Combined surgical treatment for internal genital descent and prolapse in patients with concomitant gynecological diseases

Objective: to enhance the efficiency of surgical treatment in patients with concomitant gynecological diseases accompanied by internal genital prolapse, by applying a combined (laparovaginai) access. Setting: Obstetrics and Gynecology Department One, Faculty of Therapeutics, I. M. Sechenov Moscow Medical Academy. Design: a prospective study. Subjects: 47 patients aged 39 to 64 years who had concomitant gynecological diseases accompanied by internal genital prolapse Methods: clinical, laboratory, ultrasound, endoscopic studies, X-ray study using a metallic marker, combined 2-3-stage (laparovaginai) surgical intervention with laparoscopic supravaginal hysterectomy (Stage 1), followed by extraperitoneal ligature cervicosuspension to aponeurosis via laparoscopic access (Stage 2) and colpoperineorrhaphy (Stage 3). Results: laparoscopic supravaginal hysterectomy was carried out at surgery stage 1; if there were indications, the surgeons removed uterine appendages or tubes (46.8%), resected ovaries (38.2%), dissected small pelvic adhesions (12.7%), and coagulated the foci of external genital endometriosis (12.7%). At Stage 2 of surgical treatment, laparoscopic extraperitoneal ligature cervicosuspension to aponeurosis was made in all the patients. At stage 3 of surgery, colpoperineorrhaphy with levatoroplasty was performed in most (57.4%) patients, 40.4% of the patients underwent anterior colporrhaphy and colpoperineorrhaphy with levatoroplasty, and one postmenopausal patient had midline colporrhaphy with perineorrhaphy. The total duration of surgical treatment averaged 123.5±25 min. Total intraoperative blood loss was 50 to 300 ml (mean 188.2±1.5 ml). There were no postoperative complications. Median postoperative inpatient stay was 7±2 bed/days. Conclusion: combined 2- or З-stage surgery via laparovaginai access in patients with internal genital prolapse concurrent with benign diseases of the corpus uteri and appendages, performed within one operation is a highly effective therapeutic measure with partial preservation of the organ (cervix uteri) in which stage 2 insignificantly prolongs the total time of surgery and causes no increase in blood loss. Extraperitoneal ligature cervicosuspension to anoneurosis via laparoscopic access ensures a reliable correction of genital prolapse and a reduction in intra- and postoperative complications, promotes the cervical stump position close to the physiological one and the recovery of normal anatomic relations of small pelvic organs. The satisfaction of the results of surgical treatment, the improvement of life quality, and the absence of relapses of internal genital prolapses during a long-term follow-up have allowed the proposed procedure for surgical treatment to be regarded as highly effective.