Anterior colporrhaphy: a standard operation? Systematic review of the technical aspects of a common procedure in randomized controlled trials

Halpern-Elenskaia, Ksenia; Umek, Wolfgang; Bodner‐Adler, Barbara; Hanzal, Engelbert

doi:10.1007/s00192-017-3510-5

Cited by 24 publications

(15 citation statements)

References 59 publications

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“…131 Many pelvic floor surgeons are therefore prone to use absorbable sutures for midline plication. 67 The only previous study comparing PDS® and Vicryl® is a randomized controlled feasibility trial published in 2008 by Allahdin et al They found no differences in prolapse symptom relief or quality of life scores between the groups at follow-up. The study, however, included a mix of anterior, posterior and paravaginal procedures as well as concomitant procedures (hysterectomy, incontinence surgery).…”

Section: Or Odds Ratio; CI Confidence Intervalmentioning

confidence: 98%

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Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Bergman

Söderberg

2020

Obstetrics &Amp; Gynecology

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Background and aimsThe life-time risk for a woman to undergo pelvic floor reconstructive surgery due to prolapse or incontinence is 20% and the high risk for recurrence after prolapse surgery is a major challenge. Surgical reconstruction of the perineal body is commonly performed, although studies assessing results of this procedure are scarce. Mid-urethral sling surgery has a cure rate of 80%, but whether the sling endures a subsequent delivery is largely unknown. In this thesis we aimed to investigate whether the choice of suture material has an impact on vaginal wall prolapse repair; whether cervical amputation results in similar cure rates in comparison to vaginal hysterectomy in women with uterine prolapse; if a subsequent delivery jeopardizes results from incontinence surgery; if physiotherapy and surgical treatment is equally effective in women with symptoms related to a poorly healed second-degree perineal tear. Methods and main resultsStudy I and II are both register-based cohort studies based on data from the Swedish National Quality Register for Gynecological Surgery (GynOp). In Study I, 731 women who underwent primary anterior colporrhaphy and 384 women who underwent primary posterior colporrhaphy were included. We found a significantly lower rate of women reporting vaginal bulging symptoms one year after anterior colporrhaphy if a slowly absorbable monofilament suture was used compared to a more rapidly absorbable multifilament suture, 22% vs 30% (aOR 1.6, 95% CI 1.1-2.3). There was no difference between the suture groups in the posterior colporrhaphy cohort. In Study II, women with uterine prolapse who had undergone either cervical amputation (n=1979) or vaginal hysterectomy (n=1195) were analyzed. There were no differences between the two groups regarding neither symptom relief nor patient satisfaction at one year after surgery. Vaginal hysterectomy was associated with a higher rate of severe complications compared to cervical amputation, 1.9 % vs 0.2 % (p < 0.001).Study III is a cross-sectional, survey-based study. National registers were used to identify women with a delivery subsequent to a mid-urethral sling procedure (n=207) and a matched control-group including women without childbirth after a mid-urethral sling procedure (n=521). Validated questionnaires investigating urinary symptoms were mailed to the study participants. Patient reported stress urinary incontinence was present in 22% of the women with a delivery after a mid-urethral sling procedure and in 17% of the women in the control group (aOR 1.2, 95% CI 0.7-2.0). Vaginal childbirth after mid-urethral sling surgery did not increase the risk of stress urinary incontinence compared to cesarean delivery. Study IV is a randomized controlled trial where 70 women with a poorly healed second degree perineal tear, minimum six months post-partum, were randomized to either surgery or tutored pelvic floor muscle therapy. In an intention-to-treat analysis with worst case outcome imputation, treatment success at 6 months followup was significantly...

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Section: Or Odds Ratio; CI Confidence Intervalmentioning

confidence: 98%

“…66 Nonetheless, colporrhaphy is far from a standardized procedure. 67 There are very few trials assessing details of the surgical technique used for colporrhaphies and it remains important to identify surgical factors that may optimize the result.…”

Section: Surgical Managementmentioning

confidence: 99%

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Bergman

Söderberg

2020

Obstetrics &Amp; Gynecology

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“…Anterior colporrhaphy (AC) is considered the standard surgical treatment but is associated with a significant rate of failure . Surgery with mesh augmentation was introduced to improve outcomes but there are safety concerns about its use and no data on long‐term outcomes .…”

Section: Introductionmentioning

confidence: 99%

Primary surgical management of anterior pelvic organ prolapse: a systematic review, network meta‐analysis and cost‐effectiveness analysis

Slade

Daly

Mavranezouli

et al. 2019

BJOG

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Background Anterior compartment prolapse is the most common pelvic organ prolapse (POP) with a range of surgical treatment options available. Objectives To compare the clinical effectiveness and cost‐effectiveness of surgical treatments for the repair of anterior POP. Methods We conducted a systematic review of randomised controlled trials comparing surgical treatments for women with POP. Network meta‐analysis was possible for anterior POP, same‐site recurrence outcome. A Markov model was used to compare the cost–utility of surgical treatments for the primary repair of anterior POP from a UK National Health Service perspective. Main results We identified 27 eligible trials for the network meta‐analysis involving eight surgical treatments tested on 3194 women. Synthetic mesh was the most effective in preventing recurrence at the same site. There was no evidence to suggest a difference between synthetic non‐absorbable mesh, synthetic partially absorbable mesh, and biological mesh. The cost–utility analysis, which incorporated effectiveness, complications and cost data, found non‐mesh repair to have the highest probability of being cost‐effective. The conclusions were robust to model inputs including effectiveness, costs and utility values. Conclusions Anterior colporrhaphy augmented with mesh appeared to be cost‐ineffective in women requiring primary repair of anterior POP. There is a need for further research on long‐term effectiveness and the safety of mesh products to establish their relative cost‐effectiveness with a greater certainty. Tweetable abstract New study finds mesh cost‐ineffective in women with anterior pelvic organ prolapse.

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“…Anterior repair or anterior colporrhaphy is used for surgical treatment of cystocele and mild or moderate severity cases of stress incontinence. Anterior colporrhaphy includes plication of fibromusculer layer (pubocervical facia) in midline (13). Repairing of thinning or torn endopelvic facia in midline is possible, and anterior colporrhaphy i.e.…”

Section: Discussionmentioning

confidence: 99%

Our Recurrence Ratios in Pelvic Organ Prolapse Surgical Repair

Sukgen¹,

Türkay²

2019

Kocaeli Med J

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1Sukgen Kadın Hastalıkları Ve Doğum Kliniği, Adana, Türkiye 2Sağlık Bilimleri Üniversitesi Derince Eğitim Ve Araştırma Hastanesi, Kocaeli, Türkiye ÖZ GİRİŞ ve AMAÇ: Bu çalışmanın amacı, pelvik organ prolapsusu cerrahi onarımının nüks oranlarını değerlendirmektir. YÖNTEM ve GEREÇLER: Haziran 2012 ile Mayıs 2017 tarihleri arasında rastgele seçilen 126 kadına pelvik organ prolapsusu cerrahi onarımı yapıldı. Evreleme için POP-Q Sistemini kullandık. Hastalar dört gruba ayrıldı; ön onarım grubu (n = 64), arka onarım grubu (n = 29), ön-arka onarım grubu (n = 13) ve vajen kubbe prolapsusu grubu (n = 20). BULGULAR: 126 hastanın yaş ortalaması 58.5 ± 10.8 yıl (en az 42, en fazla 75), ortalama ağırlık 70 ± 12.7 kg (en az 48 kg, en fazla 92 kg) ve ortalama parite 3 (en az 0, en fazla 6) idi. Nüks oranlarımız ön onarım grubunda 8 (%12.5), arka onarım grubunda 7 (%24.1), ön-arka onarım grubunda 1 (%7.6), vajen kubbe prolapsusu grubunda hiçbir hasta yok şeklinde idi. Tüm durumlarda, genel nüks oranı %12.69 idi. TARTIŞMA ve SONUÇ: Menopoz ile POP nüksü arasında anlamlı ilişki tespit edilmiştir. Ayrıca cerrahi teknik ile nükssüz olgular arasında da anlamlı bir ilişki bulunmuştur.Anahtar Kelimeler: Pelvik organ prolapsusu, cerrahi onarım, menopoz, nüks, ön-arka onarım ABSTRACT INTRODUCTION: The objective of this study was to assess the recurrence ratios of pelvic organ prolapse surgical repair. METHODS: Between June 2012 and May 2017, 126 nonrandomly selected women underwent pelvic organ prolapse surgical repair. We used POP-Q System for staging. The patients were divided into four groups as follows; anterior repair group (n=64), posterior repair group (n=29), anteriorposterior repair group (n=13), and vaginal cuff prolapse group (n=20). RESULTS:Mean age of the 126 patients was 58.5 ± 10.8 years (min. 42, max. 75), while mean weight was 70 ±12.7 kg (min. 48 kg, max. 92 kg) and mean parity was 3 (min. 0, max. 6). Our recurrence ratios were 8 patients (12.5%) in anterior repair group, 7 patients (24.1%) in posterior repair group, 1 patient (7.6%) in anterior-posterior repair group, and no patients in vaginal cuff prolapse group. In all cases, the overall recurrence ratio was 12.69%. DISCUSSION and CONCLUSION:A significant relationship between menopause and POP recurrence was determined. A significant relationship between surgical technique and recurrence free cases was also detected.

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Anterior colporrhaphy: a standard operation? Systematic review of the technical aspects of a common procedure in randomized controlled trials

Cited by 24 publications

References 59 publications

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Perineorrhaphy Compared With Pelvic Floor Muscle Therapy in Women With Late Consequences of a Poorly Healed Second-Degree Perineal Tear

Primary surgical management of anterior pelvic organ prolapse: a systematic review, network meta‐analysis and cost‐effectiveness analysis

Our Recurrence Ratios in Pelvic Organ Prolapse Surgical Repair

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