Modern approaches in combined surgical treatment of complex forms of genital prolapse

Abstract

BACKGROUND: Despite the existence of a considerable number of techniques for surgical correction of genital prolapse, patients and doctors cannot be always sure regarding the efficacy of surgical treatment in achieving satisfactory results. As was the case many years ago, the issues of improving the efficacy, reliability and safety of surgical treatment of genital prolapse, as well as the intent to generate individual treatment approach, taking into account the type of prolapse and medical condition of women, remain pertinent.

AIM: The objective of this study is to develop surgical techniques for patients with complex types of pelvic organ prolapse, including women with unfavourable general medical condition.

MATERIAL AND METHODS: A comprehensive clinical examination and surgical treatment of 20 patients with II–IV stage pelvic organ prolapse according to the POP-Q classification, who exhibited similar nosological forms of prolapse but disparate comorbidity status, was conducted. Group 1 included 11 patients with complex pelvic organ prolapse who underwent combined laparoscopic pectopexy. Due to the presence of decubitus changes of the cervix and adverse general status, a two-staged strategy was chosen for nine patients of the Group 2, i.e. laparoscopic correction of apical prolapse — uterine suspension with the use of titanium tapes — at the first stage, and modified Manchester (Moscow) operation with the use of titanium tape, colpoperineorrhaphy with levator ani muscles plication — at the second stage.

RESULTS: The results of the questionnaire indicated that all patients reported a notable improvement in their quality of life and social integration. In all patients, the symptoms of pelvic organ prolapse significantly improved, and no signs of disease recurrence were present.

CONCLUSION: The findings suggest that the proposed surgical techniques for treating pelvic organ prolapse are a viable, efficacious and secure option. They offer swift recuperation and reliable rehabilitation. These techniques have the potential to improve both the physical and social well-being of patients. The described surgical techniques help to restore the normal anatomical position and functions of the organs.

Keywords

genital prolapse / laparoscopy / combined laparoscopic access / mesh implants / surgical treatment of genital prolapse / laparoscopic pectopexy / laparoscopic uterine suspension / modified Manchester operation

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