Russian Federation
The aim of the study was to analyze clinical and pathogenetic approaches to the choice of surgical treatment methods of genital prolapse using synthetic materials. Material and methods. The study was conducted on the basis of retrospective assessment of 165 patients database. The patients were divided into two groups depending on the methods used. The first group consisted of 91 patients who underwent laparoscopic promontofixation, the second group - 74 women after vaginal extraperitoneal MESH-fascial reconstruction. Results. Patients in the first group belonged to a younger age category, as a result of which organ-preserving interventions were performed in all women who did not have indications for removal of the uterus or cervix due to the presence of concomitant pathology. In this group, there was a low risk of using laparoscopic access associated with concomitant somatic pathology and abdominal obesity. The risk of relapses due to the failure of patient’s own connective tissue structures was noted in only 12% of cases. Consequently, the main criterion in choosing laparoscopic promontofixation was the possibility of reliable fixation of the apex while preserving the uterus, as an alternative to its removal. In the second group, the presence of clinically significant concomitant somatic pathology was noted in 66% of women, and abdominal obesity - in 40%. This circumstance significantly increased the risks of laparoscopic intervention and determined the choice of surgical access in favor of the vaginal one. The risk of relapses due to failure of the patient’s own connective tissue structures occurred in 81,1% of women in the second group. Conclusions. Consequently, this circumstance served as the main criterion for choosing the technology using synthetic materials to duplicate the patient’s own fascial structures.
genital prolapse, promontofixation, extraperitoneal MESH-fascial reconstruction
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