Prolapsed Organ Research Articles

Laparoscopic reconstruction in McKeown esophagectomy is a risk factor for postoperative diaphragmatic hernia.

Diaphragmatic hernia is a very rare but high-risk complication after esophagectomy. Although there are many studies on the Ivor Lewis esophagectomy procedure for diaphragmatic hernia, there are fewer studies on the McKeown procedure. The present study aimed to estimate the incidence of diaphragmatic hernia after esophagectomy, describing its presentation and management with the McKeown procedure. We retrospectively evaluated the 622 patients who underwent radical esophagectomy between January 2002 and December 2020 at the Wakayama Medical University Hospital. Statistical analyses were performed to evaluate risk factors for diaphragmatic hernia. Emergency surgery for postoperative diaphragmatic hernia was performed in nine of 622 patients (1.45%). Of these nine patients, one developed prolapse of the small intestine into the mediastinum (11.1%). The other eight patients underwent posterior mediastinal route reconstructions (88.9%), one of whom developed prolapse of the gastric conduit, and seven of whom developed transverse colon via the diaphragmatic hiatus. Laparoscopic surgery was identified in multivariate analysis as the only independent risk factor for diaphragmatic hernia (odd's ratio [OR] = 9.802, p = 0.034). In all seven cases of transverse colon prolapse into the thoracic cavity, the prolapsed organ had herniated from the left anterior part of gastric conduit. Laparoscopic surgery for esophageal cancer is a risk factor for diaphragmatic hernia. The left anterior surface of gastric conduit and diaphragmatic hiatus should be fixed firmly without compromising blood flow to the gastric conduit.

TO THE TECHNIQUE OF MANAGEMENT OF THE EXTENDED UTERUS AND VAGINA IN THE PHENOMENA OF INFECTION

In the treatment of prolapse of the uterus and vagina, almost exclusive attention has been and is being paid to methods of keeping prolapsed organs in their normal position and to methods of preventing or limiting the size of such prolapse; the question of the techniques that are used in the adjustment of the falling out parts is either bypassed in silence or touched on in passing, without a desire to attach any importance to it. This is to some extent understandable if we remember that the vast majority of cases of prolapse of the genitals proceed without complications that complicate reduction, and in such cases the reduction mechanism is so simple that it is equally accessible to both the doctor and the patient herself.

Exploration of sexual experience among women with pelvic organ prolapse: a qualitative study

Pelvic organ prolapse (POP) is a common problem among women and can adversely affect sexual function. Therefore, designing a study to hear the sound of these women seems necessary. This study aimed to explore the sexual experience of women with POP. Based on a qualitative methodology, 20 untreated women with symptomatic POP were selected by purposive sampling and interviewed from March 2018 to December 2018. To achieve maximum diversity, different participants were selected based on age, education, occupation, type of delivery, type of prolapsed organ, and degree of prolapse. The data were analyzed using the MAXQDA software (Ver.10) and a qualitative content analysis approach. Ethical approval was obtained from Mashhad University of Medical Sciences, Mashhad, Iran. Mean (SD) age of women was 44.55 (10.22) years. Mean (SD) Duration of having prolapse was 6.05 (3.7). Qualitative analysis revealed the following five main themes: (I) Experiencing sexual discomfort; (II) damaged genital body image; (III) psychological problem, (IV) Husband's response to prolapse; (V) sexual problem management. These findings indicated that POP had disrupted women`s sexual life. An improved understanding of women's sexual experiences may help health provider better cover women`s unmet sexual needs.

Unusual case of utero-ovarian prolapse concurrent with cystocele in a queen.

Case Description- A 1-year-old female Domestic Shorthair cat weighing 2.5 kg with one week history of protruding mass from the vulva was admitted. Clinical Findings- The prolapse was complete involving both horns protruding from the vulva and a soft bulging mass was palpable inside the prolapsed uterus. Treatment and Outcome- The prolapsed organ was irrigated with warm saline solution and the debris was cleaned. A ventral midline celiotomy was performed for reduction of the mass and sterilization of the cat. The urinary bladder was incarcerated in the right horn of the uterus. The left ovary was inside the mass beside the bladder. Ovarian pedicles were intact but broad ligament was torn. An ovariohysterectomy was performed. Clinical Relevance- Complete uterine prolapse is an emergency case of surgery. If the prolapse includes abdominal contents, amputation of the mass may be avoided and reduction of the uterus and abdominal contents through celiotomy should be prioritized. It seems that this case is the first report of an ovarian prolapse coincident with retroversion of the uterus. The prognosis following ovariohysterectomy is excellent if shock and hemorrhage are treated appropriately.

The significance of organ prolapse in gastroschisis

PurposeThe aim of this study was to evaluate the incidence and importance of organ prolapse (stomach, bladder, reproductive organs) in gastroschisis. MethodsThis is a retrospective review of gastroschisis patients from 2000 to 2014 at a single tertiary institution. Statistical analysis was performed using a chi-square test, Student's t test, log-rank test, or Cox regression analysis models. All tests were conducted as two-tailed tests, and p-values <0.05 were considered statistically significant. ResultsOne hundred seventy-one gastroschisis patients were identified. Sixty-nine (40.6%) had at least one prolapsed organ besides bowel. The most commonly prolapsed organs were stomach (n=45, 26.3%), reproductive organs (n=34, 19.9%), and bladder (n=15, 8.8%). Patients with prolapsed organs were more likely to have simple gastroschisis with significant decreases in the rate of atresia and necrosis/perforation. They progressed to earlier enteral feeds, discontinuation of parenteral nutrition, and discharge. Likewise, these patients were less likely to have complications such as central line infections, sepsis, and short gut syndrome. ConclusionsGastroschisis is typically described as isolated bowel herniation, but a large portion have prolapse of other organs. Prolapsed organs are associated with simple gastroschisis, and improved outcomes most likely due to a larger fascial defect. This may be useful for prenatal and postnatal counseling of families. Type of studyCase Control/Retrospective Comparative Study. Level of evidenceLevel III.

Genital Prolapse at the End Term of Pregnancy: A Case Report

Uterine prolapsed is a rare condition occurs during pregnancy and lead to many complications. Usually conservative treatment approached to use a vaginal pessary accompanied with bed rest. This current case exhibited obvious role of a vaginal pessary in restoring the prolapsed organ till the time of labor and may expect delivery at home. When studying the style of labor, Gynecologist should bear in their mind the cervical irritation and edema. Along with the genital prolapsed which may affect normal vaginal delivery.

Laparoscopic Management of Vaginal Vault Prolapse Recurring After Pelvic Organ Prolapse Surgery

Introduction: Pelvic organ prolapse (POP) is a high prevalent disease.1 Based on the prolapsed organ,2 we usually distinguish between rectocele, cystocele, uterovaginal prolapse, and vaginal vault prolapse (VVP), which commonly occurs following a hysterectomy.3 Many surgical approaches for POP have been described and analyzed,4 but there are few reports on the surgical management of recurring VVP after previous sacropexy (SP)5 or previous anti-POP surgery.6 The aim of the current video is to show some tips and tricks for a salvage SP. Materials and Methods: Current study prospectively includes patients with symptomatic recurrent VVP and previous anti-POP surgery who were treated with laparoscopic sacropexy (LS), approved by the audit committee. The same surgeon operated on all patients. The overall surgery time and time for the main surgical steps were analyzed. The video shows all the steps that are required for a proper LS. In general terms, the checklist for proper re-do SP included three steps: (1) creation of surgical space and restoration of pelvic anatomy avoiding injury to hollow organs (vagina, bladder, bowel); (2) careful preparation of sacral promontory and vaginal walls leaving in place previous mesh; (3) definitive anchorage of new meshes from vaginal walls to sacral promontory. Results and Conclusions: Twenty-two women were included (mean time before recurrence 23 months, range 13–32 months; mean postoperative follow-up 43.5 months). After open SP (8 patients), the dissection of diffuse adherences and restoration of normal anatomy was difficult and long because of the variable distribution of adhesions between bowel, sigmoid colon, peritoneal wall, and meshes. In all but one case, the original meshes were secured to the sacral promontory, presenting marked fibrosis between the meshes and meso-sigma. In seven cases, a weak mesh attachment to the vaginal walls was found, thus causing the recurrence of POP. In vaginal route surgery (14 patients: 10 Perigee, 4 levator-myorrhaphy), adhesions were limited to vaginal vault and sigmoid colon; in cases of mesh insertion, there was fibrosis between mesh and bladder, anteriorly, and peritoneal layer and sigma, posteriorly. In all cases, the new meshes were anchored over the previous meshes, without any particular difficulties. Regression analysis revealed differences according to overall operating time (longer in patients who had undergone SP vs vaginal route, p = 0.028), whereas the time for adhesiolysis approached statistical significance (p = 0.059). Time for vaginal wall preparation and mesh anchorage were similar between groups. An inadvertent, small cystotomy occurred in one case and the bladder was double layer sutured with polyglactin sutures, leaving an indwelling catheter for 5 days. No significant peri- or postoperative complications were observed, whereas one patient presented with vaginal erosion 4 months later, which was corrected by the vaginal route. At follow-up, only two patients presented irritative voiding symptoms; one patient suffered from obstructed defecation. No impact on sexual function was detected. In conclusion, in recurrent VVP, after hysterectomy and previous POP surgery, a very careful approach with LS is feasible, safe, and effective in centers with extensive experience and training. No competing financial interests exist. Runtime of video: 8 mins 55 secs

Anesthetic protocol and surgical conduct for rectal prolapse in Tegu (Tupinambis merianae, LINNAEUS, 1758) - Case report

A tegu (Tupinambis merianae) was submitted to excision of prolapsed recto, caused by foreign body ingestion. As anesthesic conduct was realized neuroleptoanalgesia by combination of midazolam (2 mg/kg), and butorphanol (2 mg/kg), intramuscularly, and anesthesia maintenance by isoflurane diluted in oxygen by endotracheal intubation. For excision of the prolapsed organ, were made support points on the organ’s lateral edges, resection of the same and posterior enteroanastomosis with separate simple suture, with synthetic absorbable wire. The anesthetic protocol and surgical procedures adopted proved to be safe, effective and necessary for the animal’s health.

Pre-partum Cervico-Vaginal Prolapse in a Crossbred Cow and Its Therapeutic Management-A Case Report

A 4 years old crossbred cow was reported to have protusion of uterus in Pyllum Village, Ri-Bhoi District Meghalaya. India. The cow was restrained in standing position and epidural anaesthesia (2% Lignocaine hydrochloride @0.2 mg/kg body weight) was administered. The prolapsed organ was made aseptic by washing with 2% potassium permanganate solution followed by washing with warm normal saline. A course of parenteral antibiotic (Ceftriaxone sodium @5mg/kg) along with anti-inflammatory drug (Meloxicam @1ml/kg body weight) was given for 5days. To maintain the full term pregnancy progesterone (hydroxyprogesterone @3ml/animal) was injected intramuscularly. The cow recovered successfully and delivered a healthy calf after complete term of gestation.

Do guns kill people or...? The mesh dilemma

Many of the articles in this journal and others demonstratethe mixed messages of mesh augmented repairs for pelvicorgan prolapse. At this point, short-term data (2-yearfollow-up or less) suggest that its use for anteriorcompartment defects may provide an advantage over non-mesh augmented repairs [1, 2], but at what cost [3, 4]?Complications are certainly possible with any surgicalprocedure; but one of the most concerning complicationsthat can occur is worsening or de novo postoperative paindisorders. But are the complications of postoperative paincaused by the mesh kits or are they caused by thephysicians who are using them?I see many patients in my office sent from variousphysicians located throughout the Midwest with problems ofpostoperativepainafteramesh-augmentedtransvaginalrepairfor prolapse. Almost universally, these patients had a pelvicpain disorder that was either overt (i.e., patients who hadprolapsesurgerydonebecauseofthechiefcomplaintofpelvicpain described as pressure in the absence of prolapse beingpresent at the introitus or beyond) or had a more subtle pelvicpain disorder. These subtle pelvic pain disorders are oftencompensated for or tolerated by the patient for many years.These patients often have a history that is compatible withprimary dyspareunia or dysmenorrhea, vulvodynia, chronicconstipation, painful bladder syndrome, or fibromyalgia priortocomingtothesephysiciansaskingforsurgerytobedoneforprolapse. Clinicians must realize that 50-80% of patients withthese pelvic pain disorders have hypertonic pelvic floordysfunction and/or myofascial pain [5]. Attaching a piece ofmesh that then supports the prolapsed viscera at a single orpossibly four sites of attachments to these muscles that arealready spastic, hypertonic, and demonstrating dysfunctionand allodynia simply exacerbates and perpetuates theirchronic pain disorders.Wemustrememberthatprolapsedoesnotcausepelvicpain,especially when symptoms seem greater than the degree ofprolapse seen. If a patient has a history or findings compatiblewith pelvic floor tension myalgia and/or hypertonic dysfunc-tion we must avoid doing a surgery that involves attaching oranchoringthesupportoftheprolapsedorganstothesemuscles.This statement should not be surprising to any clinicianinvolved in the repair of pelvic organ prolapse because we allknow that procedures like sacro-spinous vaginal vault suspen-sions and posterior repairs done by techniques that involvelevatorplasty are often associated with both short-term andlong-term pain and often times dyspareunia for many yearspostoperatively.While these mesh kit procedures all involve attachmentto the pelvic floor muscles to anchor the entire repair, notall patients who undergo this procedure develop a signif-icant postoperative pelvic pain disorder. The use of musclesites seems to be intuitively a bad idea, but many of ourpatients tolerate this non-physiologic but anatomicallycorrect repair without problems. I contend that it is notthe mesh kit but the patient selection that is the key topreventing the induction of chronic myofascial pain and attimes causing these patients to become a pelvic cripple;unable to stand, sit, or have intercourse.Therefore, do guns kill people? No, people kill people.So we must avoid anchoring prolapsed organs to a fewmuscle sites in patients with pre-existing myofascialdysfunction and/or pelvic pain. These patients will bebetter served supporting their prolapse to the uterosacralligaments or the longitudinal ligament overlying the sacrum