Uterus preserving surgeries for prolapse
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Uterus sparing techniques for Prolapse for young DR Rajesh Gajbhiye Consultant Gynecologist & Lap Surgeon Mauli Women’s Hospital. Nagpur
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Transcript of Uterus preserving surgeries for prolapse
Uterus sparing techniques for
Prolapse for young
DR Rajesh Gajbhiye
Consultant Gynecologist amp Lap Surgeon
Mauli Womenrsquos Hospital
Nagpur
Introduction
Conservative surgeries- young nulliparous women where menstrual and reproductive function in desired
Vaginal hysterctomy with repair
Advent of minimal invasive surgery
Resuspend
Uterine conserving re-suspension surgery
Augmenting weak connective tissue
Stronger apical support
Laparoscoic assisted vaginal
tape
Complications
Presacral bleeding Hence a vascular
sacral plexus is a relative
contraindication for this surgery
Sigmoid colon and sigmoid mesocolon
injury hence short sigmoid
mesocolon is relative contraindication
for this surgery
Geintofemoral nerve irritation
damage to ureter recto-vaginal fascia
recurrence osteomyelitis and bowel
obstruction
Reproductive performance following Shirodkarsabdominal sling operation
Allahbadia GN1 Ambiye VR
Over a period of 4 years from January 1986 to December 1989 79 cases in whom Shirodkarsabdominal sling operation carried out were studied All the patients were admitted either in active labour or as cases of abortions or for the treatment of infertility The incidence of full term normal vaginal delivery in this study was 6956 and the incidence of caesarean section was only 29 There was one case of posterior wall rupture following previous Shirodkars sling operation The recurrence rate of prolapse was only 869
Evaluation of Shirodkarrsquos Sling
Surgery for Conservative
Management of Uterovaginal
Descent During Child Bearing Age
GroupSuchitra Narayan Pandit Vaman Babu Ghodake
Vijay Chandrakant Pawar
Observations One thousand three hundred and eighty patients having uterovaginal descent were admitted at LTM General Hospital Sion Mumbai from Jan lsquo03 - Dec lsquo04 139 patients underwent conservative surgery Sixty four (4667) patients were in the child-bearing age group and underwent Shirodkarrsquos sling surgery Twenty four patients (4137) conceived post surgery Nineteen patients delivered normally Only three patients required LSCS for obstetric indications
Conclusion Shirodkarrsquos Sling operation plays an important role in the conservative management of prolapse in the child bearing age group It does not affect fertility and course of normal labour in fact it improves it by maintaining the pelvic anatomy
Hysteropexy should not be performed
by using the ventral abdominal wall for
support because of the high risk for
recurrent prolapse particularly
enterocele
Lecel B evidence
Khanna sling
The present study demonstrates the
long-term safety and effectiveness of
pectineal ligament suspension for
vaginal vault prolapse by the open and
the laparoscopic routes
Sacrohysteropexy
-Open
-Laparoscopic
-Robotic
Advantages-
Effective correction of descent
Anteversion
No compression on rectum or ureter
Improved quality of life and sexual
function
LSH
LSC
Int Urogynecol J 2014 Jan25(1)131-8 doi
101007s00192-013-2209-5 Epub 2013 Nov 6
Laparoscopic hysteropexy 1- to 4-
year follow-up of women
postoperatively
Rahmanou P1 White B Price N
Jackson S
Laparoscopic hysteropexy is a safe
and effective treatment
High patient satisfaction and low rates
of apical prolapse recurrence
Longer term follow-up and randomized
controlled studies are required
Younger patients are best treated with
procedures with better efficacy like
sacral colpopexy to prevent
recurrence
Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy
experience of 402 patients
Stepanian AA1 Miklos JR Moore RD Mattox TF
J Minim Invasive Gynecol 2008 Mar-Apr15(2)188-96 doi
101016jjmig200711006
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Introduction
Conservative surgeries- young nulliparous women where menstrual and reproductive function in desired
Vaginal hysterctomy with repair
Advent of minimal invasive surgery
Resuspend
Uterine conserving re-suspension surgery
Augmenting weak connective tissue
Stronger apical support
Laparoscoic assisted vaginal
tape
Complications
Presacral bleeding Hence a vascular
sacral plexus is a relative
contraindication for this surgery
Sigmoid colon and sigmoid mesocolon
injury hence short sigmoid
mesocolon is relative contraindication
for this surgery
Geintofemoral nerve irritation
damage to ureter recto-vaginal fascia
recurrence osteomyelitis and bowel
obstruction
Reproductive performance following Shirodkarsabdominal sling operation
Allahbadia GN1 Ambiye VR
Over a period of 4 years from January 1986 to December 1989 79 cases in whom Shirodkarsabdominal sling operation carried out were studied All the patients were admitted either in active labour or as cases of abortions or for the treatment of infertility The incidence of full term normal vaginal delivery in this study was 6956 and the incidence of caesarean section was only 29 There was one case of posterior wall rupture following previous Shirodkars sling operation The recurrence rate of prolapse was only 869
Evaluation of Shirodkarrsquos Sling
Surgery for Conservative
Management of Uterovaginal
Descent During Child Bearing Age
GroupSuchitra Narayan Pandit Vaman Babu Ghodake
Vijay Chandrakant Pawar
Observations One thousand three hundred and eighty patients having uterovaginal descent were admitted at LTM General Hospital Sion Mumbai from Jan lsquo03 - Dec lsquo04 139 patients underwent conservative surgery Sixty four (4667) patients were in the child-bearing age group and underwent Shirodkarrsquos sling surgery Twenty four patients (4137) conceived post surgery Nineteen patients delivered normally Only three patients required LSCS for obstetric indications
Conclusion Shirodkarrsquos Sling operation plays an important role in the conservative management of prolapse in the child bearing age group It does not affect fertility and course of normal labour in fact it improves it by maintaining the pelvic anatomy
Hysteropexy should not be performed
by using the ventral abdominal wall for
support because of the high risk for
recurrent prolapse particularly
enterocele
Lecel B evidence
Khanna sling
The present study demonstrates the
long-term safety and effectiveness of
pectineal ligament suspension for
vaginal vault prolapse by the open and
the laparoscopic routes
Sacrohysteropexy
-Open
-Laparoscopic
-Robotic
Advantages-
Effective correction of descent
Anteversion
No compression on rectum or ureter
Improved quality of life and sexual
function
LSH
LSC
Int Urogynecol J 2014 Jan25(1)131-8 doi
101007s00192-013-2209-5 Epub 2013 Nov 6
Laparoscopic hysteropexy 1- to 4-
year follow-up of women
postoperatively
Rahmanou P1 White B Price N
Jackson S
Laparoscopic hysteropexy is a safe
and effective treatment
High patient satisfaction and low rates
of apical prolapse recurrence
Longer term follow-up and randomized
controlled studies are required
Younger patients are best treated with
procedures with better efficacy like
sacral colpopexy to prevent
recurrence
Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy
experience of 402 patients
Stepanian AA1 Miklos JR Moore RD Mattox TF
J Minim Invasive Gynecol 2008 Mar-Apr15(2)188-96 doi
101016jjmig200711006
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Laparoscoic assisted vaginal
tape
Complications
Presacral bleeding Hence a vascular
sacral plexus is a relative
contraindication for this surgery
Sigmoid colon and sigmoid mesocolon
injury hence short sigmoid
mesocolon is relative contraindication
for this surgery
Geintofemoral nerve irritation
damage to ureter recto-vaginal fascia
recurrence osteomyelitis and bowel
obstruction
Reproductive performance following Shirodkarsabdominal sling operation
Allahbadia GN1 Ambiye VR
Over a period of 4 years from January 1986 to December 1989 79 cases in whom Shirodkarsabdominal sling operation carried out were studied All the patients were admitted either in active labour or as cases of abortions or for the treatment of infertility The incidence of full term normal vaginal delivery in this study was 6956 and the incidence of caesarean section was only 29 There was one case of posterior wall rupture following previous Shirodkars sling operation The recurrence rate of prolapse was only 869
Evaluation of Shirodkarrsquos Sling
Surgery for Conservative
Management of Uterovaginal
Descent During Child Bearing Age
GroupSuchitra Narayan Pandit Vaman Babu Ghodake
Vijay Chandrakant Pawar
Observations One thousand three hundred and eighty patients having uterovaginal descent were admitted at LTM General Hospital Sion Mumbai from Jan lsquo03 - Dec lsquo04 139 patients underwent conservative surgery Sixty four (4667) patients were in the child-bearing age group and underwent Shirodkarrsquos sling surgery Twenty four patients (4137) conceived post surgery Nineteen patients delivered normally Only three patients required LSCS for obstetric indications
Conclusion Shirodkarrsquos Sling operation plays an important role in the conservative management of prolapse in the child bearing age group It does not affect fertility and course of normal labour in fact it improves it by maintaining the pelvic anatomy
Hysteropexy should not be performed
by using the ventral abdominal wall for
support because of the high risk for
recurrent prolapse particularly
enterocele
Lecel B evidence
Khanna sling
The present study demonstrates the
long-term safety and effectiveness of
pectineal ligament suspension for
vaginal vault prolapse by the open and
the laparoscopic routes
Sacrohysteropexy
-Open
-Laparoscopic
-Robotic
Advantages-
Effective correction of descent
Anteversion
No compression on rectum or ureter
Improved quality of life and sexual
function
LSH
LSC
Int Urogynecol J 2014 Jan25(1)131-8 doi
101007s00192-013-2209-5 Epub 2013 Nov 6
Laparoscopic hysteropexy 1- to 4-
year follow-up of women
postoperatively
Rahmanou P1 White B Price N
Jackson S
Laparoscopic hysteropexy is a safe
and effective treatment
High patient satisfaction and low rates
of apical prolapse recurrence
Longer term follow-up and randomized
controlled studies are required
Younger patients are best treated with
procedures with better efficacy like
sacral colpopexy to prevent
recurrence
Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy
experience of 402 patients
Stepanian AA1 Miklos JR Moore RD Mattox TF
J Minim Invasive Gynecol 2008 Mar-Apr15(2)188-96 doi
101016jjmig200711006
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Complications
Presacral bleeding Hence a vascular
sacral plexus is a relative
contraindication for this surgery
Sigmoid colon and sigmoid mesocolon
injury hence short sigmoid
mesocolon is relative contraindication
for this surgery
Geintofemoral nerve irritation
damage to ureter recto-vaginal fascia
recurrence osteomyelitis and bowel
obstruction
Reproductive performance following Shirodkarsabdominal sling operation
Allahbadia GN1 Ambiye VR
Over a period of 4 years from January 1986 to December 1989 79 cases in whom Shirodkarsabdominal sling operation carried out were studied All the patients were admitted either in active labour or as cases of abortions or for the treatment of infertility The incidence of full term normal vaginal delivery in this study was 6956 and the incidence of caesarean section was only 29 There was one case of posterior wall rupture following previous Shirodkars sling operation The recurrence rate of prolapse was only 869
Evaluation of Shirodkarrsquos Sling
Surgery for Conservative
Management of Uterovaginal
Descent During Child Bearing Age
GroupSuchitra Narayan Pandit Vaman Babu Ghodake
Vijay Chandrakant Pawar
Observations One thousand three hundred and eighty patients having uterovaginal descent were admitted at LTM General Hospital Sion Mumbai from Jan lsquo03 - Dec lsquo04 139 patients underwent conservative surgery Sixty four (4667) patients were in the child-bearing age group and underwent Shirodkarrsquos sling surgery Twenty four patients (4137) conceived post surgery Nineteen patients delivered normally Only three patients required LSCS for obstetric indications
Conclusion Shirodkarrsquos Sling operation plays an important role in the conservative management of prolapse in the child bearing age group It does not affect fertility and course of normal labour in fact it improves it by maintaining the pelvic anatomy
Hysteropexy should not be performed
by using the ventral abdominal wall for
support because of the high risk for
recurrent prolapse particularly
enterocele
Lecel B evidence
Khanna sling
The present study demonstrates the
long-term safety and effectiveness of
pectineal ligament suspension for
vaginal vault prolapse by the open and
the laparoscopic routes
Sacrohysteropexy
-Open
-Laparoscopic
-Robotic
Advantages-
Effective correction of descent
Anteversion
No compression on rectum or ureter
Improved quality of life and sexual
function
LSH
LSC
Int Urogynecol J 2014 Jan25(1)131-8 doi
101007s00192-013-2209-5 Epub 2013 Nov 6
Laparoscopic hysteropexy 1- to 4-
year follow-up of women
postoperatively
Rahmanou P1 White B Price N
Jackson S
Laparoscopic hysteropexy is a safe
and effective treatment
High patient satisfaction and low rates
of apical prolapse recurrence
Longer term follow-up and randomized
controlled studies are required
Younger patients are best treated with
procedures with better efficacy like
sacral colpopexy to prevent
recurrence
Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy
experience of 402 patients
Stepanian AA1 Miklos JR Moore RD Mattox TF
J Minim Invasive Gynecol 2008 Mar-Apr15(2)188-96 doi
101016jjmig200711006
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Reproductive performance following Shirodkarsabdominal sling operation
Allahbadia GN1 Ambiye VR
Over a period of 4 years from January 1986 to December 1989 79 cases in whom Shirodkarsabdominal sling operation carried out were studied All the patients were admitted either in active labour or as cases of abortions or for the treatment of infertility The incidence of full term normal vaginal delivery in this study was 6956 and the incidence of caesarean section was only 29 There was one case of posterior wall rupture following previous Shirodkars sling operation The recurrence rate of prolapse was only 869
Evaluation of Shirodkarrsquos Sling
Surgery for Conservative
Management of Uterovaginal
Descent During Child Bearing Age
GroupSuchitra Narayan Pandit Vaman Babu Ghodake
Vijay Chandrakant Pawar
Observations One thousand three hundred and eighty patients having uterovaginal descent were admitted at LTM General Hospital Sion Mumbai from Jan lsquo03 - Dec lsquo04 139 patients underwent conservative surgery Sixty four (4667) patients were in the child-bearing age group and underwent Shirodkarrsquos sling surgery Twenty four patients (4137) conceived post surgery Nineteen patients delivered normally Only three patients required LSCS for obstetric indications
Conclusion Shirodkarrsquos Sling operation plays an important role in the conservative management of prolapse in the child bearing age group It does not affect fertility and course of normal labour in fact it improves it by maintaining the pelvic anatomy
Hysteropexy should not be performed
by using the ventral abdominal wall for
support because of the high risk for
recurrent prolapse particularly
enterocele
Lecel B evidence
Khanna sling
The present study demonstrates the
long-term safety and effectiveness of
pectineal ligament suspension for
vaginal vault prolapse by the open and
the laparoscopic routes
Sacrohysteropexy
-Open
-Laparoscopic
-Robotic
Advantages-
Effective correction of descent
Anteversion
No compression on rectum or ureter
Improved quality of life and sexual
function
LSH
LSC
Int Urogynecol J 2014 Jan25(1)131-8 doi
101007s00192-013-2209-5 Epub 2013 Nov 6
Laparoscopic hysteropexy 1- to 4-
year follow-up of women
postoperatively
Rahmanou P1 White B Price N
Jackson S
Laparoscopic hysteropexy is a safe
and effective treatment
High patient satisfaction and low rates
of apical prolapse recurrence
Longer term follow-up and randomized
controlled studies are required
Younger patients are best treated with
procedures with better efficacy like
sacral colpopexy to prevent
recurrence
Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy
experience of 402 patients
Stepanian AA1 Miklos JR Moore RD Mattox TF
J Minim Invasive Gynecol 2008 Mar-Apr15(2)188-96 doi
101016jjmig200711006
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Evaluation of Shirodkarrsquos Sling
Surgery for Conservative
Management of Uterovaginal
Descent During Child Bearing Age
GroupSuchitra Narayan Pandit Vaman Babu Ghodake
Vijay Chandrakant Pawar
Observations One thousand three hundred and eighty patients having uterovaginal descent were admitted at LTM General Hospital Sion Mumbai from Jan lsquo03 - Dec lsquo04 139 patients underwent conservative surgery Sixty four (4667) patients were in the child-bearing age group and underwent Shirodkarrsquos sling surgery Twenty four patients (4137) conceived post surgery Nineteen patients delivered normally Only three patients required LSCS for obstetric indications
Conclusion Shirodkarrsquos Sling operation plays an important role in the conservative management of prolapse in the child bearing age group It does not affect fertility and course of normal labour in fact it improves it by maintaining the pelvic anatomy
Hysteropexy should not be performed
by using the ventral abdominal wall for
support because of the high risk for
recurrent prolapse particularly
enterocele
Lecel B evidence
Khanna sling
The present study demonstrates the
long-term safety and effectiveness of
pectineal ligament suspension for
vaginal vault prolapse by the open and
the laparoscopic routes
Sacrohysteropexy
-Open
-Laparoscopic
-Robotic
Advantages-
Effective correction of descent
Anteversion
No compression on rectum or ureter
Improved quality of life and sexual
function
LSH
LSC
Int Urogynecol J 2014 Jan25(1)131-8 doi
101007s00192-013-2209-5 Epub 2013 Nov 6
Laparoscopic hysteropexy 1- to 4-
year follow-up of women
postoperatively
Rahmanou P1 White B Price N
Jackson S
Laparoscopic hysteropexy is a safe
and effective treatment
High patient satisfaction and low rates
of apical prolapse recurrence
Longer term follow-up and randomized
controlled studies are required
Younger patients are best treated with
procedures with better efficacy like
sacral colpopexy to prevent
recurrence
Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy
experience of 402 patients
Stepanian AA1 Miklos JR Moore RD Mattox TF
J Minim Invasive Gynecol 2008 Mar-Apr15(2)188-96 doi
101016jjmig200711006
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Observations One thousand three hundred and eighty patients having uterovaginal descent were admitted at LTM General Hospital Sion Mumbai from Jan lsquo03 - Dec lsquo04 139 patients underwent conservative surgery Sixty four (4667) patients were in the child-bearing age group and underwent Shirodkarrsquos sling surgery Twenty four patients (4137) conceived post surgery Nineteen patients delivered normally Only three patients required LSCS for obstetric indications
Conclusion Shirodkarrsquos Sling operation plays an important role in the conservative management of prolapse in the child bearing age group It does not affect fertility and course of normal labour in fact it improves it by maintaining the pelvic anatomy
Hysteropexy should not be performed
by using the ventral abdominal wall for
support because of the high risk for
recurrent prolapse particularly
enterocele
Lecel B evidence
Khanna sling
The present study demonstrates the
long-term safety and effectiveness of
pectineal ligament suspension for
vaginal vault prolapse by the open and
the laparoscopic routes
Sacrohysteropexy
-Open
-Laparoscopic
-Robotic
Advantages-
Effective correction of descent
Anteversion
No compression on rectum or ureter
Improved quality of life and sexual
function
LSH
LSC
Int Urogynecol J 2014 Jan25(1)131-8 doi
101007s00192-013-2209-5 Epub 2013 Nov 6
Laparoscopic hysteropexy 1- to 4-
year follow-up of women
postoperatively
Rahmanou P1 White B Price N
Jackson S
Laparoscopic hysteropexy is a safe
and effective treatment
High patient satisfaction and low rates
of apical prolapse recurrence
Longer term follow-up and randomized
controlled studies are required
Younger patients are best treated with
procedures with better efficacy like
sacral colpopexy to prevent
recurrence
Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy
experience of 402 patients
Stepanian AA1 Miklos JR Moore RD Mattox TF
J Minim Invasive Gynecol 2008 Mar-Apr15(2)188-96 doi
101016jjmig200711006
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Hysteropexy should not be performed
by using the ventral abdominal wall for
support because of the high risk for
recurrent prolapse particularly
enterocele
Lecel B evidence
Khanna sling
The present study demonstrates the
long-term safety and effectiveness of
pectineal ligament suspension for
vaginal vault prolapse by the open and
the laparoscopic routes
Sacrohysteropexy
-Open
-Laparoscopic
-Robotic
Advantages-
Effective correction of descent
Anteversion
No compression on rectum or ureter
Improved quality of life and sexual
function
LSH
LSC
Int Urogynecol J 2014 Jan25(1)131-8 doi
101007s00192-013-2209-5 Epub 2013 Nov 6
Laparoscopic hysteropexy 1- to 4-
year follow-up of women
postoperatively
Rahmanou P1 White B Price N
Jackson S
Laparoscopic hysteropexy is a safe
and effective treatment
High patient satisfaction and low rates
of apical prolapse recurrence
Longer term follow-up and randomized
controlled studies are required
Younger patients are best treated with
procedures with better efficacy like
sacral colpopexy to prevent
recurrence
Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy
experience of 402 patients
Stepanian AA1 Miklos JR Moore RD Mattox TF
J Minim Invasive Gynecol 2008 Mar-Apr15(2)188-96 doi
101016jjmig200711006
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Khanna sling
The present study demonstrates the
long-term safety and effectiveness of
pectineal ligament suspension for
vaginal vault prolapse by the open and
the laparoscopic routes
Sacrohysteropexy
-Open
-Laparoscopic
-Robotic
Advantages-
Effective correction of descent
Anteversion
No compression on rectum or ureter
Improved quality of life and sexual
function
LSH
LSC
Int Urogynecol J 2014 Jan25(1)131-8 doi
101007s00192-013-2209-5 Epub 2013 Nov 6
Laparoscopic hysteropexy 1- to 4-
year follow-up of women
postoperatively
Rahmanou P1 White B Price N
Jackson S
Laparoscopic hysteropexy is a safe
and effective treatment
High patient satisfaction and low rates
of apical prolapse recurrence
Longer term follow-up and randomized
controlled studies are required
Younger patients are best treated with
procedures with better efficacy like
sacral colpopexy to prevent
recurrence
Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy
experience of 402 patients
Stepanian AA1 Miklos JR Moore RD Mattox TF
J Minim Invasive Gynecol 2008 Mar-Apr15(2)188-96 doi
101016jjmig200711006
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
The present study demonstrates the
long-term safety and effectiveness of
pectineal ligament suspension for
vaginal vault prolapse by the open and
the laparoscopic routes
Sacrohysteropexy
-Open
-Laparoscopic
-Robotic
Advantages-
Effective correction of descent
Anteversion
No compression on rectum or ureter
Improved quality of life and sexual
function
LSH
LSC
Int Urogynecol J 2014 Jan25(1)131-8 doi
101007s00192-013-2209-5 Epub 2013 Nov 6
Laparoscopic hysteropexy 1- to 4-
year follow-up of women
postoperatively
Rahmanou P1 White B Price N
Jackson S
Laparoscopic hysteropexy is a safe
and effective treatment
High patient satisfaction and low rates
of apical prolapse recurrence
Longer term follow-up and randomized
controlled studies are required
Younger patients are best treated with
procedures with better efficacy like
sacral colpopexy to prevent
recurrence
Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy
experience of 402 patients
Stepanian AA1 Miklos JR Moore RD Mattox TF
J Minim Invasive Gynecol 2008 Mar-Apr15(2)188-96 doi
101016jjmig200711006
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Sacrohysteropexy
-Open
-Laparoscopic
-Robotic
Advantages-
Effective correction of descent
Anteversion
No compression on rectum or ureter
Improved quality of life and sexual
function
LSH
LSC
Int Urogynecol J 2014 Jan25(1)131-8 doi
101007s00192-013-2209-5 Epub 2013 Nov 6
Laparoscopic hysteropexy 1- to 4-
year follow-up of women
postoperatively
Rahmanou P1 White B Price N
Jackson S
Laparoscopic hysteropexy is a safe
and effective treatment
High patient satisfaction and low rates
of apical prolapse recurrence
Longer term follow-up and randomized
controlled studies are required
Younger patients are best treated with
procedures with better efficacy like
sacral colpopexy to prevent
recurrence
Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy
experience of 402 patients
Stepanian AA1 Miklos JR Moore RD Mattox TF
J Minim Invasive Gynecol 2008 Mar-Apr15(2)188-96 doi
101016jjmig200711006
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
LSH
LSC
Int Urogynecol J 2014 Jan25(1)131-8 doi
101007s00192-013-2209-5 Epub 2013 Nov 6
Laparoscopic hysteropexy 1- to 4-
year follow-up of women
postoperatively
Rahmanou P1 White B Price N
Jackson S
Laparoscopic hysteropexy is a safe
and effective treatment
High patient satisfaction and low rates
of apical prolapse recurrence
Longer term follow-up and randomized
controlled studies are required
Younger patients are best treated with
procedures with better efficacy like
sacral colpopexy to prevent
recurrence
Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy
experience of 402 patients
Stepanian AA1 Miklos JR Moore RD Mattox TF
J Minim Invasive Gynecol 2008 Mar-Apr15(2)188-96 doi
101016jjmig200711006
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
LSC
Int Urogynecol J 2014 Jan25(1)131-8 doi
101007s00192-013-2209-5 Epub 2013 Nov 6
Laparoscopic hysteropexy 1- to 4-
year follow-up of women
postoperatively
Rahmanou P1 White B Price N
Jackson S
Laparoscopic hysteropexy is a safe
and effective treatment
High patient satisfaction and low rates
of apical prolapse recurrence
Longer term follow-up and randomized
controlled studies are required
Younger patients are best treated with
procedures with better efficacy like
sacral colpopexy to prevent
recurrence
Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy
experience of 402 patients
Stepanian AA1 Miklos JR Moore RD Mattox TF
J Minim Invasive Gynecol 2008 Mar-Apr15(2)188-96 doi
101016jjmig200711006
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Laparoscopic hysteropexy is a safe
and effective treatment
High patient satisfaction and low rates
of apical prolapse recurrence
Longer term follow-up and randomized
controlled studies are required
Younger patients are best treated with
procedures with better efficacy like
sacral colpopexy to prevent
recurrence
Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy
experience of 402 patients
Stepanian AA1 Miklos JR Moore RD Mattox TF
J Minim Invasive Gynecol 2008 Mar-Apr15(2)188-96 doi
101016jjmig200711006
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Younger patients are best treated with
procedures with better efficacy like
sacral colpopexy to prevent
recurrence
Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy
experience of 402 patients
Stepanian AA1 Miklos JR Moore RD Mattox TF
J Minim Invasive Gynecol 2008 Mar-Apr15(2)188-96 doi
101016jjmig200711006
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Risk of mesh extrusion and other mesh-related
complications after laparoscopic sacral
colpopexy with or without concurrent
laparoscopic-assisted vaginal hysterectomy
experience of 402 patients
Stepanian AA1 Miklos JR Moore RD Mattox TF
J Minim Invasive Gynecol 2008 Mar-Apr15(2)188-96 doi
101016jjmig200711006
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Risk of mesh extrusion or other mesh-related complications after laparoscopic sacral colpopexy using soft macroporous Y-shaped polypropylene mesh is about 1
No significant increase in risk of mesh-related complications was observed in patients receiving concurrent hysterectomy when compared with patients who had a previous hysterectomy
The sample size of almost 2000 patients was needed to detect a statistically significant difference in rate of mesh-extrusion in this study
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Gutman and Maher reviewed the literature on sacral colpopexy and uterine prolapse in 2012 and in meta-analysis found 339 cases of sacral colpopexy with hysterectomy and 129 cases of sacral hysteropexy
While the success rate was over 90 in each group the rate of mesh exposures was more than five times higher after sacral colpopexy and hysterectomy as compared to hysteropexy (85 versus 15)
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Sacral colpopexy long-term mesh complications requiring reoperation(s)
Arsene E1 Giraudet G Lucot JP Rubod C Cosson M
Int Urogynecol J 2015 Mar26(3)353-8 doi 101007s00192-014-2514-7 Epub 2014 Oct 17
excellent success rates there are risks of complications and reoperation may be required The purpose of this study was to evaluate the extent of complications following SC requiring reoperation(s) and to describe the reoperations performed
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Surgery for complications after SC-27
vaginal mesh exposures (VME)-19
intravesical mesh -4(including one with
VME)
ano-rectal dyschezia-1 one for
spondylodiscitis-1
mesh infection-1
vaginal fistula communicating with a
collection in the ischio-coccygeal
muscle-1
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
The median time between the initial
SC and the first reoperation was
39thinspplusmnthinsp57 years
This case series provides a
description of surgical interventions for
complications related to sacral
colpopexy These complications may
be serious and occur years after the
initial surgery
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Cochrane Database Syst Rev 2013
Apr 304CD004014 doi
10100214651858CD004014pub5
Surgical management of pelvic
organ prolapse in women
Maher C1 Feiner B Baessler K
Schmid C
Fifty-six randomised controlled trials
were identified evaluating 5954
women
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Sacral colpopexy has superior outcomes to a variety of vaginal procedures including sacrospinouscolpopexy uterosacral colpopexy and transvaginal mesh
These benefits must be balanced against a longer operating time longer time to return to activities of daily living and increased cost of the abdominal approach
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Shirodkarrsquos Extended Manchester Repair
A Conservative Vaginal Surgery for Geital
Prolapse in Young Women and Reinforcement of
Weak Uterosacral Ligaments with Merselene Tape
Retrospective and Prospective Study
Roohi ShaikhSuman Sardesai
1nternational Journal of Recent Trends in Science A
nd Technology ISSN 2277-2812 E-ISSN 2249-8109 Vol
ume 10 Issue 2 2014 pp 263-266
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Conclusion
Shirodkarrsquos Extended Manchester
Repair has a definite place in the
treatment of genital prolapse
especially during the
reproductive age where child-bearing
function has to be preserved
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Two randomized trials in women with stage II or higher POP that compared transvaginal sacrospinoushysteropexy with vaginal hysterectomy (with uterosacral or sacrospinousligament suspension of the vaginal vault) yielded consistent results the rate of prolapse recurrence after 9 to 12 months was higher in women who underwent hysteropexy in both trials
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Conclusions
Consensus is growing that the uterus
can be preserved at the time of pelvic
reconstructive surgery in appropriately
selected women who desire it
Surgeons should be ready to respond
to the wishes of female patients who
want to preserve vaginal function and
the uterus
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
conclusions
In nulliparous prolapse shirodkars
sling the operation of choice If not
comfortable then Khanna sling joshi
sling
Sacrohysteropexy is indicated in
young prolapse
It is better than vaginal SSF in terms
of recurrence and patient satisfaction
Mesh erosion compication is less as
compared to hysterectomy with SC
Thankyou
Thankyou
