1.Sacrospinous Ligament Fixation – A Malaysian’s Tertiary Centre Experience
Journal of Surgical Academia 2017;7(1):21-
During the study period from January 2008 to December 2012, 177 women had transvaginal sacrospinous ligament
fixation (SSF) for vault suspension at General Hospital Kuala Lumpur. Of the 177 women, 133 (75.1%) had severe
uterovaginal prolapse while 44 (24.9%) had post-hysterectomy vault prolapse. All patients with severe uterovaginal
prolapse and rectocele undergone vaginal hysterectomy and posterior colporrhaphy respectively. A hundred and
seventy-four patients (98.3%) had anterior repair whilst 48 (27.1%) received midurethral sling as concomitant
procedure to vault suspension (SSF). The mean duration of surgery was 92.1±30.2 minutes and the mean estimated
blood loss was 319±199.3mls. There was no surgical mortality. Two patients (1.1%) had rectal injuries. No patient
had bladder injury or de novo urinary symptoms. The commonest immediate postoperative complications was fever
(98; 55.4%) followed by buttock pain in 18 (10.2%) patients. Both complications were resolved with conservative
measures. Seven patients (3.9%) had sutures erosion as late complications. Of the 177 women, 158 (89.3%) and 141
(79.7%) came for the 6 and 12 months follow-up, respectively. The success rate for all three compartments ranged
from 92.4% to 98.1% at 6 months and reduced to range from 85.7% to 94.4% at 12 months. The highest success rate
was observed in the posterior compartment followed by apical and anterior compartment. Equally, the recurrence
rate was lowest in the posterior compartment (1.9%), followed by the central (3.8%) and anterior compartment
(7.5%) at 6 months’ review. This increased to 5.7% for rectocele, 7.8% for vault prolapse and 14.2% for cystocele at
12 months’ follow-up. None had repeated surgery for prolapse recurrence during the study period. In conclusion,
SSF remains a high priority in our therapeutic regime for the treatment of severe uterovaginal and vault prolapse as it
has a reasonably good success rate with lower serious complications in the skillful hands.
Hysterectomy, Vaginal
2.Comparison between Laparoscopic Hysterectomy and Total Vaginal Hysterectomy.
Chun Sik JEON ; Jae Yeon WON ; Jin Hong KIM ; Chun Hee LEE ; Jun Bae BANG ; Yoon Soon LEE ; Il Soo PARK
Korean Journal of Obstetrics and Gynecology 1997;40(12):2763-2769
No abstract available.
Female
;
Hysterectomy*
;
Hysterectomy, Vaginal*
3.Changing indication & clinical evaluation of 1238 vaginal hysterectomies.
Keun Soo CHEON ; Eui Yeol LEE ; Jang Hyun NAM ; Keun Young LEE ; Sung Won KANG
Korean Journal of Obstetrics and Gynecology 1991;34(11):1592-1602
No abstract available.
Female
;
Hysterectomy, Vaginal*
4.Clinical study of total vaginal hysterectomy.
Won Myung LEE ; Jong Goo KIM ; Jung Suk PARK ; Woo Jin SOHN ; In Goo KANG ; Yoon Soon LEE ; Seung Bo PARK
Korean Journal of Obstetrics and Gynecology 1993;36(7):2617-2626
No abstract available.
Female
;
Hysterectomy, Vaginal*
5.Clinical survey of total vaginal hysterectomy by pelviscopy.
Joung Hwan KIM ; Jae Chang LEE ; Zong Soo MOON ; Hong Bai KIM ; Min HUR
Korean Journal of Obstetrics and Gynecology 1993;36(4):497-502
No abstract available.
Female
;
Hysterectomy, Vaginal*
6.Clinical survey of total vaginal hysterectomy by pelviscopy.
Joung Hwan KIM ; Jae Chang LEE ; Zong Soo MOON ; Hong Bai KIM ; Min HUR
Korean Journal of Obstetrics and Gynecology 1993;36(4):497-502
No abstract available.
Female
;
Hysterectomy, Vaginal*
7.Clinical Study of Total Vaginal Hysterectomy for the Indications other than Uterine Prolapse.
Yeon Hwa LA ; Kyung Chuel CHO ; Seong Tae HAN ; Seok Hee JUNG ; Jung Lae SEO ; Woo Chuel JUNG ; Sung Won LEE ; Yong CHO ; Eu Sun RO
Korean Journal of Obstetrics and Gynecology 2000;43(8):1459-1463
No abstract available.
Female
;
Hysterectomy, Vaginal*
;
Uterine Prolapse*
8.Recurrence of prolapse following vaginal hysterectomy with and without vaginal vault fixation: A retrospective review
Lisa Teresa Prodigalidad-Jabso ; Ira Dominique Malonzo
Acta Medica Philippina 2022;56(12):42-49
Background:
The rate of prolapse recurrence after vaginal hysterectomy ranges from 6% to 12%. Vaginal vault fixation procedures like the iliococcygeus fixation and the cul-de-sac obliteration (McCall culdoplasty) have been used to address the loss of apical support in patients with advanced-stage prolapse to prevent this recurrence.
Objectives:
This study aims to assess the rate of prolapse recurrence and risk factors for recurrence as well as urinary, bowel, and sexual symptoms in women who have undergone vaginal hysterectomy with and without vaginal vault fixation for pelvic organ prolapse stage 2 or higher.
Methods:
This study is a retrospective study that included patients with pelvic organ prolapse stage 2 or greater who underwent vaginal hysterectomy with and without vaginal vault fixation from 2009 to 2014 seen at the urogynecology clinic of a Philippine tertiary referral center. The cohorts were divided into those with iliococcygeal fixation (n=171) and those without (n=83). The Z test of mean difference was used in comparing average values between the two groups. Chi-square test of independence was used in comparing the proportion of patients as stratified by various variables and their corresponding groups, while some variables were adjusted for 2x2 Fischer Exact test. Any associated p-value less than 0.05 alpha were considered statistically significant.
Results:
Of the 876 patients operated on for prolapse between 2009 to 2014, 254 were included in the study. They were divided into those with iliococcygeal fixation (n=171) and those without (n=83). Recurrence was significantly lower in the group who underwent iliococcygeal fixation (23.39% vs 36.14%, p=0.037) after a median follow-up of 28.98 months for those with fixation and 31.08 for those without. The posterior compartment prolapse recurrence rate is higher in those without fixation (16.87% vs 6.43%, p=0.013). Longer duration of menopause (16.96 ± 7.16 vs 13.37 ± 7.1, p=0.001), unemployment (52.85% vs 36.41%, p=0.22) and longer time from surgery (37.84 ± 15.69 vs 26.55 ± 12.59, p=0.000) were significantly associated with recurrence. Moreover, higher pre- (6.24 ± 1.41 vs 5.78 ± 0.95, p=0.003) and post-operative genital hiatus (4.53 ± 0.97 vs 4.23 ± 0.54, p=0.002) and shorter pre-operative perineal body (1.86 ± 0.35 vs 1.97 ± 0.35, p=0.025) measurements were also significantly associated with recurrence. Both groups have no significant difference in urinary, sexual or bowel symptoms.
Conclusion
Iliococcygeus fixation is an effective method of preventing prolapse recurrence. Increased duration of menopause, longer time from surgery, longer genital hiatus, and shorter perineal body all contribute to recurrence. Moreover, urinary, sexual and bowel symptoms do not differ significantly between those with and without iliococcygeus fixation. Thus performing prophylactic vaginal vault fixation should be contemplated in patients undergoing prolapse surgery, with careful consideration of patient factors and potential morbidities.
Pelvic Organ Prolapse
;
Recurrence
;
Hysterectomy, Vaginal
9.Comparative Study of Laparoscopically Assisted Vaginal Hysterectomy (LAVH) and Total Laparoscopic Hysterectomy (TLH).
Korean Journal of Obstetrics and Gynecology 2005;48(1):143-152
OBJECTIVE: To compare the clinical results between laparoscopically assisted vaginal hysterectomy (LAVH) and total laparoscopic hysterectomy (TLH), and to realize the merits and demerits of both operations, so we know which pelviscopic hysterectomy operation is better method at the present time. METHODS: 30 of LAVH cases and 30 of TLH cases were performed from 12 December 2002 to 25 February 2004 at department of OB and GY, Dankook University Hospital. We analyzed the results with regard to patient's characteristics, indication of hysterectomy, size of uterus, operation time, blood loss, duration of hospitalization and complications. RESULTS: LAVH operations, and TLH operations were performed by same operator respectively. There were no significant differences in patient's characteristics (age, height, weight) between the two groups. The main preoperative indication was myoma uteri in both groups, followed by CINIII in LAVH groups and adenomyosis in TLH groups. The majority of uterine size on operation field was adult fist size in both groups. The mean operation time was 86.3 +/- 19.5 min for LAVH group and 153.3 +/- 44.4 min for TLH group, the operation time is significantly longer in TLH group (P-value<0.05). The blood loss was not significantly different between the two groups (265 +/- 92.9 mL for LAVH, 268 +/- 119.2 mL for TLH, P-value>0.05). The duration of hospitalization was not significantly different between the two groups (6.1 +/- 0.4 days for LAVH, 6.2 +/- 0.8 days for TLH, P-value>0.05). There is no complication in LAVH group, 3 complications in TLH group. CONCLUSION: LAVH has no significant differences in patient's characteristics, indication of operation, size of uterus, blood loss and duration of hospitalization, compared with TLH, but it has the merits of short operation time and less complication. In this study we consider that LAVH operation method stands at advantage over TLH.
Adenomyosis
;
Adult
;
Female
;
Hospitalization
;
Humans
;
Hysterectomy*
;
Hysterectomy, Vaginal*
;
Myoma
;
Uterus
10.The Efficacy of Routine Hysteroscopy before Laparoscopic Assisted Vaginal Hysterectomy.
Korean Journal of Obstetrics and Gynecology 2003;46(6):1129-1134
OBJECTIVE: Recent advances in laparoscopic surgery have allowed to substitute Laparoscopic Assisted Vaginal Hysterectomy for classical abdominal hysterectomy. The purpose of this study was to evaluate the effectiveness and the value of hysteroscopic procedure which was helpful in taking directed biopsies of malignant suspected areas of endometrium before LAVH. METHODS: We compared hysteroscopic biopsy results with permanent biopsy results after LAVH in 100 patients (group A). In addition, we considered hysteroscopic biopsy results of 60 patients (group B) who had abnormal endometrial findings in vaginal ultrasonography. RESULTS: No endometrial malignant lesion was found between hysteroscopic biopsies and permanent pathologic results after LAVH in the study group A. The malignant hysteroscopic biopsy results of the study group B was about 25%. CONCLUSION: Hysteroscopic procedure for detecting endometrial malignant lesion before LAVH in large uterine tumors could be used. But this study provided that preoperative vaginal sonography was sufficient to evaluate endometrial condition.
Biopsy
;
Endometrium
;
Female
;
Humans
;
Hysterectomy
;
Hysterectomy, Vaginal*
;
Hysteroscopy*
;
Laparoscopy
;
Ultrasonography