The role of hydrodissection in native tissue repair of anterior vaginal wall defects.
anterior colporrhaphy
bleeding
connective tissue
cystocele
hydrodissection
pelvic floor reconstructive surgery
Journal
The Australian & New Zealand journal of obstetrics & gynaecology
ISSN: 1479-828X
Titre abrégé: Aust N Z J Obstet Gynaecol
Pays: Australia
ID NLM: 0001027
Informations de publication
Date de publication:
02 2022
02 2022
Historique:
revised:
24
06
2021
received:
09
02
2021
accepted:
31
08
2021
pubmed:
29
9
2021
medline:
16
3
2022
entrez:
28
9
2021
Statut:
ppublish
Résumé
A variety of surgical techniques are available for vaginal prolapse repair, indicating a lack of consensus. A debate regarding the utility of hydrodissection for splitting the surgical plane of the vaginal wall exists. The aim of this study is to evaluate the impact of hydrodissection in anterior colporrhaphy (AC). Patients undergoing primary AC were randomly assigned to an approach with (study group) versus without (control group) hydrodissection. Five surgeons performed both techniques, and the trimmed vaginal tissue was retrieved for histological analysis. Two pathologists, blinded to the surgical approach, evaluated the presence of a loose connective tissue at the surgical dissection plane (controversially deemed 'fascia', as explained in this article). In addition, we compared the operative time, pain score and haemoglobin levels. After statistical analysis, data were presented using percentile, and statistical significance was tested using the χ Forty-six patients underwent primary elective AC, with 23 patients in each, the study and control groups. The groups were comparable regarding age (study group 60.33 ± 11.95 years and control group 59.86 ± 12.04, P = 0.90), menopausal status (study group 17 (73.9%) and control group 15 (68.2%), P = 0.67) and other characteristics. We found no difference in sample characteristics between the two groups. Connective tissue was found in only 13.6% (n = 3) of patients after hydrodissection and in 27.3% (n = 6) of patients without hydrodissection (P = 0.46). The hydrodissection group had significantly less bleeding than the control group (ΔHB 0.66 ± 0.66 vs 1.21 ± 0.84, P = 0.05). After hydrodissection, less bleeding was noted without compromise the surgical planes.
Types de publication
Journal Article
Randomized Controlled Trial
Langues
eng
Sous-ensembles de citation
IM
Pagination
98-103Informations de copyright
© 2021 The Royal Australian and New Zealand College of Obstetricians and Gynaecologists.
Références
Neuman M, Sumerova N, Sosnovski V, Bornstein J. Anterior needle-guided mesh in advanced pelvic organ prolapse: Apical fixation on sacrospinous ligaments. Eur J Obstet Gynecol Reprod Biol 2014; 172(1): 120-123.
Barber MD, Maher C. Apical prolapse. Int Urogynecol J 2013; 24: 1815-1833.
Maher C, Feiner B, Baessler K, et al. Transvaginal mesh or grafts compared with native tissue repair for vaginal prolapse. Cochrane Database Syst Rev 2016; 2016. https://doi.org/10.1002/14651858.CD012079
Paz-Levy D, Yohay D, Neymeyer J, et al. Native tissue repair for central compartment prolapse: a narrative review. Int Urogynecol J 2017; 28: 181-189.
Food and Drug Administration. Urogynecologic surgical mesh: Update on the safety and effectiveness of transvaginal placement for pelvic organ prolapse. FDA Saf Commun [Internet] 2011; (July): 1-15. [Accessed 14 September 2021.] Available from URL: https://www.fda.gov/media/81123/download
Committee on Gynecologic Practice. Committee Opinion no. 513: vaginal placement of synthetic mesh for pelvic organ prolapse. Obstet Gynecol 2011; 118(6): 1459-1464.
Davila GW, Baessler K, Cosson M, Cardozo L. Selection of patients in whom vaginal graft use may be appropriate. Int Urogynecol J 2012; 23(S1): 7-14.
U.S. Food and Drug Administration. FDA takes action to protect women’s health, orders manufacturers of surgical mesh intended for transvaginal repair of pelvic organ prolapse to stop selling all devices. FDA News Release 2019.
Sun Y, Tang C, Luo D, et al. The treatment of anterior vaginal wall prolapsed by repair with mesh versus colporrhaphy. Int Urol Nephrol. 2016; 48(2): 155-167.
Rudnicki M, Laurikainen E, Pogosean R, et al. A 3-year follow-up after anterior colporrhaphy compared with collagen-coated transvaginal mesh for anterior vaginal wall prolapse: A randomised controlled trial. BJOG An Int J Obstet Gynaecol 2016; 123(1): 136-142.
Israeli O, Weintraub AY. Surgery for anterior compartment prolapse synthetic graft-augmented repair. Urol Clin N Am 2019; 46(1): 71-78.
Maher C, Feiner B, Baessler K, et al. Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 2010. https://doi.org/10.1002/14651858
Besser L, Schwarzman P, Mastrolia SA, et al. Comparative analysis of early adverse events of pelvic organ prolapse repair with or without transvaginal mesh using Clavien-Dindo classification. Int J Gynecol Obstet 2018; 142(1): 108-113.
Lamblin G, Delorme E, Cosson M, Rubod C. Cystocele and functional anatomy of the pelvic floor: review and update of the various theories. Int Urogynecol J 2016; 27(9): 1297-1305.
De Lancey JOL. What’s new in the functional anatomy of pelvic organ prolapse? Curr Opin Obstetr Gynecol 2016; 28: 420-429.
Lamblin G, Mayeur O, Giraudet G, et al. Pathophysiological aspects of cystocele with a 3D finite elements model. Arch Gynecol Obstet 2016; 294(5): 983-989.
DeLancey JOL. Structural anatomy of the posterior pelvic compartment as it relates to rectocele. Am J Obstetr Gynecol 1999; 180(4): 815-823.
Weber AM, Walters MD. Anterior vaginal prolapse: Review of anatomy and techniques of surgical repair. Obstetr Gynecol 1997; 89: 311-318.
Moen M, Noone M, Vassallo B. Anterior colporrhaphy: Why surgeon performance is paramount. Int Urogynecol J 2014; 25(7): 857-862.
Lensen EJM, Van Den Berg-Van Erp SHM, Stoutjesdijk JA, et al. Does the method of dissecting in anterior colporrhaphy lead to a difference in thickness of removed vaginal tissue? Eur J Obstet Gynecol Reprod Biol 2013; 168(1): 112-116.
Henn EW, Nondabula T, Juul L. Effect of vaginal infiltration with ornipressin or saline on intraoperative blood loss during vaginal prolapse surgery: a randomised controlled trial. Int Urogynecol J 2016; 27(3): 407-412.
Gould D, Kelly D, Goldstone L, Gammon J. Examining the validity of pressure ulcer risk assessment scales: developing and using illustrated patient simulations to collect the data INFORMATION POINT: Visual Analogue Scale. J Clin Nurs 2001; 10(5): 697-706. https://doi.org/10.1046/j.1365-2702.2001.00525.x
Ko KJ, Lee KS. Current surgical management of pelvic organ prolapse: Strategies for the improvement of surgical outcomes. Investig Clin Urol 2019; 60: 413-424.
Nüssler E, Kesmodel US, Löfgren M, Nüssler EK. Operation for primary cystocele with anterior colporrhaphy or non-absorbable mesh: patient-reported outcomes. Int Urogynecol J Pelvic Floor Dysfunct 2014; 26(3): 359-366.
Manodoro S, Spelzini F, Cesana MC, et al. Histologic and metabolic assessment in a cohort of patients with genital prolapse: Preoperative stage and recurrence investigations. Minerva Ginecol 2017; 69(3): 233-238.
Eilber KS, Alperin M, Khan A, et al. Outcomes of vaginal prolapse surgery among female medicare beneficiaries: the role of apical support. Obstet Gynecol 2013; 122(5): 981-987.
Bergman I, Söderberg MW, Kjaeldgaard A, Ek M. Does the choice of suture material matter in anterior and posterior colporrhaphy? Int Urogynecol J 2016; 27(9): 1357-1365.
Vasin RV, Filimonov VB, Mnikhovich MV, et al. Morphologic structure and immunohistochemical analysis of vaginal wall in women with pelvic organ prolapse. Urologiia 2019; 2019(6): 12-20.
Tasoulis M-K, Agusti A, Karakatsanis A, et al. The use of hydrodissection in nipple- and skin-sparing mastectomy. Plast Reconstr Surg Glob Open 2019; 7(11): e2495.
Raju R, Occhino JA, Linder BJ. LeFort partial colpocleisis: tips and technique. Int Urogynecol J 2019; 31(8): 1697-1699.
Finamore PS, Hunter K, Goldstein HB, et al. Does local injection with lidocaine plus epinephrine prior to vaginal reconstructive surgery with synthetic mesh affect exposure rates? A retrospective comparison. Arch Gynecol Obstet 2011; 284(3): 659-662.
Athanasiou S, Hadzillia S, Pitsouni E, et al. Intraoperative local infiltration with ropivacaine 0.5% in women undergoing vaginal hysterectomy and pelvic floor repair: Randomized double-blind placebo-controlled trial. Eur J Obstet Gynecol Reprod Biol 2019; 236: 154-159.
Maher C, Feiner B, Baessler K, et al. Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev. 2016; 11(11): CD004014. Published 2016 Nov 30. https://doi.org/10.1002/14651858.CD004014.pub6
Iyer S, Seitz M, Tran A, et al. Anterior colporrhaphy with and without dermal allograft: a randomized control trial with long-term follow-up. Female Pelvic Med Reconstr Surg 2019; 25(3): 206-212. https://doi.org/10.1097/SPV.0000000000000524.