New aspects in the surgical correction of pelvic organ prolapse

Abstract

Relevance . The relevance of the problem of pelvic prolapse is due to the prevalence of the disease, the tendency to rejuvenation and progression. This, according to the survey, affects the quality of life of women, leads to disruption of sexual functioning, and reduces the ability to work. The methods of surgical treatment that exist in the arsenal of modern operative gynecology can contribute to the development of cicatricial adhesions, infectious complications and recurrence of prolapse, which creates the need for repeated interventions. The development and introduction into practice of new methods of treatment is a natural necessity. The most effective technique for the surgical treatment of genital prolapse is laparoscopic sacrocolpopexy using titanium silk implants. Materials and Methods. A prospective cohort study of 30 patients aged 37 to 74 years with clinical manifestations of grade II-IV prolapse, statistical data analysis and analysis of the results of a survey of patients in the postoperative period in dynamics over 3-6-12 months from 2019 to 2021 was carried out. The study used a three-stage method of surgical assistance (patent dated September 15, 2020 No. 2020130382/14 (054923) in the volume - laparoscopic promontofixation, MacCoul sacro-uterine ligament plasty, colporrhaphy, colpoperineorrhaphy, levatoroplasty. Results and Discussion. It has been established that pregnancy and childbirth are among the main factors provoking the development of pelvic floor muscle failure. The duration of postoperative follow-up in our study was 3-14 months. No complications were diagnosed during this period. In 12 patients (40.0 %) during the first month there were periodic pulling pains in the lower abdomen and perineum, in 2 (6.6 %) - urinary incontinence. Titanium silk has a lower affinity for surrounding tissues compared to polypropylene scaffold systems, which makes it possible to consider it as an alternative material to synthetic analogues and reduce the risk of mesh-associated complications. The resistance of the titanium endoprosthesis to antiseptics and microbial agents predisposes to its long-term use and the absence of the need for replacement. Conclusion. The data obtained make it possible to judge the high efficiency of the developed technique for the surgical treatment of pelvic prolapse of pelvic floor defects in patients with rectocele and cystocele, minimizing the recurrence of the disease and the risk of developing mesh-associated complications, which allows choosing a personalized management strategy for this cohort of patients.