Experience in surgical correction of genital prolapse caused by abdominoperineal operations for colon cancer in anamnesis

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Abstract


In recent studies, it has been established that extralevator abdominoperineal extirpation (ELAPE) of the rectum can improve the oncological results of treatment of distal rectal cancer compared to standard abdominoperineal extirpation. As a result of extralevator dissection, a large defect of the perineum is formed, which requires plastic closure. While performing ELAPE, the structures that form the pelvic diaphragm are affected. This increases the risk of pelvic organ prolapse in women and significantly affects the quality of life of these patients, which requires subsequent surgical treatment. Despite the fact that pelvic organ prolapse develops as a consequence of previous surgical treatment by an oncologist, they do not consider it as a complication in the long-term postoperative period. Such patients are not referred to the operating gynecologist. Currently, this problem is poorly understood and there are no standardized approaches to the surgical treatment of pelvic prolapse in this category of patients.


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About the authors

Andrey N. Plekhanov

Academician I.P. Pavlov First Saint Petersburg State Medical University; Saint Petersburg Clinical Hospital of the Russian Academy of Sciences; Academy of Medical Education named after F.I. Inozemtsev

Author for correspondence.
Email: bez-vitaly@yandex.ru
ORCID iD: 0000-0002-5876-6119
SPIN-code: 1132-4360

Russian Federation, Saint Petersburg

MD, PhD, DSci (Medicine), Professor. The Department of Obstetrics, Gynecology, and Neonatology; Chief Obstetrician-Gynecologist; Head of the Department of Operative Gynecology. Academy of Medical Education named after F.I. Inozemtsev

Vitaly F. Bezhenar

Academician I.P. Pavlov First Saint Petersburg State Medical University

Email: bez-vitaly@yandex.ru
ORCID iD: 0000-0002-7807-4929
SPIN-code: 8626-7555

Russian Federation, Saint Petersburg

MD, PhD, DSci (Medicine), Professor, Head of the Department of Obstetrics, Gynecology, and Neonatology

Alexey M. Karachun

N .N. Petrov National Medical Research Center of Oncology

Email: dr.a.karachun@gmail.com
ORCID iD: 0000-0001-6641-7229
SPIN-code: 6088-9313

Russian Federation, Saint Petersburg

MD, PhD, DSci (Medicine), Associate Professor, Head of the Surgical Department of Abdominal Oncology, Leading Researcher, Head of the Scientific Department of Gastrointestinal Tract Tumors

Fyodor V. Bezhenar

Saint Petersburg Clinical Hospital of the Russian Academy of Sciences

Email: bez-vitaly@yandex.ru
ORCID iD: 0000-0001-5515-8321
SPIN-code: 6074-5051

Russian Federation, Saint Petersburg

MD. The Surgical Department

Anna A. Tsypurdeyeva

Saint Petersburg State University; Research Institute of Obstetrics, Gynecology, and Reproductology named after D.O. Ott

Email: bez-vitaly@yandex.ru
ORCID iD: 0000-0001-7774-2094
SPIN-code: 5208-9707

Russian Federation, Saint Petersburg

MD, PhD, Assistant Professor. The Department of Obstetrics, Gynecology, and Reproductive Sciences, the Faculty of Medicine; Head of the Department of Gynecology with the Operating Unit

Tatyana A. Epifanova

Academician I.P. Pavlov First Saint Petersburg State Medical University; Saint Petersburg Clinical Hospital of the Russian Academy of Sciences

Email: bez-vitaly@yandex.ru
ORCID iD: 0000-0003-1572-1719
SPIN-code: 5106-9715

Russian Federation, Saint Petersburg

MD, Post-Graduate Student The Department of Obstetrics, Gynecology, and Neonatology; Obstetrician-Gynecologist. The Surgical Department

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Supplementary files

Supplementary Files Action
1.
Fig. 1. Dissection line for standard (a) and extralevator (b) abdominoperineal extirpation

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2.
Fig. 2. Perineal wound after extralevator abdominoperineal extirpation

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3.
Fig. 3. Patient’s condition before surgery

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Fig. 4. Bladder dissection

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Fig. 5. Immersion of the separated bladder with circular sutures

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Fig. 6. Suturing the vesicovaginal and rectovaginal fascia

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Fig. 7. Schematic representation of the perineum after surgery

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Fig. 8. Skin suturing in the last step of surgery

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Fig. 9. Nine months after performing surgery

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Fig. 10. Patient’s condition before surgery

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11.
Fig. 11. Bowa ARC 400 electrosurgical unit and Bowa TissueSeal PLUS COMFORT sealing clamp for open surgery

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Fig. 12. Use of the Bowa TissueSeal PLUS COMFORT sealing clamp for vaginal hysterectomy

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Fig. 13. Operation area on the 7th day of the postoperative period

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Fig. 14. Patient’s condition before surgery

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Fig. 15. Bladder dissection

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Fig. 16. Introduction of guiding and fixing threads to fix the mesh implant

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Fig. 17. VYPRO mesh implant fixation

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Fig. 18. Suturing the operating wound

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Fig. 19. Plastic surgery of the back of the vagina

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Fig. 20. Skin suturing in the last step of surgery

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Fig. 21. Four months after the first stage of surgery

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Fig. 22. Posterior vaginal wall dissection

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Fig. 23. Posterior vaginal wall reconstruction

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Fig. 24. Skin suturing in the last step of surgery

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Fig. 25. One month after the second stage of surgery

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Copyright (c) 2020 Plekhanov A.N., Bezhenar V.F., Karachun A.M., Bezhenar F.V., Tsypurdeyeva A.A., Epifanova T.A.

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This work is licensed under a Creative Commons Attribution 4.0 International License.

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