ABSTRACT INTERNAL - AGES

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18<strong>ABSTRACT</strong>S continuedFRIDAY 21 NOVEMBER 2008randomized control trial compared sacral hysteropexyand vaginal hysterectomy and repair10 reported asignificantly higher re-operation rate for prolapse in thehysteropexy group at 2 and 5years.The literature demonstrates that the vaginal approach issuperior to abdominal approach in the management ofuterovaginal prolapse in those requesting uterinepreservation.References:1 Maher CF, Cary MP, Slack MC, Murray CJ, Milligan M,Schluter P. Uterine preservation or hysterectomy atsacrospinous colpopexy for uterovaginal prolapse? IntUrogynecol J Pelvic Floor Dysfunct 2001;12(6):381-4.2 Hefni M, El Toukhy T, Bhaumik J, Katsimanis E.Sacrospinous cervicocolpopexy with uterineconservation for uterovaginal prolapse in elderlywomen: an evolving concept. Am J Obstet Gynecol2003;188(3):645-50.3 Kovac SR, Cruikshank SH. Successful pregnancies andvaginal deliveries after sacrospinous uterosacralfixation in five of nineteen patients. Am J ObstetGynecol 1993;168(6 Pt 1):1778-83.4 Hiltunen R, Nieminen K, Takala T, et al. Low-weightpolypropylene mesh for anterior vaginal wall prolapse:a randomized controlled trial. Obstetrics AndGynecology 2007;110(2 Pt 2):455-462.5 Nguyen JN, Burchette RJ. Outcome after anteriorvaginal prolapse repair: a randomized controlled trial.Obstet Gynecol 2008;111(4):891-8.6 Sivaslioglu A, Unlubilgen E, Dolen I. A randomisedcomparison of polypropelene mesh surgery with sitespecificsurgery in treatment of cystocele.International Urogynecology Journal And Pelvic FloorDysfunction 2007;published online(DOI 10.1007/s00192-007-0465-y).7 Belot F, Collinet P, Debodinance P, Ha Duc E, Lucot JP,Cosson M. [Risk factors for prosthesis exposure intreatment of genital prolapse via the vaginalapproach]. GynÃ©cologie, ObstÃ©trique & FertilitÃ©2005;33(12):970-974.8 Leron E, Stanton SL. Sacrohysteropexy with syntheticmesh for the management of uterovaginal prolapse.BJOG 2001;108(6):629-33.9 Barranger E, Fritel X, Pigne A. Abdominalsacrohysteropexy in young women with uterovaginalprolapse: long-term follow-up. Am J Obstet Gynecol2003;189(5):1245-50.10 Roovers JP, van der Vaart CH, van der Bom JG, vanLeeuwen JH, Scholten PC, Heintz AP. A randomisedcontrolled trial comparing abdominal and vaginalprolapse surgery: effects on urogenital function. BJOG2004;111(1):50-6.Author Affiliation: Associate Professor ChristopherMaher, Brisbane, Qld, Australia.LAPAROSCOPIC APPROACH TO UTERINE PRESERVINGPROLAPSE SURGERYFriday 21 November / Session 10 / 1450-1510Lam ATraditional approach to significant utero-vaginal prolapse,defined as ≥ stage 2 POP-Q prolapse, often involvesvaginal hysterectomy and vaginal repair. Increasinglymore and more women are interested in uterinepreservingprolapse surgery. The variety of reasons whichmay influence women in seeking this line of surgicalmanagement includes:• Fertility-preserving option – nulliparous or multiparouswomen• Fear of loss of femininity• Cultural factor• Psychological factor• Potential de-novo bladder or bowel dysfunction• Potential impact on sexual function• Anatomical considerations – loss of vaginal length,loss of central support leading to possible subsequentvault prolapse• Morbidity associated with hysterectomy• Hysterectomy may not necessarily reduce the risk oflong-term prolapse recurrenceAnatomical considerations: Uterine prolapse occurs as aresult of damage to Delancey level I support ie theutero-sacral cardinal complex.Uterine prolapse may occur in isolation or as part of amulti-level, multi-compartment pelvic floor damage.Uterine prolapse may therefore occur along with level IIanterior and /or posterior compartment defects, and levelIII defects.Women who have uterine prolapse may also havecervical elongation which can result in the leading edgeof the prolapse, namely the cervix (point C of POP-Q)presenting outside while vaginal posterior fornix (point D)remaining above the hymenal remant.Management options: Frequently, most women withsignificant utero-vaginal prolapse are advisedOvum II by Ana Duncan
<strong>AGES</strong> Focus Meeting Sheraton ENDOSCOPY Perth Hotel, FOR West Australia FERTILITY 20 & 21 November 200819conservative management if they wish to preservefertility. The conservative measures include pelvic floorexcercise with or without the use of vaginal pessary.Surgery is often delayed until childbearing is completebecause of:• The risk of recurrence of prolapse with furtherchildbirth which in turn may necessitate repeatsurgery• Possible impact on fertility from cervical surgery(shortening, amputation)• Possible development of cervical incompetenceresulting necessitating cervical cerclage• Possibility of cervical stenosis and hematometra• Hysterectomy is frequently considered an inevitablecomponent of surgery for significant utero-vaginalprolapseLaparoscopic approach: Laparoscopic approach offerswomen who are symptomatic of their prolapse the choiceof uterine preserving surgery. This can be achieved by• Suture repair – level I hysteropexy uterosacralsuspension +/- level II anterior and posterior paravaginalattachment and level III repair• Mesh repair – in cases where the quality ofuterosacral ligaments is inadequate:o sacro-cervicopexy with mesho sacro-hysteropexy with mesh attachment to boththe anterior and posterior cervix.o sacro-hystero-colpopexy with mesh attachment toboth the anterior and posterior vaginal wall and thecervixIt is important to assess the length of the cervix. Ingeneral, women wishing to preserve fertility should avoidcervical repair. Where necessary, only the removal of thehypertrophic, elongated infra-vaginal portion of thecervix maintaining a minimum of 2 cm of endocervicalcanal to the internal os to minimise the risk of cervicalincompetence.Results: There are a number of case series in theliterature reporting on open or laparoscopic approach touterine-preserving prolapse surgery. In this presentationwe will examine the literature as well as present our owntechniques and experience to date.Author Affiliation: Associate Professor Alan Lam; CARE,Royal North Shore Hospital, Northern Clinical School,University of Sydney, NSW, Australia.CAN WE USE MESH SAFELY IN FERTILITY PRESERVINGPROLAPSE SURGERY?Friday 21 November / Session 10 / 1510-1530Daborn PThis interactive session will review the limited availableliterature for the use of mesh in fertility preservingprolapse surgery. In particular the options ofSacrohysteropexy and vaginal placement of meshincluding the new mesh kit systems will be covered.Pertinent clinical issues will be discussed in the setting ofa case presentation highlighting the “pros and cons” ofmesh graft augmentation.Author Affiliation: Dr J Phillippe Daborn. King EdwardMemorial Hospital for Women, Subiaco, WA, Australia.CONTROLLING INTRA-OPERATIVE HAEMORRHAGEFriday 21 November / Session 11 / 1600-1630Chandraratna HHemorrhage can come in many shapes and forms, from aminor annoying ooze to life threatening bleeding that canterminate a life in minutes. The modern surgeons needs toknow an array of maneuvers and have an understandingof the modern tools available to them to get out ofunexpected (and expected) events safely and succinctly.This may involve not only intra-operative techniques butalso the need to give advice to anesthetists who may notbe familiar with catastrophic events.In this talk we will cover preoperative preparation.Emergency surgical maneuvers, advanced techniques oflocal control, simple vascular reconstruction techniques,stabilizing measures as well as correcting coagulopathy.Author Affiliation: Dr H Chandraratna. University of NotreDame, Freemantle, WA, Australia.Conclusion: Laparoscopic approach to uterine preservingprolapse surgery is a feasible and effective surgicaloption which can be offered to women wishing topreserve fertility or those without significant uterinepathology wishing to avoid hysterectomy.
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