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Abstract
Anterior vaginal wall prolapse is one of the most challenging aspects of surgical gynecology. The traditional midline anterior colporrhaphy was designed on the assumption that anterior vaginal wall prolapse was caused by attenuation and weakening of the fascial supports of the bladder and vaginal wall. White first described the paravaginal repair 1909 as an alternative to anterior colporraphy for the correction of cystocele (White 1909; 1912).
The concept of site-specific fascial defects popularized by Richardson et al. 1976, from the basis for the current paravaginal defect repair, which can be performed abdominally, vaginally or laparoscopically (Richardson et al., 1976).
The single most common etiologic factor of genital prolapse is parturition. The surgeon should think of prolapse in terms of sites of damage to the musclo- connective tissue supports of the birth canal rather than give sole consideration to the positions of the uterus and cervix relative to the vulval outlet.
Women who suffer from pelvic floor dysfunction may experience myriad symptoms including disorders of urination, sexual dysfunction, and pelvic discomfort. A careful history and physical examination are important to identify life style or medical factors that may contribute to a patient’s symptoms.
A thorough pelvic examination with a complete description of support topography is vital to delineate treatment options and should be performed in a standardized fashion. Prolapse of the anterior vaginal wall may be due to site-specific fascial defects in the pubocervical fascia, which can be classified as midline, transverse, lateral (paravaginal) or a combination. Attenuation or weakening of the endopelvic fascia may also contribute to the degree of prolapse. (Richardson et al., 1976).
Surgical repair of prolapse can be performed through abdominal incisions, incisions high up inside the vagina or, more recently, through laparoscopic approach. It is not uncommon for more than one supporting structure of the pelvis to develop weakness or tears, so it’s very common to find more than one area is in need of repair. With a very bright light directly shinning onto the operative field and the magnification afford by laparoscope, Laparoscopic approach to genital organ prolapse provides a much clearer and better view of the pelvic floor defects, much more precise suture placements, less blood loss, diminished postoperative pain and discomfort, shorter hospital stay and quicker recovery.
From May 2001 to April 2005, 15 patients with symptomatic grad I to III paravaginal defect cystocele were enrolled in the study and admitted for surgical correction of prolapse by laparoscopic approach.
The cure rate of prolapse of the anterior vaginal (paravaginal defect) either associated with urinary stress incontinence or not was symptomatically and anatomically improved significantly
This cure rate is consistent with cure rate of other published studies laparoscopic, abdominal, or vaginal as mentioned in the literature.
In our opinion, laparoscopic surgery may be particularly attractive for patients, as the surgery respects anatomic structures and maintains organ functions. Moreover, laparoscopy benefits the surgeon by improving visualization and magnifying the pelvic floor defects that need to be repaired. Other advantages, such as decreased blood loss, postoperative pain, shorter hospital stays, and quicker recovery time, together with an earlier return to better quality of life. With looking forward for easier methods of stitching as mesh or stapler.
However, one must keep in mind that paravaginal defects are only a portion of entire reconstructive procedure. For the patient to have a durable and long-term result, all defects must be repaired. Further reports and longer follow-up are needed to gain additional insight into the durability of the laparoscopic approach.