A New Surgical Method of Suprapubic and Extraperitoneal Approach with Uterine Preservation for Pelvic Organ Prolapse: Kurt Extraperitoneal Ligamentopexy
Objective. To introduce an alternative surgical approach for the optimal treatment of pelvic organ prolapse (POP). Methods. Twenty symptomatic women with grades 2–4 POP diagnosis who opted to choose this alternative surgery were retrospectively analyzed. Results. A total of 22 cases were included. The mean age of the patients was years (29–72 years) with a mean gravid and parity of and , respectively. The mean body-mass index of the patients was . Nine (45%) patients were premenopausal and 11 (55%) patients were postmenopausal. Uterine descensus was present in all patients, and additionally cystorectocele in 9 patients (45%), cystocele in 6 patients (30%), rectocele in 4 patients (20%), and elangatio colli in 6 patients (30%) were diagnosed. In addition to the alternative surgery, Manchester procedure and anteroposterior vaginal wall repair or Burch procedure was performed where necessary. Mean follow-up time was months (6–171 months). No recurrence of POP occurred. Conclusions. Suprapubic, extraperitoneal, and minimally invasive ligamentopexy of the round ligament to the anterior rectus fascia offers an alternative to conventional POP surgery with favorable outcomes without any recurrence. 1. Introduction Pelvic organ prolapse (POP) is the descent of adjacent organs to the vaginal vault through the vagina due to damage to the supportive and suspensory elements of the pelvic floor and endopelvic fascia. Genetic, environmental, and multifactorial determinants play a role in the etiology. The terms cystocele, cystouretherocele, uterine prolapse, rectocele, and enterocele are used to define the place of exit and the anatomic defect [1, 2]. The prevalence varies depending on the geographical regions and advancing age ranging between 11 and 64.8% [3, 4]. POP prevalence increases with prolongation of life in developed countries and improvement of health care services in underdeveloped countries. It is not a mortal disease, but its morbidity is common. POP is the 3rd common cause of hysterectomy for benign conditions with almost one billion dollars treatment costs a year in the United States (US) [5]. Notwithstanding, it generates a remarkable irony that hysterectomy is both the cause and the result of POP. While the hysterectomies are being done for POP increase, evidence related to posthysterectomy POP development is also on the rise [6–8]. Moreover, some women wish to preserve their uterus and look for a surgical opportunity instead of a hysterectomy operation for POP. Herein, we report a new surgical approach for women suffering from POP but wish to
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