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van Oudheusden AMJ, van IJsselmuiden MN, Menge LF, Coolen ALWM, Veen J, van Eijndhoven HWF, Dietz V, Kluivers KB, Spaans WA, Vollebregt A, van de Pol G, Radder CM, van der Ploeg JM, van Kuijk SMJ, Bongers MY. Laparoscopic sacrocolpopexy versus vaginal sacrospinous fixation for vaginal vault prolapse: a randomised controlled trial and prospective cohort (SALTO-2 trial). BJOG 2023; 130:1542-1551. [PMID: 37132094 DOI: 10.1111/1471-0528.17525] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Revised: 03/30/2023] [Accepted: 04/17/2023] [Indexed: 05/04/2023]
Abstract
OBJECTIVE To determine whether laparoscopic sacrocolpopexy (LSC) or vaginal sacrospinous fixation (VSF) is the most optimal surgical treatment in patients with POP-Q stage ≥2 vaginal vault prolapse (VVP). DESIGN Multicentre randomised controlled trial (RCT) and prospective cohort study alongside. SETTING Seven non-university teaching hospitals and two university hospitals in the Netherlands. POPULATION Patients with symptomatic post-hysterectomy vaginal vault prolapse, requiring surgical treatment. METHODS Randomisation in a 1:1 ratio to LSC or VSF. Evaluation of prolapse was done using the pelvic organ prolapse quantification (POP-Q). All participants were asked to fill in various Dutch validated questionnaires 12 months postoperatively. MAIN OUTCOME MEASURES Primary outcome was disease-specific quality of life. Secondary outcomes included composite outcome of success and anatomical failure. Furthermore, we examined peri-operative data, complications and sexual function. RESULTS A total of 179 women, 64 women randomised and 115 women, participated in a prospective cohort. Disease-specific quality of life did not differ after 12 months between the LSC and VSF group in the RCT and the cohort (RCT: P = 0.887; cohort: P = 0.704). The composite outcomes of success for the apical compartment, in the RCT and cohort, were 89.3% and 90.3% in the LSC group and 86.2% and 87.8% in the VSF group, respectively (RCT: P = 0.810; cohort: P = 0.905). There were no differences in number of reinterventions and complications between both groups (reinterventions RCT: P = 0.934; cohort: P = 0.120; complications RCT: P = 0.395; cohort: P = 0.129). CONCLUSIONS LSC and VSF are both effective treatments for vaginal vault prolapse, after a follow-up period of 12 months.
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Affiliation(s)
- Anique M J van Oudheusden
- Department of Gynaecology and Obstetrics, VieCuri Medical Centre, Venlo, The Netherlands
- Department of Gynaecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, Maastricht, The Netherlands
| | - Mèlanie N van IJsselmuiden
- Department of Gynaecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Gynaecology and Obstetrics, Isala Medical Centre, Zwolle, The Netherlands
| | - Leah F Menge
- Department of Gynaecology and Obstetrics, Reinier de Graaf Guesthouse, Delft, The Netherlands
| | - Anne-Lotte W M Coolen
- Department of Gynaecology and Obstetrics, Zuyderland Medical Centre, Sittard-Geleen, The Netherlands
| | - Joggem Veen
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
| | | | - Viviane Dietz
- Department of Gynaecology and Obstetrics, Catharina Hospital, Eindhoven, The Netherlands
| | - Kirsten B Kluivers
- Department of Gynaecology and Obstetrics, Radboud University Medical Centre, Nijmegen, The Netherlands
| | - Wilbert A Spaans
- Department of Gynaecology and Obstetrics, Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Astrid Vollebregt
- Department of Gynaecology and Obstetrics, Spaarne Gasthuis, Haarlem, The Netherlands
| | - Geerte van de Pol
- Department of Gynaecology and Obstetrics, Gelre Hospitals, Apeldoorn, The Netherlands
| | - Celine M Radder
- Department of Gynaecology and Obstetrics, OLVG, Amsterdam, The Netherlands
| | | | - Sander M J van Kuijk
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Centre +, Maastricht, The Netherlands
| | - Marlies Y Bongers
- Department of Gynaecology and Obstetrics, GROW, School for Oncology & Reproduction, Maastricht University, Maastricht, The Netherlands
- Department of Gynaecology and Obstetrics, Máxima Medical Centre, Veldhoven, The Netherlands
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Heusinkveld J, Khandekar M, Winget V, Tigner A, Addis I. Pectopexy vs sacrocolpopexy: an analysis of 50 cases in a North American hospital. AJOG Glob Rep 2023; 3:100254. [PMID: 37600747 PMCID: PMC10432240 DOI: 10.1016/j.xagr.2023.100254] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/22/2023] Open
Abstract
BACKGROUND Laparoscopic pectopexy is an alternative to sacrocolpopexy that was first reported in 2010. This procedure has been performed at our hospital since 2019 in patients with contraindications to sacrocolpopexy. OBJECTIVE This study aimed to compare the outcomes of 50 cases of pectopexy with historical outcomes data for sacrocolpopexy. STUDY DESIGN This was a retrospective review of 50 laparoscopic pectopexies performed from July 2020 to July 2022 at an academic tertiary referral center; this was the second reported use of this technique in North America. The outcomes from laparoscopic pectopexy were compared with laparoscopic sacrocolpopexy performed at the same institution by the same surgeons (n=207). The primary outcomes were complication rate, rate of recurrent prolapse (stage II or greater), and reoperation. RESULTS Overall complication rates were 6.0% for pectopexy and 16.5% for sacrocolpopexy (relative risk, 0.79; P=.65). Recurrent prolapse was seen among 2.0% of patients who underwent pectopexy and 6.3% of patients who underwent sacrocolpopexy at most recent follow-up (relative risk, 1.27; P=.66). The rates of reoperation were 2.0% for pectopexy and 3.9% for sacrocolpopexy (relative risk, 1.04; P=.96). The average operative times were 138 minutes for pectopexy and 158 minutes for sacrocolpopexy. The average lengths of follow-up were 88.1 days for pectopexy and 325.5 for sacrocolpopexy. CONCLUSION Although pectopexy was typically employed in patients with extensive pelvic adhesions or other conditions that placed them at higher risk of complications, both the success rate and the adverse event rate were similar to those in the historical cohort who underwent sacrocolpopexy. Although sacrocolpopexy remains the gold standard operation for apical prolapse, our data suggest that pectopexy can be employed to offer similar outcomes in many patients with contraindications to sacral fixation. These data give us increasing confidence that we can counsel our patients that this operation is likely to produce an outcome similar to a sacrocolpopexy.
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Affiliation(s)
- John Heusinkveld
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, AZ (Drs Heusinkveld, Winget, Tigner, and Addis)
| | | | - Veronica Winget
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, AZ (Drs Heusinkveld, Winget, Tigner, and Addis)
| | - Alyssa Tigner
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, AZ (Drs Heusinkveld, Winget, Tigner, and Addis)
| | - Ilana Addis
- Department of Obstetrics and Gynecology, University of Arizona, Tucson, AZ (Drs Heusinkveld, Winget, Tigner, and Addis)
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Chene G, Cerruto E, Moret S, Nohuz E. Long-Term Results after Bilateral Sacrospinous Colposuspension: A Prospective Study. J Clin Med 2023; 12:4691. [PMID: 37510805 PMCID: PMC10380842 DOI: 10.3390/jcm12144691] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 05/20/2023] [Revised: 07/08/2023] [Accepted: 07/13/2023] [Indexed: 07/30/2023] Open
Abstract
The loss of apical support is usually present in patients with pelvic organ prolapse. An effective correction for the vaginal apex may be an essential part of a durable repair for these women. Apical suspension of the sacrospinous ligament is likely one of the best treatments by the vaginal route. We proposed the evaluation of the functional and anatomical long-term results of an ultralight and macroporous sling. In this prospective study, bilateral sacrospinous colposuspension was performed in 32 patients with a specific mesh. Functional assessment with several validated quality of life questionnaires and pelvic examination was performed at 1, 6, 12, and 24 months after surgery. Pelvic examination using the POP-Q classification showed a very good efficacy of the BSC mesh with only three prolapse recurrences at 24 months after surgery. All the following QoL scores were significantly improved by two years: PFIQ-7 (p < 0.0001), PFDI-20 (p < 0.0001), and SF-12 (p < 0.0001). No improvement was achieved by the PISQ12 questionnaire. This vaginal minimally invasive procedure is effective, quick, reproducible, and easy. It may be a relevant option for a vaginal vault or cervical or uterine prolapse.
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Affiliation(s)
- Gautier Chene
- Department of Gynecology, Hôpital Femme Mère Enfant (HFME), 59 Boulevard Pinel, University Hospital of Lyon, 69500 Bron, France
- EMR 3738 CICLY, University Claude Bernard of Lyon 1, 69000 Lyon, France
| | - Emanuele Cerruto
- Department of Gynecology, Hôpital Femme Mère Enfant (HFME), 59 Boulevard Pinel, University Hospital of Lyon, 69500 Bron, France
| | - Stephanie Moret
- Department of Gynecology, Hôpital Femme Mère Enfant (HFME), 59 Boulevard Pinel, University Hospital of Lyon, 69500 Bron, France
| | - Erdogan Nohuz
- Department of Gynecology, Hôpital Femme Mère Enfant (HFME), 59 Boulevard Pinel, University Hospital of Lyon, 69500 Bron, France
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Muacevic A, Adler JR. Vaginal Vault Prolapse in an Elderly Woman. Cureus 2023; 15:e34341. [PMID: 36865962 PMCID: PMC9974015 DOI: 10.7759/cureus.34341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 01/30/2023] Open
Abstract
Vaginal vault prolapse is a painful condition in which the vaginal cuff descends. This report presents a case of a 65-year-old obese and diabetic female who was suffering from a third-degree vault prolapse. Conventionally used non-surgical treatments, such as exercises for the pelvic floor, are not as effective as surgical approaches for the treatment of third-degree vault prolapse. Post-hysterectomy vaginal vault prolapse can be treated safely and effectively with abdominal sacral colpopexy using a permanent mesh. Due to several risk factors, such as grand parity, advancing age, and poor lifestyle mainly involving exercise to strengthen pelvic floor musculature, the vaginal route of surgery was employed, which was found to be effective, and thus the treatment was successful. In conclusion, such individualized as well as unique approaches to such rare cases can produce efficacious results.
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Affiliation(s)
- Alexander Muacevic
- Department of Obstetrics and Gynaecology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, IND
| | - John R Adler
- Department of Obstetrics and Gynaecology, NKP Salve Institute of Medical Sciences and Research Centre, Nagpur, IND
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Brunes M, Ek M, Drca A, Söderberg M, Bergman I, Warnqvist A, Johannesson U. Vaginal vault prolapse and recurrent surgery: A nationwide observational cohort study. Acta Obstet Gynecol Scand 2022; 101:542-549. [PMID: 35238023 DOI: 10.1111/aogs.14341] [Citation(s) in RCA: 0] [Impact Index Per Article: 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: 11/15/2021] [Revised: 01/29/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022]
Abstract
INTRODUCTION In surgical repair of pelvic organ prolapse the recurrence rate is about 30% and the importance of apical support was recently highlighted. In surgical randomized controlled studies, the external validity can be compromised because the surgical outcomes often depend on surgical volume. Therefore, we sought to study outcomes of surgical treatment in patients with vaginal vault prolapse in a nationwide setting with a variety of surgical volumes. MATERIAL AND METHODS This is a nationwide cohort study. All patients with a vaginal vault prolapse undergoing surgery, between January 1, 2015 and December 31, 2018, were identified from the Swedish National Quality Register of Gynecological Surgery, GynOp. The primary outcome was the frequency of recurrent pelvic organ prolapse surgery within 2 years postoperatively. Secondary outcomes included patient-reported vaginal bulging, operative time, estimated blood loss and 1-year postoperative complications. RESULTS In 1812 patients with vaginal vault prolapse, 538 (30%) had a sacrospinous ligament fixation (SSLF) with graft, 441 (24%) underwent SSLF without graft, and 200 (11%) underwent minimally invasive sacrocolpopexy (SCP) or sacrocervicopexy (SCerP). A significantly higher proportion of patients undergoing recurrent pelvic organ prolapse surgery was seen in SSLF without graft than in SSLF with graft (adjusted odds ratio [aOR] 2.2, 95% CI 1.4-3.6). Patient-reported sensation of vaginal bulging 1 year after surgery was higher in the SSLF group without graft than in the SSLF group with graft (aOR 1.9, 95% CI 1.3-2.8) and in the SCP/SCerP group (aOR 2.0, 95% CI 1.1-3.4). Finally, we found a significantly higher rate of complications 1 year after surgery in SSLF without graft (aOR 2.3, 95% CI 1.2-4.2) and in SSLF with graft (aOR 2.2, 95% CI 1.2-4.2) compared with SCP/SCerP. CONCLUSIONS In patients with vaginal vault prolapse, SSLF without graft was associated with a higher frequency of recurrent pelvic organ prolapse surgery compared with SSLF with graft, and a higher subjective relapse rate compared with SCP/SCerP and SSLF with graft. Additionally, the complication rate 1 year after primary surgery was higher in SSLF both with and without graft than in SCP/SCerP.
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Affiliation(s)
- Malin Brunes
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden
| | - Marion Ek
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden
| | - Anna Drca
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden
| | - Marie Söderberg
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden
| | - Ida Bergman
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynecology at Södersjukhuset, Stockholm, Sweden
| | | | - Ulrika Johannesson
- Department of Clinical Sciences, Danderyd Hospital, Karolinska Institutet, Stockholm, Sweden.,Division of Obstetrics and Gynecology at Danderyd Hospital, Stockholm, Sweden
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Mowat A, Wong V, Goh J, Krause H, Pelecanos A, Higgs P. A descriptive study on the efficacy and complications of the Capio (Boston Scientific) suturing device for sacrospinous ligament fixation. Aust N Z J Obstet Gynaecol 2017; 58:119-124. [PMID: 28940223 DOI: 10.1111/ajo.12720] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [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: 04/11/2017] [Accepted: 08/27/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Sacrospinous colpopexy is an effective vaginal apical support operation. Due to morbidity associated with traditional approaches which require wide dissection, slim-line suture delivery devices have been introduced in the hope of reducing morbidity without compromise to outcomes. AIM The aim of our series was to report outcomes and complications (particularly buttock pain and blood loss) of the sacrospinous colpopexy using the Capio suturing device and evaluate it against published results using the Miya hook. METHODS This is a prospective, multi-centre descriptive study. The primary outcome is objective success at 12 months. Secondary outcomes include subjective success at 12 months, patient-reported outcomes at 12 months, operating time, estimated blood loss and post-operative buttock pain. RESULTS Fifty-one consenting patients undergoing sacrospinous colpopexy were recruited at four Queensland hospitals. Objective success at 12 months was 95% (41/43) and subjective success at 12 months was 92% (44/48). Eighty-four percent of patients reported buttock pain at one week, reducing to 16% by six weeks, of which 7% required analgesia. CONCLUSIONS At a mean of 17 months follow up, we found that the sacrospinous colpopexy using the Capio suturing device provided excellent apical support with a low requirement for blood transfusion and an average operating time of seven minutes. We found a high rate of buttock pain immediately post-operatively, but our rates became consistent with previous reports by six weeks post-operation.
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Affiliation(s)
- Alex Mowat
- Gynaecology Department, Royal Brisbane and Women's Hospital, Brisbane, University of Queensland,Queensland, Australia
| | - Vivien Wong
- Gynaecology Department, QEII Hospital, Robina Hospital, Brisbane, Queensland, Australia
| | - Judith Goh
- Gynaecology Department, Greenslopes Private Hospital, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia
| | - Hannah Krause
- Gynaecology Department, Greenslopes Private Hospital, QEII Jubilee Hospital, Coopers Plains, Queensland, Australia
| | - Anita Pelecanos
- Queensland Institute of Medical Research, Brisbane, Queensland, Australia
| | - Peta Higgs
- The Sunshine Coast Private Hospital, Nambour General Hospital, Nambour, Queensland, Australia
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Nováčková M, Pastor Z, Brtnický T, Chmel R. [What is the risk of pelvic organ prolapse recurrence after vaginal hysterectomy with colporrhaphy?]. Ceska Gynekol 2017; 82:383-389. [PMID: 29020786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
OBJECTIVE To determine the risk of prolapse recurrence in patients after vaginal hysterectomy with colporrhaphy. DESIGN Retrospective clinical study. SETTING Department of Obstetrics and Gynaecology, Second Faculty of Medicine, Charles University and Motol University Hospital, Prague. METHODS The trial involved 220 women who underwent vaginal hysterectomy with anterior and posterior kolporrhaphy at our department for uterine prolapse at least grade 2. It was the first vaginal surgery in all of the patients. Subjective feeling of pressure in the vagina and/or palpable mass in the vagina or in front of the vaginal entrance and/or objective finding decline of the vaginal walls or fundus at lest the second degree or repeated surgery for prolapse were considered as a prolapse recurrence. RESULTS The mean age at the time of vaginal hysterectomy was 66.7 years (range 37-88). Only 11 patients were premenopausal (5%), the others were postmenopausal, a mean time of posmenopause was 16.9 years. The average parity rate of the study group was 2.1. The average duration of the surgery was 68 minutes. Postoperative urinary retention was observed in one patient (0.45%). 156 women were enrolled in the study. The average length of follow-up was 47 months (minimum 24 months). Recurrence of prolapse based on subjective assessment occured in 24 patients (15.4 %) with pressure and resistance in the vaginal introitus. According to objective criteria, the recurrence of prolapse was diagnosed in 33 (21.2%) patients, of which 16 had prolapse of the anterior vaginal wall, three of the posterior vaginal wall (two rectocoele, one rectoenterocoele), eight combination prolapse of anterior and posterior vaginal wall and vaginal vault prolapse was diagnosed in six women. Eight patients (5. 1%) underwent surgery because of prolapse recurrence. The mean interval from primary surgery to the time of reoperation was 24.4 months (range 6-62). CONCLUSION Patients have to be preoperatively informed about the risk of the prolapse recurrence with the recommendation of appropriate preventive arrangements.
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Abstract
Background: Mesh rectopexy may be associated with infective complications, erosion into the vagina or rectum, and disintegration or dislodgement. A mesh-free rectopexy will avoid these complications. Objective of the study was to perform mesh-free ventral rectopexy and assess its safety and effectiveness. Materials and Methods: Nine women with complete rectal and uterovaginal prolapse were treated with total abdominal hysterectomy, closure of the vaginal vault, extirpation of the pouch of Douglas and suture of anterior rectal wall to the posterior vaginal wall (ventral suture rectopexy). The ventral suture rectopexy was achieved by three pairs of interrupted silk sutures, 2.5 cm above each other, and the first pair very close to the pelvic floor. This composite structure (anterior rectal wall and posterior vaginal wall), sits astride the perineal body. Intussusception and subsequent prolapse of the sutured rectum and vaginal wall is prevented. Vaginal vault prolapse was prevented by the suture of each round ligament of the uterus to the corresponding lateral vaginal fornix. No mesh was used. Results: Nine multiparous women aged between 52 and 70 years had the procedure. The mean operative time was 135 minutes (range 110-220). The follow-up period was between 29 months and 7 years. Full continence was restored in all patients within eight weeks of the operation. Bowel habit returned to once daily in four patients and once every other day in the remaining five patients, within thirteen weeks of surgery. One patient had intermittent mucus discharge per rectum for six months. This stopped without a specific treatment. There has been no known recurrence in these nine patients. One patient developed wound infection as a complication. There was no mortality. All the patients are now asymptomatic. Conclusion: Ventral suture rectopexy is a safe and effective treatment for complete rectal prolapse in a selected group of patients.
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Affiliation(s)
- Adedayo O Tade
- Department of Surgery, Olabisi Onabanjo University Teaching Hospital, Sagamu, Nigeria
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