three surgical techniques. In: American Journal of Obstetrics and Gynecology. 2001; 185:1299–1306.
• 6. Nieminen K, Hiltunen R, Takala T, Heiskanen E, Merikari M, Niemi K, et al. Outcomes after anterior vaginal wall repair with mesh: A randomized, controlled trial with a 3 year follow-up. Am J Obstet Gynecol. 2010;203(3):235.e1-235.e8.
• 7. Altman MD PhD D, Väyrynen MD T, Engh MD PhD ME, Axelsen MD PhD S, Falconer MD PhD C. Anterior Colporrhaphy versus Transvaginal Mesh for Pelvic-Organ Prolapse. N Engl J Med. 2011;364(19):1826–36.
• 8. El-Nazer MA, Gomaa IA, Ismail Madkour WA, Swidan KH, El-Etriby MA. Anterior colporrhaphy versus repair with mesh for anterior vaginal wall prolapse: A comparative clinical study. Arch Gynecol Obstet. 2012;286(4):965–72.
• 9. Withagen MI, Milani AL, den Boon J, Vervest HA, Vierhout ME. Trocar-guided mesh compared with conventional vaginal repair in recurrent prolapse: A randomized controlled trial. Obstet Gynecol. 2011; 117(2), 242–250.
• 10. Sivaslioglu AA, Unlubilgin E, Dolen I. A randomized comparison of polypropylene mesh surgery with site-specific surgery in the treatment of cystocoele. Int Urogynecol J. 2008; 19(4), 467–471
• 11. Nguyen JN; Burchette RJ. Outcome after anterior vaginal prolapse repair: a randomized controlled trial. 2008;111(4):891–8.
• 12. Moore RD, Miklos JR. Vaginal repair of cystocele with anterior wall mesh via transobturator route: Efficacy and complications with up to 3-year followup. Adv Urol. 2009; doi:10.1155/2009/743831.
• 13. Carey M, Higgs P, Goh J, Lim J, Leong A, Krause H, et al. Vaginal repair with mesh versus colporrhaphy for prolapse: A randomised controlled trial. BJOG An Int J Obstet Gynaecol. 2009;116(10), 1380–1386.
• 14. Cervigni M, Natale F, Penna C, Panei M, Mako A. Transvaginal cystocele repair with polypropylene mesh using a tension-free technique. Int Urogynecol J. 2008; 19, 489–496.
• 15. Natale F, Costantini E, La Penna C, Illiano E, Balsamo R, Carbone A, et al. Trocar-guided trans-vaginal mesh surgery for pelvic organ prolapse: effects on urinary continence and anatomical and functional outcomes. A prospective observational study. Eur J Obstet Gynecol Reprod Biol. 2017; 210, 29–34.
• 16. Collinet P, Belot F, Debodinance P, Ha Duc E, Lucot JP, Cosson M. Transvaginal mesh technique for pelvic organ prolapse repair: Mesh exposure management and risk factors. Int Urogynecol J. 2006; 17(4), 315–320.
• 17. Van der Aa F, De Ridder D. Vaginal Pelvic Organ Prolapse Repair Using Mesh: Let’s Welcome Science into the Mesh Debate. Eur Urol. 2018;0–1.
• 18. Delroy C a., De A. Castro R, Dias MM, Feldner PC, Bortolini MAT, Girão MJBC, et al. The use of transvaginal synthetic mesh for anterior vaginal wall prolapse repair: A randomized controlled trial. Int Urogynecol J Pelvic Floor Dysfunct. 2013; 24, 1899–1907.
• 19. Eboue C, Marcus-Braun N, Von Theobald P. Cystocele repair by transobturator four arms mesh: Monocentric experience of first 123 patients. Int Urogynecol J. 2010;21(1):85–93.