Subjective and Objective Results of Native Anterior Vaginal Wall Repair in Local Anesthesia:A 10-Year Follow-Up

Introduction and Hypothesis: This follow-up study evaluates long-term subjective and objective outcome of native tissue anterior vaginal wall repair using local anesthesia. Methods: 72 women were operated. At 10-year follow-up anatomical results were evaluated by clinical examination. Furthermore, the women filled in a validated symptom and quality of life questionnaire. Results: Forty women (56%) completed the 10-year follow-up. Eighteen women (25%) had died within the ten-year follow-up period and fourteen women (19%) were lost to follow-up. Six (15%) of the women who came for follow-up had been reoperated for anterior vaginal wall prolapse within the 10-year follow-up period and were analysed as a separate group. Of the 40 women who came for the 10-year clinical examination none had stage 0 pelvic organ prolapse. Twenty (50%) women had stage 1, whereas, 13 (32%) had stage 2 and 1 (3%) had stage 3 pelvic organ prolapse. Ten years after surgery, 28 women (70%) had no bulge symptoms. Six (15%) of the women experienced bulge symptoms at the time of follow-up. Ten years postoperatively, 30 (75%) of the women in an overall quality of life assessment considered their condition improved after surgery. Conclusion: At 10-year follow-up 70% of women were relieved from their bulge symptoms and 75% still considered themselves better or much better than before the operation. However, 15% of women had been reoperated and 15% still experienced bulge symptoms.

Clinical analysis of laparoscopic lateral peritoneal suspension in the treatment of severe pelvic organ prolapse

Objective:To investigate the clinical effects of laparoscopic lateral peritoneal suspension for severe pelvic organ prolapse(POP).Methods:Thirty-eight patients who underwent laparoscopic lateral peritoneal suspension for pelvic organ prolapse in the gynecology department of our hospital from January 2019 to January 2020 were selected for retrospective analysis.Postoperative outcomes were recorded for patients at 3,6,and 12 months postoperatively.Results:All 38 patients completed the surgery safely,and the duration of surgery was 85-190 min,with a mean of(138±40.75)min;surgical bleeding was 30-80 ml,with a mean of(57±35.4)ml;the duration of postoperative catheterization was 4-6 days,with a mean of(5±0.73)days;postoperative hospitalization was 6-12 days,with a mean of(8.49±2.18)days.2.18)days.At 3,6,and 12 months after the end of surgery,all follow-up patients had their uterus and anterior vaginal wall restored to normal position without prolapse.The pelvic floor rehabilitation of the patients after surgery was good and their sexual life was significantly improved in all cases.Conclusion:Laparoscopic lateral peritoneal suspension for severe pelvic organ prolapse is safe,efficacious,minimally traumatic,less painful,with short hospital stay,fast postoperative recovery,greater choice of uterine de-positioning,with the advantages of permanence and good pelvic floor anatomical recovery,and this procedure can maintain a certain vaginal length with 100%efficiency,which is worthy of clinical promotion.

The Usefulness of Zhukovsky Double Balloon in Obstetric Hemorrhage

Objective:To evaluate the effectiveness of the use of a modified Zhukovsky double(vaginal and uterine)balloon to improve the results of treatment in women with obstetric hemorrhage.Methods:We conducted an observational controlled study including 701 puerperas,which were divided into two groups:The main group consisted of 508 women,who underwent a combined management,that is,traditional(transfusion of fresh frozen plasma,erythrocyte mass,uterotonics,hemostatic agents),surgical hemostasis in cases of caesarean section,and insertion of a double Zhukovsky balloon;while the comparison group included 193 patients,who were managed traditionally.The main group and the comparison group were divided into subgroups according to the main etiology of obstetric hemorrhage:ⅠA andⅠB-postpartum;ⅡA andⅡB-placenta accreta;ⅢA andⅢB-postpartum hysterectomy.Results:The most frequent causes of massive obstetric hemorrhage were atony of the uterus(39.2%),placenta previa(29.1%),and placental abruption(11.5%).Of the 508 balloon insertions,345(70.7%)were inserted for hemorrhage during cesarean section and 148(29.3%)for obstetric hemorrhage after spontaneous delivery.Among the obstetric hemorrhage at caesarean section,lower segment bleeding prevailed(78.1%),caused mainly by placenta previa,placenta accreta,placental abruption,polyhydramnios,and uterine scar defects.Combined management,including surgical hemostasis and insertion of vaginal and uterine balloon of Zhukovsky,reduced blood loss by 1.5 times and the number of hysterectomies by 6.72 times compared to controls.Conclusion:The use of a modified Zhukovsky double balloon in the management of obstetric hemorrhage may reduce the number of hysterectomies and the amount of blood loss.