Advantages of the modified colpocleisis operation in patients with atypical types of pelvic organ prolapse

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Abstract

Background: Currently, there is no general universal unified surgical treatment strategy for patients with pelvic organ prolapse. Considering the risks of installing mesh implants and the increasing incidence of implant-associated complications, mesh-free pelvic floor surgery techniques have become relevant again. A method was developed and introduced into clinical practice, which is an electrosurgical vaginal hysterectomy followed by vaginal suturing using a modified colpocleesis operation, which allows combining all the advantages of this method and at the same time minimizing the risks of cancer in the future.

Aim: The aim of this study was to improve the results of surgical treatment in patients with rare, complicated and recurrent forms of pelvic organ prolapse.

Materials and methods: This study included 140 patients diagnosed with pelvic organ prolapse. The main group consisted of 70 individuals with rare, severe and complicated cases of genital prolapse, who underwent surgical treatment using our modified colpocleisis operation. The control group comprised 70 other individuals with newly diagnosed uncomplicated cases of pelvic organ prolapse, who underwent surgical treatment using mesh implants.

Results: All patients underwent planned surgical treatment. The operated patients were monitored for 1–5 years. In the main group, the effectiveness of the operation was 100%, while the effectiveness of surgical treatment with a mesh implant in the control group was 95.7%. All patients in the main group had complete tissue healing. There were no cases of long-term complications or relapses in any of the patients.

Conclusions: the use of the modified colpocleisis operation for atypical types of pelvic organ prolapse is a highly effective method of prolapse correction. This, in combination with a simple execution technique, allows it for being offered as a basic method for vaginal access in patients without sexual activity.

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About the authors

Andrey N. Plekhanov

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

Email: a_plekhanov@mail.ru
ORCID iD: 0000-0002-5876-6119
SPIN-code: 1132-4360

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg; Saint Petersburg; Saint Petersburg

Vitaly F. Bezhenar

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

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

MD, Dr. Sci. (Medicine), Professor

Russian Federation, Saint Petersburg

Fedor V. Bezhenar

St. Petersburg Clinical Hospital of the Russian Academy of Sciences; St. Petersburg State Pediatric Medical University

Author for correspondence.
Email: fbezhenar@gmail.com
ORCID iD: 0000-0001-5515-8321
SPIN-code: 6074-5051

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg; Saint Petersburg

Tatiana A. Epifanova

St. Petersburg Clinical Hospital of the Russian Academy of Sciences; F.I. Inozemtsev Academy of Medical Education

Email: epifanova-tatiana@mail.ru
ORCID iD: 0000-0003-1572-1719
SPIN-code: 5106-9715

MD, Cand. Sci. (Medicine)

Russian Federation, Saint Petersburg; Saint Petersburg

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Supplementary files

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2. Fig. 1. Bipolar electroligation instrument

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3. Fig. 2. Peritonization of the abdominal cavity

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4. Fig. 3. Hydropreparation of the anterior vaginal wall

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5. Fig. 4. Dissection of the vaginal mucosa

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6. Fig. 5. Application of purse string sutures

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7. Fig. 6. Suturing of the vaginal mucosa wound

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8. Fig. 7. Distribution of patients of all the study groups by number of births. A, subgroup of women with recurrent forms of pelvic organ prolapse; B, subgroup of women with rare forms of pelvic organ prolapse after extralevatory abdominal-perineal extirpation of the rectum in the anamnesis; C, subgroup of women with complicated forms of pelvic organ prolapse after supravaginal amputation of the uterus with a history of prolapse of the cervical stump

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СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
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