VSSR Anterior vaginal prolapse repair Using a side

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VSSR Anterior vaginal prolapse repair Using a side specific technique and bolstering repair with

VSSR Anterior vaginal prolapse repair Using a side specific technique and bolstering repair with SIS Andri Nieuwoudt Terneuzen

Symphasis pubis Obturator internus fascia (ATFP) Pubic rami cervix Ischial spines

Symphasis pubis Obturator internus fascia (ATFP) Pubic rami cervix Ischial spines

Effect of Plication on paravaginal defect

Effect of Plication on paravaginal defect

Pull direction in prolapse

Pull direction in prolapse

Correcting the mechanical deffect

Correcting the mechanical deffect

Vicryl Maxon Ti-Cron Placing sutures

Vicryl Maxon Ti-Cron Placing sutures

Vicryl Ti-Cron Suturing the vesicovaginal septum (using the same sutures)

Vicryl Ti-Cron Suturing the vesicovaginal septum (using the same sutures)

Biomesh usage: 1. Bridging: a bridge of biomesh to be sole support of bladder

Biomesh usage: 1. Bridging: a bridge of biomesh to be sole support of bladder (as with synthetic neshes) Crosslinked biomeshes (Pelvicol) or non crosslinked biomesh ( Surgi. SIS) 2. Bolstering: secondary support of side specific suturing non crosslinked matrix (Surgi. SIS, Inte. Xen, Hydrix) Author’s preferance: Non crosslinked matrix used as a bolster (act as a “bandaid” to induce collagen ingrowth into operating field)

Biomesh collagen ingrowth Bolstering with SIS after suturing vesico vaginal septum to sidewall

Biomesh collagen ingrowth Bolstering with SIS after suturing vesico vaginal septum to sidewall

Biomesh collagen ingrowth Correcting the collagen deffect by bridging with SIS

Biomesh collagen ingrowth Correcting the collagen deffect by bridging with SIS

Left paravaginal defect

Left paravaginal defect

Placing of sutures on left ATFP

Placing of sutures on left ATFP

Placing suture on edge of Vesico vaginal septum

Placing suture on edge of Vesico vaginal septum

Incorporating the pubo vesical fassia

Incorporating the pubo vesical fassia

Second to the back stitch Most distal stitch Suture running from ATPF through Vesico-vaginal

Second to the back stitch Most distal stitch Suture running from ATPF through Vesico-vaginal adventitia

Tying and drawing bladder up Bladder wall pulled back in position when knots are

Tying and drawing bladder up Bladder wall pulled back in position when knots are tied

Side specific repair: plicating to sides using sidewall placed sutures

Side specific repair: plicating to sides using sidewall placed sutures

Inferior border of repair Residual High transverse deffect Sutures on uterosacrals Comparing before and

Inferior border of repair Residual High transverse deffect Sutures on uterosacrals Comparing before and after

Closing HTD

Closing HTD

before after

before after

Bolstering with Surgi. SIS

Bolstering with Surgi. SIS

Baie Dankie! AJ Nieuwoudt www. pelvicorganreconstruction. com

Baie Dankie! AJ Nieuwoudt www. pelvicorganreconstruction. com