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Noé GK, Barnard A, Spüntrup C, Schiermeier S, Soltécz S, Anapolski M, Alkatout I. Laparoscopic versus vaginal native tissue repair in combination with pectopexy. Sub-analysis from an international, prospective, and multi-centre study: short term results. MINIM INVASIV THER 2021;:1-7. [PMID: 34278938 DOI: 10.1080/13645706.2021.1941118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
INTRODUCTION The use of mesh for vaginal repairs is currently problematic and as a consequence, there is increased interest in native tissue repair. We describe the follow-up data of a sub-analysis of a prospective and multi-center study focusing on the combination of pectopexy and native tissue repair. Patients were followed up for 12-18 months after surgery (+ SD: 15). Two-hundred and sixty-four patients attended the clinics for physical examination and were integrated into the follow-up. Cystocele repair was performed laparoscopically in 84 patients and vaginally in 52 patients. Posterior repair was performed vaginally in 40 patients and laparoscopically in 53 patients. Results: Clinical success rate, patient recommendations and patient satisfaction rates were similar in both groups. The laparoscopic anterior repair resulted in an 89% cure or anatomical improvement rate; this compared to 94.2% for the vaginal approach. In the posterior group, laparoscopy resulted in a 94.3% cure or improvement rate compared to 97.5% in the second group. Conclusions: The outcomes of both strategies showed satisfactory results in our study. Consequently, surgeons may choose between the two strategies according to their preference and skill. The two approaches only differed with regard to vaginal scarring. We suggest future research investigating the long-term impact of scarring.
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Noé GK. Genital Prolapse Surgery: What Options Do We Have in the Age of Mesh Issues? J Clin Med 2021; 10:E267. [PMID: 33450901 DOI: 10.3390/jcm10020267] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/08/2021] [Accepted: 01/11/2021] [Indexed: 12/16/2022] Open
Abstract
Here, we describe the current laparoscopic procedures for prolapse surgery and report data based on the application of these procedures. We also evaluate current approaches in vaginal prolapse surgery. Debates concerning the use of meshes have seriously affected vaginal surgery and threaten to influence reconstructive laparoscopic surgery as well. We describe the option of using autologous tissue in combination with the laparoscopic approach. Study data and problematic issues concerning the existing techniques are highlighted, and future options addressed.
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Noé GK, Schiermeier S, Papathemelis T, Fuellers U, Khudyakov A, Altmann HH, Borowski S, Morawski PP, Gantert M, De Vree B, Zbigniew T, Ugarteburu RG, Anapolski M. Prospective international multicenter pectopexy trial: Interim results and findings post surgery. Eur J Obstet Gynecol Reprod Biol 2019; 244:81-86. [PMID: 31765998 DOI: 10.1016/j.ejogrb.2019.10.022] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2019] [Revised: 10/10/2019] [Accepted: 10/17/2019] [Indexed: 10/25/2022]
Abstract
The technique of laparoscopic pectopexy was published in 2010. A subsequent randomized trial focused on pectopexy versus sacropexy revealed no new risks for patients and significant advantages in terms of operating time and de novo defecation disorders compared to sacrocolpopexy. The present international multicenter trial was performed to evaluate the applicability of the technique in clinical routine. MATERIAL AND METHOD Eleven clinics and 13 surgeons in four European counties participated in the trial. To ensure a standardized approach and obtain comparable data, all surgeons followed the same rules in placing the apical tape, no further mesh was used. Data were collected for 14 months on a secured server; 501 surgeries were documented and evaluated. RESULTS Patients treated at the leading center (2 surgeons) contributed 44 % of the patient population. We made a distinction between high-volume (48-135 surgeries annually) (n = 4), intermediate-volume (28-37 surgeries annually) (n = 4), and low-volume (7-22 surgeries annually) (n = 5) surgeons. 97.3 % of the patients (n = 501) had delivered children; 5.6 % had had a Caesarian section. 29.7 % of the patients had undergone a hysterectomy. The operating time for pectopexy was less than 60 min in 79 % of cases. The procedures were completed in less than 159 min in 71 % of cases. Severe complications (n = 5) included four cases of organ damage (related to concomitant surgeries or adhesions) and one case of relevant bleeding. De novo incontinence was registered in two cases and voiding dysfunction in three. No intestinal obstruction or defecation disorder was observed. Two complicated infections were noted. Urinary infection occurred in 2 % of patients. CONCLUSION In clinical routine severe complications occurred in 1 %. The latter were unrelated to pectopexy, but occurred due to concomitant procedures or adhesions. The overall operating time as well as the operating time for pectopexy were similar to those reported in published studies on sacrocolpopexy.
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Affiliation(s)
- Günter K Noé
- University of Witten-Herdecke, Department of Obstetrics and Gynecology, District Hospital Dormagen, Dr. Geldmacherstr. 20, 41539, Dormagen, Germany.
| | - Sven Schiermeier
- Department of Obstetrics and Gynecology, University Witten-Herdecke, Marien-Hospital, Witten Marienplatz, 258452, Witten, Germany.
| | - Thomas Papathemelis
- Department of Obstetrics and Gynecology, St. Marien Hospital Amberg, Klinikum St. Marien Amberg, Mariahilfbergweg 7, 92224, Amberg, Germany.
| | - Ulrich Fuellers
- Private Department of Surgical Gynecology, GTK Krefeld, Violstrasse 92, 47800, Krefeld, Germany.
| | - Alexander Khudyakov
- Private Department of Surgical Gynecology, GTK Krefeld, Violstrasse 92, 47800, Krefeld, Germany.
| | - Harald-Hans Altmann
- Department of Obstetrics and Gynecology, Regiomed Clinics Coburg, Klinikum Coburg GmbH, Ketschendorfer Str. 33, D - 96450, Coburg, Germany.
| | - Stefan Borowski
- Department of Obstetrics and Gynecology, Clinic Links Der Weser, Klinikverbund Bremen, Senator-Weßling-Straße 1, 28277, Bremen, Germany.
| | - Pawel P Morawski
- Department of Obstetrics and Gynecology, Helios Clinic Bad Sarow, Helios Klinikum Bad Saarow, Pieskower Straße 33, 15526, Bad Saarow, Germany.
| | - Markus Gantert
- Department of Obstetrics and Gynecology, St Franziskus Hospital Ahlen, Robert-Koch-Str. 55, 59227, Ahlen, Germany.
| | - Bart De Vree
- Department of Obstetrics and Gynecology, ZNA Middelheim Antwerp, ZNA Campus Middelheim, Lindendreef 1, 2020, Antwerpen, Belgium.
| | - Tkacz Zbigniew
- Department of Obstetrics and Gynecology, NHS Tayside Dundee, NHS Tayside Ninewells Hospital, DD1 9SY, Dundee, Scotland, United Kingdom.
| | - Rodrigo Gil Ugarteburu
- Department of Obstetrics and Gynecology, University Hospital de Cabueñes, Clínica Asturias, Calle Naranjo de Bulnes, 4, 33012, Oviedo, Gijon, Spain.
| | - Michael Anapolski
- University of Witten-Herdecke, Department of Obstetrics and Gynecology, District Hospital Dormagen, Dr. Geldmacherstr. 20, 41539, Dormagen, Germany.
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Videourology Abstracts. J Endourol 2019; 33:505-508. [DOI: 10.1089/end.2019.29059.vid] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Affiliation(s)
- Guenter Karl Noé
- University of Witten Herdecke, Germany
- Department of OB/GYN, District Hospital Dormagen, Dormagen, Germany
| | - Sven Schiermeier
- University of Witten Herdecke, Germany
- Department of OB/GYN, Marien Hospital Witten, Dormagen, Germany
| | - Michael Anapolski
- University of Witten Herdecke, Germany
- Department of OB/GYN, District Hospital Dormagen, Dormagen, Germany
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Noé GK, Alkatout I, Schiermeier S, Soltécz S, Anapolski M. Laparoscopic anterior and posterior native tissue repair: a new pelvic floor approach. MINIM INVASIV THER 2018; 28:241-246. [PMID: 30261775 DOI: 10.1080/13645706.2018.1510420] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
Abstract
Introduction: Traditionally, a cystocele caused by a midline defect of the pelvic fascia is treated by vaginal fascia duplication, also known as anterior colporraphy. The rectocele is managed by suturing the posterior fascia and, frequently, the levator ani muscles. We developed the approach of laparoscopic anterior and posterior fascia repair by native tissue. Material and methods: The methods were based on anterior and posterior exposure of pelvic fascia similar to the preparation of an extended sacral colpopexy. The fascia was compressed and narrowed by absorbable woven sutures, size 1. Twenty-seven patients were followed up for 6-13 months. All patients received additional apical fixation by pectopexy. Results: In the examination group, 13 patients underwent anterior laparoscopic fascia repair and 23 had posterior repair. We detected one apical and one posterior relapse, and also one in the anterior repair group. The patient with the apical relapse reported pain and de novo urgency. Anatomical reconstruction was achieved in all other patients. Summary: Laparoscopic anterior and posterior native tissue repair appears to be a feasible method for the treatment of midline cystocele and rectocele. No new risks were observed. The technique leaves no scar in the vagina and is well accepted. Abbreviations: POPQ: Pelvic Organ Prolapse Quantification System; FDA: Food and Drug Association; US: United States; Fig: Figure; ICIQ: International Consultation on Incontinence Questionnaire.
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Affiliation(s)
- Guenter Karl Noé
- a University of Witten Herdecke Medical Department , Witten , Germany.,b Department of OB/GYN , Communal Hospital Dormagen , Dormagen , Germany
| | | | - Sven Schiermeier
- d Department of OB/GYN , University of Witten Herdecke, Marien Hospital Witten , Witten , Germany
| | - Stephan Soltécz
- b Department of OB/GYN , Communal Hospital Dormagen , Dormagen , Germany
| | - Michael Anapolski
- a University of Witten Herdecke Medical Department , Witten , Germany.,b Department of OB/GYN , Communal Hospital Dormagen , Dormagen , Germany
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Noé KG, Schiermeier S, Alkatout I, Anapolski M. Laparoscopic pectopexy: a prospective, randomized, comparative clinical trial of standard laparoscopic sacral colpocervicopexy with the new laparoscopic pectopexy-postoperative results and intermediate-term follow-up in a pilot study. J Endourol 2014; 29:210-5. [PMID: 25350228 DOI: 10.1089/end.2014.0413] [Citation(s) in RCA: 58] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
PURPOSE The purpose of the study was to compare the outcome of laparoscopic sacral colpocervicopexy with laparoscopic pectopexy. Our aim was to show that the safety and effectiveness of the new technique is similar to the traditional technique. We expected differences regarding defecation disorders. PATIENTS AND METHODS We randomly assigned patients to two treatment groups: 44 in the pectopexy and 41 in the sacropexy group. If necessary, the operative procedures were planned in a so-called multicompartment setting regarding the different pelvic floor disorders. All defects were managed at the same time. Eighty-one patients were examined 12 to 37 months after treatment (mean follow-up 20.67 months). RESULTS The long-term follow-up (21.8 months for pectopexy and 19.5 months for sacropexy) showed a clear difference regarding de novo defecation disorders (0% in the pectopexy vs 19.5% in the sacropexy group). The incidence of de novo stress urinary incontinence was 4.8% (pectopexy) vs 4.9% (sacropexy). The incidence of rectoceles (9.5% vs 9.8%) was similar in both groups. No de novo lateral defect cystoceles were found after pectopexy, whereas 12.5% were found after sacropexy. The apical descensus relapse rates, 2.3% for pectopexy vs 9.8% for sacropexy, were not statistically significant. The occurrence of de novo anterior defect cystoceles and rectoceles revealed no significant differences. CONCLUSION Laparoscopic pectopexy is a novel method of vaginal prolapse therapy that offers clear practical advantages compared with laparoscopic sacropexy. Because laparoscopic pectopexy does not reduce the pelvic space, it results in a zero percentage of defecation disorders.
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Affiliation(s)
- Karl-Günter Noé
- 1 Department of OB/GYN, University of Witten Herdecke, Hospital Dormagen , Dormagen, Germany
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Noé KG, Spüntrup C, Anapolski M. Laparoscopic pectopexy: a randomised comparative clinical trial of standard laparoscopic sacral colpo-cervicopexy to the new laparoscopic pectopexy. Short-term postoperative results. Arch Gynecol Obstet 2012; 287:275-80. [PMID: 22945837 DOI: 10.1007/s00404-012-2536-7] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2012] [Accepted: 08/16/2012] [Indexed: 11/25/2022]
Abstract
PURPOSE Sacral colpopexy is a well established method of vaginal prolapse correction. Although it is capable of restoring the physiologic axis of the vagina, this method also bears some serious operative risks [1]. The aim of the study was to compare the laparoscopic sacral colpopexy with a laparoscopic bilateral fixation of the vagina/cervix to the iliopectineal ligaments via a PVDF-mesh (pectopexy). METHODS This part of a single-center randomized prospective clinical trial (Canadian Task Force Classification) compared the short-term operative outcome of laparoscopic sacropexy and pectopexy. We evaluated the operating time, blood loss, hospital stay duration, occurrence of major complications, episodes of constipation, urinary retention, de novo urinary incontinence, urinary tract infections, body mass index and postoperative Creactive protein values. The 1-year follow up examination will be carried out to evaluate the occurrence of relapse as well as late complications. Local symptoms and sexual activity will be evaluated using a German version of the ICIQ Vaginal Symptoms Questionnaire. RESULTS We carried out 43 pectopexies and 40 sacropexies in conjunction with other laparoscopic and/or vaginal procedures, as indicated. No major complications occurred in both groups during the hospital stay. There were no significant differences in the body mass index, average age, hospital stay duration and occurrence of constipation. The average operating time (43.1 vs. 52.1 min) and blood loss (4.6 vs. 15.3 ml) were significantly lower in the pectopexy group (p < 0.001). CONCLUSION Although laparoscopic pectopexy cannot yet be generally recommended as an alternative to sacropexy until the follow-up data is obtained, the new method can be considered in patients where the presacral preparation bears a higher risk of injury.
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Affiliation(s)
- K G Noé
- Hospital Dormagen, Teaching Hospital of the University of Cologne, Dr. Geldmacherstr. 20, 41539 Dormagen, Germany.
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Hertel H, Grüßner S, Kotsis S, Hillemanns P. Vaginal sacrocolporectopexy for the surgical treatment of uterine and vaginal vault prolapses: confirmation of the surgical method and perioperative results of 101 cases. Arch Gynecol Obstet 2012; 286:1463-71. [PMID: 22854876 DOI: 10.1007/s00404-012-2495-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2012] [Accepted: 07/19/2012] [Indexed: 10/28/2022]
Abstract
PURPOSE In this study, we sought to confirm the surgical method of vaginal sacrocolporectopexy and previously reported positive perioperative results of this procedure in a large patient group. We describe the approach which offers a vaginal, safe alternative to sacrospinous repair, laparoscopic or open vaginosacropexy and the use of synthetic meshes to treat pelvic organ prolapse. METHODS We conducted a monocentric, prospective, nonrandomized study for treatment of patients with uterine and vaginal vault relapse (grade 2-4). All patients underwent a preoperative urogynecological urodynamic examination. We focus on method, operative time, complications, blood transfusions, hospital stay and clinical data. RESULTS Between March 2006 and March 2011, 101 consecutive patients of mean age 64 (40-89) years, with sub or total uterine prolapse (n=69, grade 2-4) and vaginal vault prolapse (n=32, grade 2-4) were treated with vaginal sacrocolporectopexy. Cystocele (grade 2-4) was found in 88 (87.1%) and rectocele (grade 2-4) in 43 (42.5%) patients. Mean duration of surgery with sacrocolporectopexy was 70 min (28-165) without hysterectomy, and 76 min (40-219) with hysterectomy. Regression analysis of all patients (n=101) showed a significant decrease of operative time in the group without hysterectomy after 40 cases. Three bladder lesions, two in patients with a history of hysterectomy, occurred during surgery and were corrected intraoperatively without further complications. No patient required a blood transfusion. Hemoglobin levels decreased slightly from a preoperative mean of 13.6 mg/dl (10.3-15.7) to a postoperative mean of 11.7 mg/dl (8.6-14.7). CONCLUSION Vaginal sacrocolporectopexy is a safe vaginal method for the treatment of sub-/total uterine/vaginal vault prolapse.
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Bibliography. Female urology. Current world literature. Curr Opin Urol 2011; 21:343-6. [PMID: 21654401 DOI: 10.1097/MOU.0b013e3283486a38] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Banerjee C, Noé KG. Laparoscopic pectopexy: a new technique of prolapse surgery for obese patients. Arch Gynecol Obstet 2010; 284:631-5. [PMID: 20941503 DOI: 10.1007/s00404-010-1687-7] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2010] [Accepted: 09/13/2010] [Indexed: 11/24/2022]
Abstract
PURPOSE Obesity is a chronic disease which affects a substantial number of patients. It also increases a person's risk of genital prolapse. Conventional techniques of prolapse repair (sacropexy, transvaginal meshes and sacrospinal fixation) are used in very adipose women, but the effectiveness of this technique is sometimes restricted due to the difficultly of performing the surgery. METHOD Here we will describe a new method of endoscopic prolapse surgery, which is especially developed for obese patients. The lateral parts of the iliopectineal ligament are used for a bilateral mesh fixation of the descended structures. We have already used this method successfully in 12 patients without any complications. RESULT AND CONCLUSION This method provides a stable and durable repair. The laparoscopic access reduces morbidity. The operation time for this procedure is approximately 50 min.
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Affiliation(s)
- Carolin Banerjee
- Hospital Dormagen, Teaching Hospital of the University of Cologne, Dr. Geldmacherstr. 20, 41539 Dormagen, Germany
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