Evre 3-4 vajinal cuff prolapsusu tedavisinde konvansiyonel enstrümanlar kullanılarak sakrospinöz ligament fiksasyon sonuçları

Amaç: Çalışmamızda sakrospinöz ligament fiksasyonunun (SSLF) ameliyat sonrası 12 aylık dönemdeki etkinliği araştırıldı.Gereç ve Yöntem: Çalışmaya Ocak 2014 ve Mayıs 2017 tarihleri arasında vajinal cuff prolapsusu tanısı almış ve SSLF uygulanmış hastalar dahil edildi. Sübjektif değerlendirme Hasta Global Düzelme İzlenimi (PGI-I) skorlama sistemi kullanılarak gerçekleştirildi. 12. ayda objektif başarı oranı değerlendirildi ve Pelvik Organ Prolapsusu-Kantifikasyon Sistemi (POP-Q) Evre 0 veya 1 sonuçları objektif başarı kriteri olarak kabul edildi. Operasyonun bir yıllık dönemdeki etkinliği ve komplikasyon oranları değerlendirildi.Bulgular: Toplam 26 hasta çalışmaya dahil edildi. On iki hastaya (%46.2) unilateral SSLF uygulanırken, 14 hastaya (%53.8) bilateral SSLF yapıldı. Objektif ve sübjektif başarı oranı 12. ayda sırasıyla %100 ve %100 idi. Bilateral ve unilateral SSLF uygulanmış gruplar arasında ameliyat süresi ve intraoperatif kanama miktarı yönünden anlamlı bir fark izlendi. Bir yıllık takibin sonunda yalnızca üç hastada hafif şiddette gluteal ağrı gözlendi.Sonuç: Unilateral veya bilateral sakrospinöz ligament süspansiyonunun histerektomi sonrası vajinal cuff prolapsusu olan kadınlarda etkili ve güvenli bir cerrahi yöntem olduğunu göstermektedir.

Anahtar Kelimeler:

Sacrospinous ligament, vaginal prolapse, hysterectomy

Outcome of sacrospinous ligament fixation with conventional instruments in the treatment of Stage 3-4 vaginal vault prolapse

Purpose: The objective of this study was to investigate the effectiveness of the sacrospinous ligament fixation (SSLF) at 12 months following the operation.Materials and Methods: This retrospective study included patients diagnosed with vaginal vault prolapse and underwent SSLF between January 2014 and May 2017. The subjective evaluation was performed according to the Patient Global Impression of Improvement (PGI-I). The objective success rate at the end of 12 months was evaluated, and the Pelvic Organ Prolapse-Quantification System (POP-Q) Stage 0 or 1 was considered as a successful outcome. The effectiveness of the operation and the complication rates were evaluated during one-year follow-up.Results: A total of 26 patients were included in the study. Twelve patients (46.2%) underwent unilateral SSLF and 14 patients (53.8%) bilateral SSLF operation. At 12 months, the objective and subjective success rates were 100% and 100%, respectively. There was a significant difference between the unilateral and bilateral SSLF groups in terms of the operation time and intraoperative bleeding. After one-year follow-up, only three patients (11.3%) complained about mild gluteal pain. Conclusion: The suspension of the vagina to the unilateral or bilateral sacrospinous ligament was an effective and safe surgical method in patients with post-hysterectomy vaginal vault prolapse.

Keywords:

Sacrospinous ligament, vaginal prolapse, hysterectomy,

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1. Dietz HP. Pelvic organ prolapse - a review. Aust Fam Physician. 2015;44:446-52.
2. Marchionni M, Bracco GL, Checcucci V, Carabaneanu A, Coccia EM, Mecacci F et al. True incidence of vaginal vault prolapse. Thirteen years of experience. J Reprod Med. 1999;44:679-84.
3. Uzoma A, Farag KA. Vaginal vault prolapse. Obstet Gynecol Int. 2009;2009:275621.
4. Maher CF, Cary MP, Slack MC, Murray CJ, Milligan M, Schluter P. Uterine preservation or hysterectomy at sacrospinous colpopexy for uterovaginal prolapse? Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:381- 4.
5. Dietz V, de Jong J, Huisman M, Schraffordt Koops S, Heintz P, van der Vaart H. The effectiveness of the sacrospinous hysteropexy for the primary treatment of uterovaginal prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18:1271-6.
6. Aksakal O, Doganay M, Onur Topcu H, Kokanali K, Erkilinc S, Cavkaytar S. Long-term surgical outcomes of vaginal sacrospinous ligament fixation in women with pelvic organ prolapse. Minerva Chir. 2014;69:239-44.
7. Vitale SG, Lagana AS, Noventa M, Giampaolino P, Zizolfi B, Buttice S et al. Transvaginal Bilateral Sacrospinous Fixation after Second Recurrence of Vaginal Vault Prolapse: Efficacy and Impact on Quality of Life and Sexuality. Biomed Res Int. 2018;2018:5727165.
8. Doganay M, Aksakal O. Minimally invasive sacrospinous ligament suspension: perioperative morbidity and review of the literature. Arch Gynecol Obstet. 2014;289:35.
9. Richter K. [The surgical anatomy of the vaginaefixatio sacrospinalis vaginalis. A contribution to the surgical treatment of vaginal blind pouch prolapse]. Geburtshilfe Frauenheilkd. 1968;28:321-7.
10. Nichols DH. Sacrospinous fixation for massive eversion of the vagina. Am J Obstet Gynecol. 1982;142:901-4.
11. Tseng LH, Chen I, Chang SD, Lee CL. Modern role of sacrospinous ligament fixation for pelvic organ prolapse surgery--a systemic review. Taiwan J Obstet Gynecol. 2013;52:311-7.
12. Bump RC, Mattiasson A, Bo K, Brubaker LP, DeLancey JO, Klarskov P et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10-7.
13. Visco AG, Wei JT, McClure LA, Handa VL, Nygaard IE, Pelvic Floor Disorders N. Effects of examination technique modifications on pelvic organ prolapse quantification (POP-Q) results. Int Urogynecol J Pelvic Floor Dysfunct. 2003;14:136-40.
14. Srikrishna S, Robinson D, Cardozo L. Validation of the Patient Global Impression of Improvement (PGII) for urogenital prolapse. 2009;21.
15. Ren C, Song XC, Zhu L, Ai FF, Shi HH, Sun ZJ et al. [Prospective cohort study on the outcomes of sacrospinous ligament fixation using conventional instruments in treating stage - pelvic organ prolapse]. Zhonghua Fu Chan Ke Za Zhi. 2017;52:369-73.
16. Senturk MB, Dogan O. Sacrospinous Ligament Fixation Under Local Anesthesia in Elderly Patients at High Risk of General Anesthesia. J Invest Surg. 2018:1-7.
17. Sze EH, Karram MM. Transvaginal repair of vault prolapse: a review. Obstet Gynecol. 1997;89:466-75.
18. Miyazaki FS. Miya Hook ligature carrier for sacrospinous ligament suspension. Obstet Gynecol. 1987;70:286-8.
19. Veronikis DK, Nichols DH. Ligature carrier specifically designed for transvaginal sacrospinous colpopexy. Obstet Gynecol. 1997;89:478-81.
20. Sharp TR. Sacrospinous suspension made easy. Obstet Gynecol. 1993;82:873-5.
21. Schlesinger RE. Vaginal sacrospinous ligament fixation with the Autosuture Endostitch device. Am J Obstet Gynecol. 1997;176:1358-62.
22. Lind LR, Choe J, Bhatia NN. An in-line suturing device to simplify sacrospinous vaginal vault suspension. Obstet Gynecol. 1997;89:129-32.
23. Aksakal OS, Ozyer SS, Gungor T, Doganay M, Bilge U, Mollamahmutoglu L. Comparison of a new technique with Deschamps ligature carrier for sacrospinous ligament fixation. Arch Gynecol Obstet. 2007;276:591-4.
24. Doganay M, Aksakal O. Minimally invasive sacrospinous ligament suspension: perioperative morbidity and review of the literature. Arch Gynecol Obstet. 2013;287:1167-72.
25. Barksdale PA, Gasser RF, Gauthier CM, Elkins TE, Wall LL. Intraligamentous nerves as a potential source of pain after sacrospinous ligament fixation of the vaginal apex. Int Urogynecol J Pelvic Floor Dysfunct. 1997;8:121-5.
26. Unger CA, Walters MD. Gluteal and posterior thigh pain in the postoperative period and the need for intervention after sacrospinous ligament colpopexy. Female Pelvic Med Reconstr Surg. 2014;20:208-11.
27. Ferrando CA, Walters MD. A randomized doubleblind placebo-controlled trial on the effect of local analgesia on postoperative gluteal pain in patients undergoing sacrospinous ligament colpopexy. Am J Obstet Gynecol. 2018.
28. Ellerkmann RM, Cundiff GW, Melick CF, Nihira MA, Leffler K, Bent AE. Correlation of symptoms with location and severity of pelvic organ prolapse. Am J Obstet Gynecol. 2001;185:1332-7.
29. Benson JT, Lucente V, McClellan E. Vaginal versus abdominal reconstructive surgery for the treatment of pelvic support defects: a prospective randomized study with long-term outcome evaluation. Am J Obstet Gynecol. 1996;175:1418-21.
30. Maher CF, Qatawneh AM, Dwyer PL, Carey MP, Cornish A, Schluter PJ. Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study. Am J Obstet Gynecol. 2004;190:20-6.
31. Agacayak E, Yaman Tunc S, Icen MS, Basaranoglu S, Findik FM, Sak S, et al. Should we add unilateral sacrospinous ligament fixation to vaginal hysterectomy in management of stage 3 and stage 4 pelvic organ prolapse? Turk J Obstet Gynecol. 2015;12:144-50.