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Options for POP surhery

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different options available for vaginal pelvic organ reconstructive surgery

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Options for POP surhery

  1. 1. Surgical Options in Repairing Anterior Vaginal Wall Prolapse Vaginal Approach
  2. 2. Pathogenesis of POP Primary Events Secondary Events
  3. 3. bladder vagina
  4. 4. Pelvic Organ Prolapse bladder vagina
  5. 5. Paravaginal Defect
  6. 6. Paravaginal Defect
  7. 7. Paravaginal Defect
  8. 8. bladder vagina Paravaginal Defect
  9. 9. 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
  10. 10. 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
  11. 11. Option A Plicating the buldge Removing “extra” tissue
  12. 12. bladder vagina Paravaginal Defect
  13. 13. bladder vagina
  14. 14. bladder vagina
  15. 15. bladder vagina Why am I not surprised it´s not working?
  16. 16. Problems with OptionA <ul><li>Tissue is scared and damaged </li></ul><ul><li>Tissue is removed </li></ul><ul><li>“ New” anatomy is created </li></ul><ul><li>The “symptom” is treated and not the pathology </li></ul><ul><li>Success in getting rid of the buldge is about 40-50% (anterior wall) </li></ul><ul><li>putting repeat surgery and success at risk. </li></ul><ul><li>Poor treatment for stress incontinense </li></ul>
  17. 17. 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
  18. 18. bladder vagina Paravaginal Defect
  19. 19. bladder vagina <ul><li>Open vaginal skin </li></ul><ul><li>Dissect into paravaginal and </li></ul><ul><li>paravesicle space </li></ul><ul><li>3. Strip bladder and ureter medially </li></ul>Vaginal Paravaginal Repair (VPVR)
  20. 20. bladder vagina Vaginal Paravaginal Repair (VPVR) 4.Suture vesico-vaginal fascia on to obturator membrane 5. Close vaginal skin
  21. 21. Problem with VPVR: High reported recurrence rate – same as one will find with any hernia repear using native tissue.
  22. 22. 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
  23. 23. bladder vagina Options C and D
  24. 24. bladder vagina Options C and D
  25. 27. 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
  26. 28. With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com
  27. 29. OptionD Synthetic Mesh Implants
  28. 31. 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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