Options for POP surhery

Surgical Options in Repairing Anterior Vaginal Wall Prolapse Vaginal Approach

Pathogenesis of POP Primary Events Secondary Events

bladder vagina

Pelvic Organ Prolapse bladder vagina

Paravaginal Defect

bladder vagina Paravaginal Defect

B C D A VPVR VPVR (side specific repair) VPVR (sidespecific repair) Plication “ treating the bulge” Remove/ damage tissue New Anatomy Biomesh SSynthet Synthetic mesh “ Cured” Pelvic Organ Reconstruction Options

OptionA: Main aim is to remove the buldge into the vagina. Thus: 1. open vaginal wall over the buldge-stay medial between pubic rami 2. plicate the bladder/rectal wall onto itself 3. remove extra vaginal skin 4. close the vaginal skin defect

Option A Plicating the buldge Removing “extra” tissue

bladder vagina

bladder vagina Why am I not surprised it´s not working?

Problems with OptionA
Tissue is scared and damaged
Tissue is removed
“ New” anatomy is created
The “symptom” is treated and not the pathology
Success in getting rid of the buldge is about 40-50% (anterior wall)
putting repeat surgery and success at risk.
Poor treatment for stress incontinense

B C D A VPVR VPVR (side specific repair) VPVR (side specific repair) Plication “ treating the bulge” Remove/ damage tissue New Anatomy Biomesh SSynthet Synthetic mesh “ Cured” Pelvic Organ Reconstruction Options

bladder vagina
Open vaginal skin
Dissect into paravaginal and
paravesicle space
3. Strip bladder and ureter medially
Vaginal Paravaginal Repair (VPVR)

bladder vagina Vaginal Paravaginal Repair (VPVR) 4.Suture vesico-vaginal fascia on to obturator membrane 5. Close vaginal skin

Problem with VPVR: High reported recurrence rate – same as one will find with any hernia repear using native tissue.

B C D A VPVR VPVR (side specific repair) VPVR (sidespecific repair) Plication “ treating the bulge” Remove/ damage tissue New Anatomy Biomesh SSynthet Synthetic mesh “ Cured” Pelvic Organ Reconstruction Options

bladder vagina Options C and D

Biomesh implants Following implantation, tissues adjacent to the SIS matrix begin to deliver cells and nutrients. The body’s tissue grows completely into the surgical site while SIS maintains the needed tissue support. SIS is gradually replaced as the body reinforces and rebuilds the weakened site. Cells rapidly invade the SIS matrix. Capillary growth follows allowing more nutrients and cells to enter the matrix. SurgiSIS, SymphaSIS Option C

With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

OptionD Synthetic Mesh Implants

B C D A VPVR VPVR (side specific repair) VPVR (sidespecific repair) Plication “ treating the bulge” Remove/ damage tissue New Anatomy Biomesh SSynthet Synthetic mesh “ Cured” Pelvic Organ Reconstruction Options Success rate Complication risks Repeat surgery routes

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Options for POP surhery

by nieuwoudt on Nov 26, 2006

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Options for POP surhery — Presentation Transcript