Sacrovaginopexy with prolene net application in genitalia prolapsus cure

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Material and methods. 170 been operated patients at age of 35-78 (average age was 47) were under dynamic observation with complex examination during 5 years. All the examined patients were divided into 5 groups according to their pathologies. The first group consisted of 24 patients with vagina prolapsus and cysto- and rectocele. The second group consisted of 39 patients with incomplete womb falling. The third one - 98 patients with fall womb falling. The fourth one - 8 patients with womb stump falling after abvaginal amputation. The fifth group - 1 patient with vagina cupola prolapsus after abdominal womb extirpation.

A lot of ways of surgical correction of this pathology are well-known now (including laparoscopy), what is the witness of urgency of this problem at one hand, and insufficient effectiveness of surgical methods and disease high frequency recurrence at the other hand. According to the various researches data every third patient suffers from recurrence within the first three postoperational years. Searching for optimum technology of genitalia prolapsus cure we have implemented synthetic materials into pelvis fundus surgery.

For the sake of stump falling surgical correction after abvaginal womb amputation and correction of vagina cupola falling after womb extirpation, we made sacred bone colpopexy.

We used prolene net of GyneMech series with length of 8cm and width of 2 cm as fixing material.

The main steps of surgical interference we have outworked, are given below:

1. Patient is on her back in metotomic position. Two clamps are applied at the apex of vagina. If hysterectomy have been done earlier, sutures on the vagina apex are seen.
2. Vaginal celiotomy ( PfannenstieFs incision, seldom - median incision).
3. After intestine abduction with moisturized cloths surgeon finds right ureter and rectosigmoid part of intestine. He makes the incision of parietal peritoneum down from the promontory of the sacrum, across Douglas space and vagina apex. Vagina places into peritoneum with the help of 4 cm in length obturator or spongy tampon on the oval clamp.
4. Fixing material (prolene net in our case) is sewing to the periosteum of sacrum. First, it is necessary to make sutures on the periosteum, then to follow them through the fascia, 3-4 sutures must be made. Distal end of stripe is sewed to the apex of vagina, 3 separate synthetic nonabsorbtional sutures are made on the anterior wall of the vagina. The stripe of fixing material is laying on the vagina cupola and can be sewed to it, if it is necessary. Douglas space is closed by sewing of sacrum uteri ligament along medium line.
5. Parietal peritoneum is sewed above the stripe of the fixing material, small pelvis is peritonized.

Sacral vaginopexy with prolene net application was made in 8 cases. There were no recurrences during 5 years.

Conclusions. Sacral vaginopexy with prolene net application has many advantages in comparison with the other methods of genitalia prolapsus cure where only proper tissues are used. GyneMech series prolene stripe application when sacral vaginopexy takes place, makes possible to save the depth of vagina and to recover normal axis of vagina cupola. As sacral vaginopexy is followed by pelvis hernia closure, the prolene net usage for the anatomic correction is justified. This material is well modeling, demonstrates itself as unresolving and unreactive and easy in application.

About the authors

О. S. Abulhairova

Bashkir State Medical University; City Hospital №18

Author for correspondence.
Email: info@eco-vector.com

Obstetrics and Gynecology Chair №2

Russian Federation, Ufa-city; Ufa-city

L. V. Luzina

Bashkir State Medical University; City Hospital №18

Email: info@eco-vector.com

Obstetrics and Gynecology Chair №2

Russian Federation, Ufa-city; Ufa-city

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