scholarly journals Amniotic Membrane Graft in the Management of Complex Vaginal Mesh Erosion

2020 ◽  
Vol 9 (2) ◽  
pp. 356
Author(s):  
Hui-Hsuan Lau ◽  
Quan-Bin Jou ◽  
Wen-Chu Huang ◽  
Tsung-Hsien Su
Keyword(s):  
Amniotic Membrane ◽  
Intraoperative Complications ◽  
Mesh Erosion ◽  
Surgical Revision ◽  
Vaginal Mesh ◽  
Management Options ◽  
Mesh Surgery ◽  
Amniotic Graft ◽  
Vaginal Erosions

Vaginal mesh erosion is a devastating complication after pelvic floor mesh surgery and it can be treated conservatively or with surgical revision. However, the management options following a failed primary revision or complex vaginal erosions are very limited. The aim of this study is to describe a novel treatment using an amniotic membrane as an inlay graft for such patients. Eight patients who failed conservative or primary surgical revision were enrolled. The complex erosions included vaginal agglutination, multiple vaginal erosions, recurrent erosions, and mesh cutting through the urethra. We used an amniotic membrane as a graft to cover the vaginal defect after partial excision of the mesh erosion and we describe the technique in this study. There were no intraoperative complications and none of the patients reported any further symptoms at a mean of 27 months follow-up. Only one patient had recurrent erosion, however, the erosion size was narrower and was subsequently successfully repaired. No further vaginal mesh erosions were noted in the other patients who all had good functional recovery. The use of an amniotic graft can be an economic and alternative method in the management of complex vaginal mesh erosions.

Long-term observation on postoperative recurrence and complications of transvaginal mesh surgery for pelvic organ prolapse

2021 ◽  
Author(s):  
Junfang Yang ◽  
Kun Zhang ◽  
Jinsong Han ◽  
Yiting Wang ◽  
Ying Yao ◽  
...  
Keyword(s):  
Risk Factors ◽  
Pelvic Organ Prolapse ◽  
Protective Factor ◽  
Pelvic Organ ◽  
Vaginal Mesh ◽  
Transvaginal Mesh ◽  
Mesh Exposure ◽  
Mesh Surgery ◽  
Post Menopause

Objective: This study aims to evaluate the risk factors for subjective recurrence and complications of patients who underwent transvaginal synthetic mesh surgery. Design：This retrospective cohort study included patients who received transvaginal mesh (TVM) surgery between January 2005 and June 2019. Methods: The information of patients was collected, including basic characteristics, subjective recurrence, and mesh-related complications. The clinical characteristics of patients with and without subjective recurrence were compared. The sexual activities of patients before and after the operation were recorded. SPSS 20.0 was used for the statistical analysis. Results: A total of 257 patients were included. Among them, 62 (24.1%) patients were lost to follow-up. The median follow-up time was 80 months (12 months, 170 months). Finally, 195 patients were followed up, 11 (5.6%) patients had a subjective recurrence of pelvic organ prolapse, and 26 (13.3%) patients had mesh-related complications (11 patients with de novo pain and 15 patients with mesh exposure). We found significant differences in age (68.9±5.1 vs. 63.4±5.8 years old), years of post-menopause (17.5±6.3 vs. 13.3±6.9 years), previous hysterectomy (27.3% vs. 6.0%), and concomitant hysterectomy (45.5% vs. 81.0%) between patients with and without subjective recurrence (P<0.05). The mesh exposure proportion of patients with total vaginal mesh (47.6%) was significantly higher than that with anterior vaginal mesh (2.9%) (P<0.05). Furthermore, 6.7% of sexually active patients reported do novo dyspareunia. Limitation: The investigators could only record the subjective recurrence of patients, thus there is a lack of objective recurrence data. Conclusion: Age, years of post-menopause and previous hysterectomy are risk factors for subjective recurrence of transvaginal mesh surgery; however，concomitant hysterectomy is a protective factor. Mesh exposure is the most common complication, especially for total vaginal mesh repair surgery.

A case of mesh erosion in the ureter eight years after a tension-free vaginal mesh surgery

2019 ◽  
Vol 30 (12) ◽  
pp. 2199-2200
Author(s):  
Tomomi Nakagawa ◽  
Shohei Kawaguchi ◽  
Atsushi Mizokami
Keyword(s):  
Mesh Erosion ◽  
Vaginal Mesh ◽  
Tension Free ◽  
Mesh Surgery

scholarly journals Trans-urethral bladder suture in female patients: Not a tour de force but a quick and realistic answer to complex situations

2021 ◽  
pp. 039156032110011
Author(s):  
Fanourios Georgiades ◽  
Chryssanthos Kouriefs ◽  
Jonathan Makanjuola ◽  
Philippe Grange
Keyword(s):  
Operative Time ◽  
Intraoperative Complications ◽  
Laser Lithotripsy ◽  
Defect Closure ◽  
Management Options ◽  
Mattress Suture ◽  
Needle Holder ◽  
Effective Option ◽  
Average Operative Time

Introduction: Trans-urethral bladder surgery has gained popularity in the fields of electro-resection and laser lithotripsy, with endoscopic suturing being overlooked. Bladder defect closure using a pure trans-urethral suturing technique can provide a quick and effective solution in situations where conventional management options are not feasible. Methods: Here we describe this innovative novel technique developed by our group that was used to treat two different cases with bladder perforation at two different institutions. We used a 5 mm laparoscopic port with gas insufflation and a laparoscopic needle holder trans-urethrally to achieve defect closure with a monofilament 2/0 monocryl mattress suture on a small 22 mm needle. Results: The defects were successfully closed without any intraoperative complications. Average operative time for the technique was 18 min with minimal blood loss. Bladder closure was sustained at a median follow-up of 2 years for one of these cases. Conclusions: We claim that transurethral bladder suturing is quick, safe in expert hands and provides an effective option where the clinical condition/situation of the patient warrants a minimally invasive surgery approach.

scholarly journals Vaginal mesh surgery is efficient to treat pelvic organ prolapse grade 3 in elderly women

2019 ◽  
Vol 4 (4) ◽  
pp. 38-46
Author(s):  
O. S. Korotkevich ◽  
V. G. Mozes ◽  
I. A. Eizenakh ◽  
A. V. Soloviev ◽  
V. V. Vlasova
Keyword(s):  
Surgical Treatment ◽  
Pelvic Organ Prolapse ◽  
Outcome Measure ◽  
Elderly Women ◽  
Pelvic Organ ◽  
Vaginal Mesh ◽  
Mesh Surgery ◽  
Grade 3

Aim. To evaluate the surgical treatment of pelvic organ prolapse grade 3 in elderly women.Materials and Methods. We consecutively recruited 86 elderly women (60 to 75 years old) suffering from pelvic organ prolapse grade 3. Out of them, 56 patients underwent vaginal mesh surgery while 30 refused surgical treatment. After 1 year, we assessed stress urinary incontinence using a cough test and Valsalva maneuver. Pain intensity was measured using the Numeric Rating Scale whereas quality of life was assessed by Pelvic Floor Disability Index (PDFI-20). The primary outcome measure was the prevalence of pelvic organ prolapse symptoms while the secondary outcome measure was the frequency of stress urinary incontinence and low quality of life upon 1 year of follow-up.Results. After 1 year of follow-up, patients who received a surgical treatment were characterized by a statistically significant decrease in both frequency and intensity of complaints and symptoms of pelvic organ prolapse. Pelvic Organ Prolapse Distress Inventory score was 8.3 (4.2-12.5) and 79.2 (79.2-100) in patients with or without surgical treatment respectively. Similar results were showed using Colorectal-Anal Distress Inventory score (6.2 (3.1-6.2) and 68.8 (62.5-71.9) and Urinary Distress Inventory score (8.3 (4.2-8.3) and 83.3 (79.2-87.5), in treated and untreated individuals, respectively. Total Pelvic Floor Disability Index score was 22.8 (11.5-27.0) in women who underwent a vaginal mesh surgery and 227.2 (226.1251.0) in those who did not. All indicated differences were statistically significant.Conclusions. Vaginal mesh surgery is efficient for the treatment of pelvic organ prolapse grade 3 in elderly women.

scholarly journals Hüvelyi hálóműtétek gyakorlata az amerikai korlátozó figyelmeztetés után. Merjem, vagy ne merjem?

2018 ◽  
Vol 159 (10) ◽  
pp. 397-404 ◽  
Author(s):  
Zoltán Fekete ◽  
Szilvia Körösi ◽  
Gábor Németh
Keyword(s):  
The Elderly ◽  
Pelvic Organ ◽  
Vaginal Mesh ◽  
Referral Centre ◽  
Tertiary Referral Centre ◽  
Mesh Surgery ◽  
Operative Complications ◽  
Short And Long Term

Abstract: Introduction: The prevalence of pelvic organ prolapse (POP) with aging is escalating alarmingly, and now becoming a growing epidemic among the elderly. Synthetic transvaginal mesh (TVM) has been employed with increasing popularity in the treatment of POP until the end of the last decade. After the U.S. Drug and Food Administration (FDA) warnings in the years 2008 and 2011, the number of vaginal mesh operations has decreased dramatically. Aim: The aim of the study was to evaluate and compare the anti-POP effectivity, the anti-stress incontinence (anti-SUI) efficacy, and the late (36 months) post-operative complications of the anterior vaginoplasty and the TVM operations. Method: We analysed the clinical data from 120 patients with stage II–III anterior prolapse and concomitant SUI who had undergone surgery at a tertiary referral centre in Hungary between January 2013 and January 2014. Sixty patients underwent Kelly–Stoeckel vaginoplasty and the other 60 cases had TVM operation. The surgical complications were classified using the Clavien–Dindo (CD) classification system. Results: The anti-POP (91.6% vs. 63.3%; p<0.001) and the anti-SUI efficacy (90% vs. 55%, p<0.001) were significantly higher in the TVM group than in the vaginoplasty group, while the overall extrusion rate was found 8.3% after a 3-year follow-up. The Clavien–Dindo score (CD) proved that the early post-operative complication profile was similar among the TVM patients as compared to the vaginoplasty group (p = 0.405). Conclusion: Vaginal mesh surgery represents an effective procedure for prolapse and concomitant SUI with a decreased risk of short- and long-term complications. Orv Hetil. 2018; 159(10): 397–404.

Extra-peritoneal Laparoscopic Resection of Benign Prostate Adenoma >150 CC with preservation of posterior wall of prostatic urethra: Dundee Technique and early outcomes

2021 ◽  
pp. 003693302110681
Author(s):  
Hollie A Clements ◽  
Ghulam Nabi
Keyword(s):  
Intraoperative Complications ◽  
Case Series ◽  
Posterior Wall ◽  
Prostatic Urethra ◽  
Laparoscopic Technique ◽  
Management Options ◽  
Residual Symptoms ◽  
Peritoneal Space ◽  
Prostate Adenoma

Background There are limited options for men with large benign prostates (>150cc) and bladder outflow obstruction due to benign prostatic hyperplasia (BPH). Management options include surgery (open or minimal access) and endoscopic procedures. There is a paucity of literature on outcomes for prostates >150cc. Methods In this case series we describe a step-by-step, illustrated, modified extra-peritoneal technique of laparoscopic prostatectomy with preservation of the posterior prostatic urethra. This involves creation of extra-peritoneal space, transverse incision of prostate capsule, progressive adenoma dissection, resection, and closure of the capsule. Results Ten patients underwent this procedure between 2015 and 2019. The mean age was 72.4 years and mean prostate size was 215.5cc. Mean procedure duration was 200 min and there were no intraoperative complications. Most patients were discharged on postoperative day 1. Mean intraoperative blood loss was 120 ml with no patient requiring blood transfusion. At follow up (mean 37 months) no patients had residual symptoms of BPH. Conclusion We describe a novel extraperitoneal laparoscopic technique for benign prostates of >150cc with very good outcomes. The transferability of this technique to centres with laparoscopic expertise at minimal extra cost and future adaptability in the robotic setting are some of the advantages of this technique.

scholarly journals Characteristics and recurrence of pterygium in Saudi Arabia: a single center study with a long follow‐up

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Waleed Alsarhani ◽  
Saeed Alshahrani ◽  
Mahmood Showail ◽  
Nawaf Alhabdan ◽  
Osama Alsumari ◽  
...  
Keyword(s):  
Mitomycin C ◽  
Recurrence Rate ◽  
Dry Eye ◽  
Amniotic Membrane ◽  
Univariate Analysis ◽  
Dry Eye Disease ◽  
Eye Disease ◽  
First Year ◽  
Conjunctival Autografting

Abstract Background This study described the clinical features of patients with pterygium and analyzed the recurrence rate of conjunctival autografting alone, conjunctival autografting combined with intraoperative mitomycin C, and amniotic membrane grafting. Methods A retrospective cohort study of primary pterygium was conducted between January 2017 and February 2020. Factors associated with pterygium severity and recurrence were analyzed by univariate analysis and logistic regression models. Results The study included 292 patients with an average age of 53.3 ± 14.1 years, while the number of operated cases was 94. Pterygia involving the cornea were observed in 55 % of the cases. The overall rate of recurrence for the three procedures was 17 %. The average time of recurrence was 14.2 ± 11.9 months, with 37 % of the recurrences occurring after the first year. The only factor associated with a significant risk of recurrence was dry eye disease in both univariate (p = 0.021) and multivariate analysis (p = 0.026). The recurrence rates following conjunctival autografting with and without mitomycin C were 15.6 and 15.8 %, respectively. The recurrence rate following the amniotic membrane graft was  twofold (OR= 2.02)  (27 %) that following the conjunctival autograft (15.8 %). Conclusions The only factor associated with the recurrence of pterygium was dry eye disease. More than one-third of recurrences developed after the first year, which stresses the importance of a long follow-up. The recurrence rate in our study following conjunctival graft was slightly higher compared to the literature mainly due to differences in study areas, populations, and follow-up periods.

A Novel Surgical Technique for Large Frontoencephalocele Management: The Mercy Ships Approach

FACE ◽  
2021 ◽  
pp. 273250162097932
Author(s):  
Naikhoba C. O. Munabi ◽  
Eric S. Nagengast ◽  
Gary Parker ◽  
Shaillendra A. Magdum ◽  
Mirjam Hamer ◽  
...  
Keyword(s):  
Surgical Technique ◽  
Intraoperative Complications ◽  
Complication Rates ◽  
The Novel ◽  
Middle Income ◽  
Middle Income Countries ◽  
Lumbar Drain ◽  
Cerebral Herniation ◽  
Long Nose

Background: Large frontoencephaloceles, more common in low and middle-income countries, require complex reconstruction of cerebral herniation, elongated nose, telecanthus, and cephalic frontal bone rotation. Previously described techniques involve multiple osteotomies, often fail to address cephalad brow rotation, and have high complication rates including up to 35% mortality. This study presents a novel, modified, single-staged technique for frontoencephalocele reconstruction performed by Mercy Ships. This technique, which addresses functional and aesthetic concerns with minimal osteotomies, may help improve outcomes in low resources settings. Methods: Retrospective review was performed of patients who underwent frontoencephalocele reconstruction through Mercy Ships using the technique described. Patient data including country, age, gender, associated diagnoses, and prior interventions were reviewed. Intraoperative and post-operative complications were recorded. Results: Eight patients with frontoencephalocele (ages 4-14 years) underwent surgery with the novel technique in 4 countries. Average surgical time was 6.0 ± 0.9 hours. No intraoperative complications occurred. Post-operatively 1 patient experienced lumbar drain dislodgement requiring replacement and a second had early post-operative fall requiring reoperation for hardware replacement. In person follow-up to 2.4 months showed no additional complications. Follow-up via phone at 1 to 2 years post-op revealed all patients who be satisfied with surgical outcomes. Conclusions: Reconstruction of large frontoencephaloceles can be challenging due to the need for functional closure of the defect and craniofacial reconstruction to correct medial hypertelorism, long nose deformity, and cephalad forehead rotation. The novel surgical technique presented in this paper allows for reliable reconstruction of functional and aesthetic needs with simplified incision design, osteotomies, and bandeau manipulation.

Sign in / Sign up

Export Citation Format

Share Document