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Tela de polipropileno versus corre??o sítio-especifica no tratamento do prolapso de parede vaginal anterior: resultados preliminares de ensaio clínico rand?mico
Lunardelli, Jacqueline Leme;Auge, Antonio Pedro Flores;Lemos, Nucélio Luiz de Barros Moreira;Carram?o, Silvia da Silva;Oliveira, André Lima de;Duarte, Eliana;Aoki, Tsutomu;
Revista do Colégio Brasileiro de Cirurgi?es , 2009, DOI: 10.1590/S0100-69912009000300006
Abstract: objective: pelvic organ prolapse is a disorder caused by the imbalance between the forces responsible for supporting the pelvic organs in their normal position and those that tend to expel them from the pelvis. anterior vaginal wall prolapse, known as cystocele, is the most common form of prolapse and can result from lesions in different topographies of the endopelvic fascia. currently, a woman has an 11% risk of being submitted to a surgical procedure to correct pelvic floor disorder, and a 29% chance of being reoperated due to failure in the first surgery. methods: a prospective randomized study was conducted to compare the use of polypropylene mesh with site-specific repair in the surgical treatment of anterior vaginal prolapse. thirty-two patients aged between 50 and 75 years, who had previous vaginal prolapse at stage iii or iv, or prolapse recurrence, were operated. mean follow-up was 8.5 months. results: the results demonstrate the superiority of the anatomical outcomes with the use of polypropylene mesh over site-specific repair. regarding surgical morbidity, shorter operative time was observed for the mesh group. conclusion: the results observed in this study indicate the superiority of anatomical results obtained with the use of polypropylene mesh over site-specific repair.
IVS POSTERIOR (POSTERIOR INTRAVAGINAL SLINGPLASTY) PARA EL TRATAMIENTO DE PROLAPSO DE CúPULA VAGINAL O PROCIDENCIA DE úTERO: SERIE DE CASOS
Alfredo Silva R.,Luis Ferrada C.,Carlos Arroyo M.,Kinovape Nalbandian L.
Revista Chilena de Obstetricia y Ginecología , 2004,
Abstract: Presentamos una serie de casos de pacientes con prolapso de cúpula vaginal post histerectomía o procidencia de útero, tratadas quirúrgicamente con técnica de IVS posterior (Posterior Intravaginal Slingplasty), también llamada sacropexia infracoccígea. Se analiza la técnica, indicaciones y resultados We present a series of cases of patients with vaginal vault prolapse posthysterectomy or uterine prolapse or enterocele, surgically solved with the posterior IVS (Posterior Intravaginal Slingplasty), also called infracoccigeal sacropexy. We analyzed the surgical technique, indications and results
Prolapso de tuba uterina após histerectomia vaginal: relato de caso  [cached]
Noviello Maurício B.,Silva-Filho Agnaldo L.,Santos-Filho Admário S.,Candido Eduardo B.
Revista Brasileira de Ginecologia e Obstetrícia , 2003,
Abstract: O prolapso de tuba uterina é complica o rara após histerectomia, com aproximadamente 80 casos descritos na literatura. A sintomatologia é inespecífica, podendo incluir sangramento genital, dispareunia e dor pélvica cr nica. O diagnóstico diferencial deve ser feito com granuloma de cúpula vaginal e carcinoma de vagina. O tratamento deve ser individualizado, podendo ser realizado por via vaginal, abdominal ou laparoscópica. Relatamos o caso de uma paciente, 47 anos, com miomatose uterina, submetida a histerectomia vaginal, evoluindo com prolapso de tuba uterina após 11 meses de pós-operatório. O exame especular evidenciava les o vegetante, friável e sangrante localizada na cúpula vaginal. Esses achados clínicos sugeriam o diagnóstico de prolapso de tuba uterina. A paciente foi submetida a nova interven o cirúrgica, com ressec o da tuba uterina por via vaginal. O exame natomopatológico confirmou o diagnóstico e a paciente evoluiu com remiss o completa da sintomatologia.
Estudo rand?mico da corre??o cirúrgica do prolapso uterino através de tela sintética de polipropileno tipo I comparando histerectomia versus preserva??o uterina
Carram?o, Silvia;Auge, Antonio Pedro Flores;Pacetta, Aparecida Maria;Duarte, Eliana;Ayrosa, Paulo;Lemos, Nucélio LML;Aoki, Tsutomu;
Revista do Colégio Brasileiro de Cirurgi?es , 2009, DOI: 10.1590/S0100-69912009000100012
Abstract: objectives: to compare surgical morbidity and time, as well as anatomical outcomes between vaginal histerectomy and uterine preservation in the treatment of uterine prolapse using a mesh kit (nazca ?). methods: randomized controled trial with 31 women with uterine prolapse pop-q stage 3 or 4 pelvic organ prolapse who underwent vaginal surgery using tipe i polypropilene mesh (nazca ?). they were randomized in two groups: group hv: hysterectomy and pelvic reconstruction floor with mesh (n=15); group hp: hysteropexy and pelvic reconstruction floor with mesh (n=16). race, miccional urgency, intestinal constipation, sacral pain were assessed as well as the amount of bleeding and time of operation. results: median follow-up was nine months on both groups. no difference was observed on complication rates and functional outcomes. operation time was 120 minutes on group hv, versus 58.9 minutes on group hp (x2 = 17.613*, p < 0.001 ) and intraoperative blood loss was 120 ml on group hv versus 20 ml on group hp (x2 = 19.425*; p < 0.001). there was no differences in relationship to anatomical cure rates. objective success rate was 86.67% to group hv and 75% to group hp (p=0,667) at nine months of follow-up. the anatomical results were similar between the two groups. conclusion: the anatomic results between histeropexy and hysterectomy were similar. however, surgical time and blood loss were greater in group with histerectomies. the erosion rate were also similar. vaginal surgery using mesh is an effective procedure for pelvic organ prolapse.
IVS POSTERIOR (POSTERIOR INTRAVAGINAL SLINGPLASTY) PARA EL TRATAMIENTO DE PROLAPSO DE CúPULA VAGINAL O PROCIDENCIA DE úTERO: SERIE DE CASOS
Silva R.,Alfredo; Ferrada C.,Luis; Arroyo M.,Carlos; Nalbandian L.,Kinovape;
Revista chilena de obstetricia y ginecología , 2004, DOI: 10.4067/S0717-75262004000600003
Abstract: we present a series of cases of patients with vaginal vault prolapse posthysterectomy or uterine prolapse or enterocele, surgically solved with the posterior ivs (posterior intravaginal slingplasty), also called infracoccigeal sacropexy. we analyzed the surgical technique, indications and results
Histerectomía vaginal sin prolapso genital Vaginal hysterectomy without genital prolapse  [cached]
Abelardo S Toirac Lamarque,Viviana Pascual López,Nancy Moya Rodríguez
MEDISAN , 2012,
Abstract: Se efectuó una investigación analítica, longitudinal y retrospectiva de una muestra de 110 mujeres de un total de 639 con diferentes afecciones de los órganos genitales, excluidas las sépticas, e intervenidas las primeras por vía vaginal durante el quinquenio 2005-2009, las cuales fueron asignadas a 2 grupos: el A, integrado por 37 pacientes sin prolapso genital (técnica de Peham-Amreich); y el B, conformado por 73 féminas con dicho prolapso (técnica de Heany) en estadios clínicos I y II-III, quienes fueron reagrupadas en subgrupos de 32 y 41 pacientes, respectivamente. En la serie se consideraron las variables: edad, sangrado peroperatorio, tiempo quirúrgico, estadía posoperatoria, complicaciones peroperatorias y posoperatorias, así como control ambulatorio (trigésimo día). Las integrantes del grupo A se ajustaron a requerimientos clínicos y ecográficos preseleccionados: útero móvil y equivalente en volumen al pu o de un hombre adulto de biotipo medio, campo operatorio suficiente y normalidad en examen de anejos. Para el análisis estadístico se aplicó el test de Pearson, con valores de significación considerados en 3 categorías, a saber: I, p=0,05 (estándar); II, p=0,01 (alta) y III, p=0,001 (muy alta). Se demostró, con muy alta significación, que el prolapso genital es una afección privativa de mujeres de edad superior a 50 a os. El resto de las variables escogidas careció de valor estadístico en este estudio. An analytic, longitudinal and retrospective investigation was carried out in a sample of 110 women from a total of 639 with different disorders of the genitals, excluding the septic ones. The former group had surgeries through vagina during the five year period 2005-2009, and were assigned to 2 groups: group A, formed by 37 women without genital prolapse (Peham-Amreich technique); and group B, formed by 73 women with this disorder (Heany technique) in clinical stages I and II-III, who were regrouped in subgroups of 32 and 41 patients, respectively. Variables such as: age, peroperative bleeding, surgical time, postoperative stay, peroperative and postoperative complications, as well as ambulatory control (thirtieth day) were considered in the series. The members of group A were adjusted to previously selected clinical and echographic requirements: mobile uterus and equivalent in volume to the fist of an adult man of average biotype, adequate operative field and normality in the adnexa examination. For the statistical analysis the Pearson test was applied, with significance values considered in 3 categories, that is: I, p=0.05 (standard); II, p=0.
Fijación sacroespinosa en el manejo del prolapso de cúpula vaginal y hernia pélvica: diez a os de experiencia(1992-2002) Sacrospinal fixation for the treatment of vaginal vault prolapse and pelvic hernia: ten years of experience, 1992-2002  [cached]
Luis Guillermo Echavarría Restrepo
Revista Colombiana de Obstetricia y Ginecología , 2004,
Abstract: El prolapso de cúpula vaginal es una complicación molesta de la histerectomía abdominal o vaginal que puede presentarse meses o a os después de la cirugía. La fijación de la cúpula al ligamento sacroespinoso es una alternativa por la vía vaginal para corregir el prolapso de cúpula o la hernia pélvica. Mediante un estudio descriptivo, se pretende dar a conocer los resultados de la fijación de cúpula vaginal al ligamento sacroespinoso en 130 pacientes sometidas a este procedimiento en cuatro centros de cirugía ginecológica de Medellín, en el periodo comprendido entre 1991 y 2002. De las pacientes intervenidas se logró hacer seguimiento a 78 de ellas; 32 (41%) tenían cirugía ginecológica previa, y por ende un diagnóstico de prolapso de cúpula. 46 (58%) tenían diagnóstico de hernia pélvica. Se presentaron complicaciones inherentes a la cirugía en un 13% de las pacientes, todas consideradas menores y ninguna puso en peligro la vida de la paciente o generó secuelas. En las pacientes que tuvieron seguimiento que fluctuó entre seis meses y cinco a os, se obtuvieron resultados satisfactorios en el 100% para soporte de la cúpula vaginal, pero se presentó relajación de la pared vaginal anterior, cistocele sintomático, en el 12%. No se detectó ninguna recurrencia de prolapso de cúpula vaginal. La interpretación final está limitada por desconocer el resultado definitivo de las pacientes a las que no se pudo realizar el seguimiento, 40% de pacientes del estudio, que podría introducir un error. El principal motivo de no seguimiento en estas pacientes fue la imposibilidad de localizarlas, por lo que podemos asumir que se pueden comportar como el grupo base del estudio. El promedio de días estancia hospitalaria fue de 1,7. La fijación de la cúpula al ligamento sacroespinoso parece ser es una alternativa eficiente y segura para el manejo de las pacientes con prolapso de cúpula o hernia pélvica. The prolapse of the vaginal vault is an annoying complication of the abdominal or vaginal hysterectomy that can appear months or years after the surgery. The vaginal fixation of the vault to the sacrospinal ligament is an alternative to correct the prolapse of vault or genital prolapse. This is a description of the results of the fixation of vaginal vault to the sacrospinous ligament in 130 patients who underwent this procedure in four centers of gynecological surgery of Medellín, from 1991 to 2002. Follow up was possible in 78 patients. 32 of the 78 patients (41%) had previous gynecological surgery, and therefore a diagnosis of vaginal vault prolapse. 46 patients (58%) had pelvic
Colpopexia sacroespinhal: análise de sua aplica??o em portadoras de prolapso uterovaginal e de cúpula vaginal pós-histerectomia
Netto, Octacílio Figueirêdo;Figueirêdo, Octacílio;Macéa, José Rafael;Prado, Roberto Adelino de Almeida;
Revista Brasileira de Ginecologia e Obstetrícia , 2004, DOI: 10.1590/S0100-72032004001000002
Abstract: purpose: to analyze the results of a technical alternative to perform sacrospinous colpopexy for the treatment of vault prolapse after hysterectomy, and also as an additional facilitating procedure in cases of total uterovaginal prolapse. methods: forty-six patients underwent hysterectomy and were followed-up for 12 to 44 months, with an average of 32 months. twenty-three of them presented vaginal vault prolapse (gvault), and 23 had total uterovaginal prolapse (guterus). the inclusion criterion was the presence of symptomatic prolapse grade iii or iv according to the classification proposed by the international continence society. patients presenting lower grade prolapse were excluded. the average age of the patients was similar: 67.0 years in gvault and 67.5 years in guterus. average body mass index was also similar: 27.4 kg/m2 in gvault and 25.6 kg/m2 in guterus. deliveries varied from 0 to 13 in gvault (average: 4.4 deliveries), and from 1 to 13 in guterus (average: 6.2 deliveries). among the 23 patients in gvault, eight had undergone previous surgical repair without success. the results obtained in both groups were analyzed and compared. the used method takes into account well-known anatomical principles, and differs from the original technique by using a curved needle holder oriented upside down to place sutures through the right sacrospinous ligament under direct vision, approximately 2 cm medially to the ischial spine, thus minimizing the risk of injury to the pudendal vessels and nerve. results: average duration of the surgery was 90.0 min in gvault and 119.5 min in guterus, a statistically significant difference (p<0.05). three blood transfusions were needed, one in gvault and two in guterus. there was no bladder, rectal or ureteral injury nor death in any of the groups. the incidence and type of postoperative complications were similar in the two groups, and included urinary infection, granuloma, urinary retention, transient neuropathy, buttock pain and bl
Histerectomía vaginal en pacientes sin prolapso uterino Vaginal hysterectomy in patients with uterus prolapse  [cached]
Miguel Emilio García Rodríguez,Ramón Ezequiel Romero Sánchez
Revista Cubana de Cirugía , 2011,
Abstract: INTRODUCCIóN. En la literatura médica se cita la nuliparidad, la existencia de operaciones anteriores y el tama o del útero como factores excluyentes a la hora de elegir la técnica de histerectomía. El objetivo de la investigación fue determinar la eficacia y factibilidad de la histerectomía vaginal por la técnica de Heaney, practicada en pacientes sin prolapso uterino, incluso en presencia de los factores antes mencionados. MéTODOS. Se realizó un estudio observacional descriptivo multivariado, en una muestra de 1 000 pacientes operadas en el servicio de Cirugía General del Hospital Universitario Martín Chang Puga , en Nuevitas (Camagüey), entre mayo del 1994 y diciembre del 2006. Se dise ó una base datos en Excel, que se importó al paquete estadístico profesional SPSS, con el que se realizaron análisis univariados, bivariados y multivariados, que finalmente se representaron en tablas de frecuencias y porcentajes. Se utilizó una significación de p = 0,05. RESULTADOS. El 6 % de las pacientes eran nulíparas y el 23,5 % tenían cirugías previas en la pelvis. Un 82,6 % de las pacientes tenían úteros que no sobrepasaban un valor aproximado de 12 semanas de gestación, y el fibroma uterino fue el motivo principal (88,5 %) de la intervención. Solamente un 4,1 % de las pacientes necesitó transfusión sanguínea. Las complicaciones peri- y posoperatorias ocuparon el 1,7 % y el 10,3 % respectivamente. El 97,2 % de las pacientes estuvo menos de 48 h en el hospital y el 99,4 % se reincorporó antes de los 30 días. CONCLUSIONES. Se desestiman la nuliparidad, el tama o del útero y las operaciones anteriores como factores aislados y excluyentes para la vía vaginal. No obstante, el tipo de histerectomía dependerá de la decisión tomada en conjunto por la paciente y su médico tratante, según los costos y beneficios que implique en cada caso. INTRODUCTION. In the medical literature is quoted the nulliparity, the existence of previous operations and the uterus size as exclusion factors to choice the hysterectomy technique. The aim of present research was to determine the effectiveness and feasibility of vaginal hysterectomy by Heaney's technique, carried out in patients without uterus prolapse even in presence of the above mentioned factors. METHODS. A multivariate, descriptive and observational study was conducted in a sample including 1 000 patients operated on in the General Surgery service of the "Martín Chang Puga" University Hospital in Nuevitas municipality (Camagüey province, between May, 1994 and December, 2006. A database was designed in Excel transferred to SPSS prof
CIRUGíA MíNIMAMENTE INVASIVA PARA EL PROLAPSO DE CúPULA VAGINAL: PROMONTOSUSPENSIóN CON MALLA Y ANCLAJE HELICOIDAL DE TITANIO, A TRAVéS DE MINILAPAROTOMíA CON SEPARADOR ELáSTICO DE AUTOMANTENCIóN  [cached]
Vicente Solá D,Jack Pardo S,Paolo Ricci A,Enrique Guiloff F
Revista Chilena de Obstetricia y Ginecología , 2005,
Abstract: Objetivo: Evaluar la factibilidad, eficacia y seguridad de la promontosuspensión con malla de polipropileno anclada con implantes helicoidales de titanio, a través de minilaparotomía con retractor elástico de automantención, en la reparación del prolapso de cúpula vaginal. Pacientes y Método: Entre enero y agosto de 2005 se realizaron cuatro reparaciones de prolapso de cúpula vaginal con esta nueva técnica. Dos en el Departamento de Ginecología de Clínica Las Condes, y 2 en la Unidad de Ginecología del Hospital Barros Luco-Trudeau. Se utilizó malla de polipropileno y anclajes de titanio, realizada por minilaparotomía con retractor elástico de automantención. El rango de edad de las pacientes fue entre 56 y 70 a os, la paridad vaginal entre 2 y 3. Resultados: En todos los casos la técnica quirúrgica corrigió el prolapso de cúpula vaginal. No hubo complicaciones intraoperatorias, ni en el postoperatorio inmediato ni tardío. El tiempo operatorio fluctuó entre 40 y 60 minutos. Conclusiones: Se trata de una técnica nueva, factible de realizar, segura y eficaz en la corrección del prolapso de cúpula vaginal, con cirugía mínimamente invasiva Objective: To evaluate the feasibility, efficacy and safety of the vaginal vault suspension with polypropylene mesh anchored with helicoidal titanium implant attended for minilaparotomy with elastic self-retaining retractor. Patients and Method: Between January and August of the 2005, four repairs of vaginal vault prolapse with this new technique were performed. Two surgeries were performed in patients of Uroginecology and Vaginal Surgery Unit of Las Condes Clinic, and the other two surgeries in the Barros Luco-Trudeau Hospital. Polypropylene mesh and anchorages of titanium were used in this technique by minilaparotomy attended with self-retaining elastic retractor. The patient age fluctuated between 56 to 70 years. Results: The operating time was between 40 and 60 minutes. In all cases the surgical technique corrected the vaginal cuff prolapse. Intraoperative, immediate and remote postoperative period not registered any complication. Conclusions: This is a novel, safe and effective minimally invasive alternative to vault suspension
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