Saint Petersburg State University Hospital, 154, Fontanka Embankment, Saint Petersburg, 190103, Russia.
Int Urogynecol J. 2021 Nov;32(11):3085-3087. doi: 10.1007/s00192-021-04790-2. Epub 2021 Apr 16.
Post-hysterectomy vaginal vault prolapse is quite frequent and at the same time a challenging surgery for pelvic organ prolapse.
One of the most popular methods of treatment is sacrospinous fixation, including its mesh modification.
Despite the high efficiency in the apical compartment, the incidence of the anterior compartment prolapse is quite high. Erosion remains an unsolved problem. A 44-year-old patient with grade IV post-hysterectomy prolapse underwent a sacrospinous fixation procedure with mesh according to the described technique. Surgery was performed successfully without complications. The duration of the operation was 40 min. A year after the operation, the recurrence of POP was not recorded in any compartments of the pelvic floor. It was possible to maintain the length of the vagina. Dyspareunia and vaginal erosion were not detected. The patient also noted a significant improvement in her quality of life.
The demonstrated approach allows performing minimally invasive reconstruction of all three compartments of the pelvic floor. Moreover, the use of a full-thickness vascularized vaginal flap allows safely fixing the mesh to the vaginal vault, minimizing the risk of erosion and pain syndrome due to excessive tension.
子宫切除术后阴道穹窿脱垂较为常见，同时也是治疗盆腔器官脱垂的一项极具挑战性的手术。
治疗方法中最受欢迎的之一是骶棘韧带固定术，包括其网片改良。
尽管在前穹窿部位的效果很高，但前穹窿脱垂的发生率相当高。网片侵蚀仍然是一个尚未解决的问题。一位 44 岁的患者，因子宫切除术后 IV 度脱垂而行骶棘韧带固定术并结合了网片修补。手术成功完成，无并发症。手术时长 40 分钟。术后一年，未记录到任何盆腔器官脱垂部位的复发。阴道长度得以维持。未发现性交困难和阴道侵蚀。患者还注意到生活质量有显著改善。
所展示的方法允许对所有三个盆腔器官脱垂部位进行微创重建。此外，使用全层血管化阴道瓣可安全地将网片固定到阴道穹窿，最大程度地降低因过度张力导致的网片侵蚀和疼痛综合征的风险。
