Elvis I. Seman

Two-Year Experience with Laparoscopic Pelvic Floor Repair

STUDY OBJECTIVE To evaluate the cumulative experience at our institution of laparoscopic pelvic floor repair to treat genital prolapse and associated symptoms. DESIGN Retrospective analysis (Canadian Task Force classification II-2). SETTING University hospital. PATIENTS Seventy-three consecutive women treated surgically for symptomatic genital prolapse. INTERVENTION Surgical treatment was site specific depending on findings on physical examination. Anterior compartment defects were treated by laparoscopic paravaginal repair, laparoscopic Burch colposuspension, or transvaginal anterior vaginal repair. Defects in the posterior compartment were treated by a combination of laparoscopic supralevator repair, laparoscopic vaginal vault suspension, enterocele sac invagination or excision, and transvaginal posterior vaginal repair. Anatomic defects in the apical compartment were primarily treated by laparoscopic vaginal vault suspension and enterocele sac excision. Patients whose anatomic anomalies contained elements of anterior, posterior, and apical compartments were classified in a global group. MEASUREMENTS AND MAIN RESULTS Preoperatively, prolapse was considered as an attachment or fascial defect at DeLancey level I, II, or III. Each was then quantified by the pelvic organ prolapse quantification (POPQ) system and compartmentalized according to site of the major defect. Women were assessed by physical examination and repeat POPQ staging 6 weeks postoperatively and every 6 months thereafter. A standard interview was administered to assess functional status. Major complications occurred in 4.1% of women. Objective and subjective cure rates were 90% at 2 years. CONCLUSIONS Laparoscopic pelvic floor repair is an effective procedure with low morbidity. It should play a primary role in surgical management of DeLancey levels I and II attachment defects. For fascial defects, in particular DeLancey level II anteriorly and posteriorly, it should be complemented with vaginal repair.

Pregnancy following endometrial ablation: Case history and literature review

A total of 43 pregnancies that occurred subsequent to endometrial ablation were reported to July 2002. Only 17 of these pregnancies had progressed beyond 20 weeks. We report a successful planned pregnancy following endometrial ablation and sterilization reversal, culminating in vaginal birth after a previous Caesarean section. The English literature has been reviewed to ascertain family planning practices, uterine cavity assessment and pregnancy outcomes after endometrial ablation/resection. Pregnancy management recommendations are provided. Target Audience: Obstetricians & Gynecologists, Family Physicians Learning Objectives: After completion of this article, the reader will be able to list the various pregnancy complications associated with a history of endometrial ablation, and to describe the changes in the endometrial cavity following endometrial ablation.

Survey of current management of prolapse in Australia and New Zealand

Objective:  To compare current practice in the treatment of pelvic organ prolapse between Australian/New Zealand and United Kingdom (UK) gynaecologists.

Endocervicosis of the Urinary Bladder

Summary: A further case of endocervicosis of the urinary bladder is described. It is important that gynaecologists and pathologists be aware of this entity and its possible relationship to previous Caesarean section to avoid confusion with a neoplastic process.

Laparovaginal hysterectomy: A decade of evolution

Objective:  To compare surgical outcomes for laparoscopically‐assisted vaginal hysterectomy (LAVH) to total laparoscopic hysterectomy (TLH) and to document the modifications to the technique of laparovaginal hysterectomy which have occurred over the last decade at Flinders Endogynaecology, South Australia, Australia. The method of choice at the start of the decade was LAVH and by the end of the study period it had been superceded by TLH.

Use of surgisis for treatment of anterior and posterior vaginal prolapse.

Aim. To evaluate the anatomical success and complication rate of Surgisis in the repair of anterior and posterior vaginal wall prolapse. Methods. A retrospective review of 65 consecutive Surgisis prolapse repairs, involving the anterior and/or posterior compartment, performed between 2003 and 2009, including their objective and subjective success rates using the pelvic organ prolapse quantification (POPQ) system. Results. The subjective success rate (no symptoms and no bulge beyond the hymen) was 92%, and the overall objective success rate (no subsequent prolapse in any compartment) was 66% (43 of 65). The overall reoperation rate for de novo and recurrent prolapse was 7.7% with 3 women undergoing repeat surgery at the same site (anterior compartment). No long-term complications occurred. Conclusions. Surgisis has a definite role in the surgical treatment of prolapse. It may decrease recurrences seen with native tissue repair and long-term complications of synthetic mesh. Its use in posterior compartment repair in particular is promising.

Laparoscopic treatment of enterocele: A 3-year evaluation

Objective:  To report the morbidity associated with the laparoscopic treatment of enteroceles and assess the durability of the repair.

Laparoscopic Supralevator Repair for Combined Apical and Posterior Compartment Prolapse

STUDY OBJECTIVE To analyze the objective outcome of laparoscopic supralevator repair in the treatment of rectoenterocele with the Pelvic Organ Prolapse Quantification (POPQ) system. STUDY DESIGN Retrospective cohort study 1999-2009 (Canadian Taskforce Classification II-2). SETTING University hospital in South Australia. PATIENTS A total of 166 women with a median age of 63 years (range 36-89) who underwent laparoscopic supralevator repair for rectoenterocele and treatment of associated conditions over a 10-year period. INTERVENTIONS All patients were assessed with the POPQ scoring system before surgery and at 6 weeks, 6 months, annually, and biannually after surgery. MEASUREMENTS AND MAIN RESULTS The median operating time was 151 minutes (range 35-390); median blood loss was 50 mL (range 50-600); and median hospital stay was 4 days (range 1-14). Four women, 2 of whom required laparotomy, had a major complication. Ten women (6%) needed day surgery to treat vaginal granulations or suture exposure. With a median follow-up time of 45 months (interquartile range 16-67) the overall objective success rate was 63% according to National Institute of Health criteria. The median time to failure was 24 months. Of 61 objective failures, 23 required further prolapse surgery, representing a 14% reoperation rate. CONCLUSION Laparoscopic supralevator repair is a safe and effective procedure for the treatment of rectoenterocele.

Long-term outcomes of laparoscopic repair of cystocoele.

There is little information on the effectiveness of laparoscopic techniques for native tissue repair of cystocoele.

Recent trends in the management of pelvic organ prolapse in Australia and New Zealand

To compare current practice in the management of female pelvic organ prolapse in Australia and New Zealand with that in 2007, and assess the impact on practice of the withdrawal of Prolift® and Prosima® mesh kits in 2015.