Clinical Efficacy of Laparoscopic Paravaginal Repair in the Treatment of Anterior Vaginal Prolapse in Women of Child-bearing Age_West China Medical Journal

Authors：

 CHIYu-gang ,  LEILi , LIULu-bin , YANGMei , WENYa-ling , HEPing

Department of Gynecology, Chongqing Health Center for Women and Children, Chongqing 400020, P. R. China;

Corresponding?author：

LEILi, Email: a63521399@163.com

Keywords：

Laparoscopy; Pelvic organ prolapse; Anterior vaginal prolapse; Paravaginal repair; Women of childbearing period

DOI：

10.7507/1002-0179.20150358

Video：

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Objective To evaluate the feasibility and efficacy of laparoscopic paravaginal repair (LPVR) for anterior vaginal prolapse in women of child-bearing age. Methods Totally, 21 patients with anterior vaginal prolapse underwent laparoscopic extraperitoneal vaginal vault suspension between January 2012 and May 2013. Among the 21 patients, 5 were in grade Ⅲ, 15 in grade Ⅱ, and 1 in grade Ⅰ. Under laparoscope, the bilateral white lines and ischial spines were exposed, and then the angle of vaginal fornix was sutured to the ipsilateral ischial spine and the vaginal wall was sutured to the ipsilateral white line. Laparoscopic sacrocolpopexy or Burch or posterior vaginal wall repair was performed as well if necessary. The patients without any subjective symptom were defined as subjective cure and those whose pelvic organ prolapse quantification of anterior vaginal was zero degree were defined as objective cure. Results Laparoscopic sacrocolpopexy was performed in 5 patients, Burch in 3, and posterior vaginal wall repair alone in 6. The operation time ranged from 110 to 225 minutes with an average of 155 minutes, and the intraoperative blood loss ranged from 30 to 100 mL with an average of 60 mL. No intraoperative complication occurred. The marking point of pelvic organ prolapse quantitation Aa before and after operation was (1.0±0.4) cm and (-3.0±0.8) cm, and Ba was (1.5±0.4) cm and (-3.0±0.5) cm, and there were significant differences (P<0.01). The patients were discharged from hospital within 5 to 10 days averaging 7 days. The cost of hospitalization was 7 000 to 11 000 yuan, with an average of 8 500 yuan. One patient who felt obstruction of urethra and diffcult urination was improved by keeping indwelling urinary catheter for 7 days. Follow-up was achieved in 21 patients for 10 to 18 months with a mean of 15 months, and 19 of them had subjective cure and 20 of them objective cure. Conclusion LPVR can be successfully completed in anterior vaginal prolapse patients with paravaginal defect with less injury and shorter recovery time.

Citation： CHIYu-gang, LEILi, LIULu-bin, YANGMei, WENYa-ling, HEPing. Clinical Efficacy of Laparoscopic Paravaginal Repair in the Treatment of Anterior Vaginal Prolapse in Women of Child-bearing Age. West China Medical Journal, 2015, 30(7): 1246-1249. doi: 10.7507/1002-0179.20150358 Copy

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10.	Halaska M, Maxova K, Sottner O, et al. A multicenter, randomized, prospective, controlled study comparing sacrospinous fixation and transvaginal mesh in the treatment of posthysterectomy vaginal vault prolapse[J]. Am J Obstet Gynecol, 2012, 207(4):301.e1-301.e7.
11.	Claydon CS, Maccarone JL, Grody MH, et al. The distance between the perceived and the actual arcus tendineus fascia pelvis during vaginal paravaginal repair[J]. Am J Obstet Gynecol, 2005, 192(5):1707-1711.
12.	郭英花, 孫靄萍, 林華. 腹腔鏡下經腹膜外陰道旁修補術治療陰道前壁脫垂9例報告[J]. 中國微創外科雜志, 2012, 12(9):795-798.
13.	唐建軍, 陸安偉, 徐春佳. 經陰道骶棘韌帶固定術在子宮及陰道穹隆脫垂預防和治療中的應用價值[J]. 實用婦產科雜志, 2010, 26(1):66-68.
14.	朱蘭, 郎景和, 王宏, 等. 腹腔鏡下Burch術治療解剖型壓力性尿失禁52例分析[J]. 實用婦產科雜志, 2007, 23(7):434-436.
15.	魯永鮮, 劉昕, 劉靜霞, 等. 經陰道行陰道旁修補術在陰道前壁及膀胱膨出治療中的應用[J]. 中華婦產科雜志, 2005, 40(3):154-158.

1. Gumanga SK, Munkaila A, Malechi H. Social demographic characteristics of women with pelvic organ prolapse at the Tamale Teaching Hospital, Ghana[J]. Ghana Med J, 2014, 48(4):208-213.
2. Hosni MM, El-Feky AE, Agur WI, et al. Evaluation of three different surgical approaches in repairing paravaginal support defects:a comparative trial[J]. Arch Gynecol Obstet, 2013, 288(6):1341-1348.
3. Bump RC, Mattiasson A, B? K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction[J]. Am J Obstet Gynecol, 1996, 175(1):10-17.
4. Hamada H. Laparoscopic surgery in the treatment of urogenital prolapse. Current status[J]. J Gynecol Obstet Biol Reprod (Paris), 2012, 41(5):399-408.
5. 徐惠成, 王延洲, 袁吉釗, 等. 腹腔鏡下陰道旁修補術治療陰道前壁膨出的臨床療效分析[J]. 第三軍醫大學學報, 2008, 30(17):1661-1664.
6. Sikora M, Scheiner D, Betschart C, et al. Label-free, threedimensional multiphoton microscopy of the connective tissue in the anterior vaginal wall[J]. Int Urogynecol J, 2015, 26(5):685-691.
7. 朱蘭, 郎景和. 女性盆底學[M]. 北京:人民衛生出版社, 2008:175.
8. Kohli N, Sze EH, Roat TW, et al. Incidence of recurrent cystocele after anterior colporrhaphy with and without concomitant transvaginal needle suspension[J]. Am J Obstet Gynecol, 1996, 175(6):1476-1480; discussion 1480-1482.
9. 韓勁松. 前盆腔缺陷的手術治療進展[J]. 中國實用婦科與產科雜志, 2006, 22(3):237-239.
10. Halaska M, Maxova K, Sottner O, et al. A multicenter, randomized, prospective, controlled study comparing sacrospinous fixation and transvaginal mesh in the treatment of posthysterectomy vaginal vault prolapse[J]. Am J Obstet Gynecol, 2012, 207(4):301.e1-301.e7.
11. Claydon CS, Maccarone JL, Grody MH, et al. The distance between the perceived and the actual arcus tendineus fascia pelvis during vaginal paravaginal repair[J]. Am J Obstet Gynecol, 2005, 192(5):1707-1711.
12. 郭英花, 孫靄萍, 林華. 腹腔鏡下經腹膜外陰道旁修補術治療陰道前壁脫垂9例報告[J]. 中國微創外科雜志, 2012, 12(9):795-798.
13. 唐建軍, 陸安偉, 徐春佳. 經陰道骶棘韌帶固定術在子宮及陰道穹隆脫垂預防和治療中的應用價值[J]. 實用婦產科雜志, 2010, 26(1):66-68.
14. 朱蘭, 郎景和, 王宏, 等. 腹腔鏡下Burch術治療解剖型壓力性尿失禁52例分析[J]. 實用婦產科雜志, 2007, 23(7):434-436.
15. 魯永鮮, 劉昕, 劉靜霞, 等. 經陰道行陰道旁修補術在陰道前壁及膀胱膨出治療中的應用[J]. 中華婦產科雜志, 2005, 40(3):154-158.

West China Medical Journal

Clinical Efficacy of Laparoscopic Paravaginal Repair in the Treatment of Anterior Vaginal Prolapse in Women of Child-bearing Age

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