VSSR Anterior vaginal prolapse repair Using a side
- Slides: 22
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
Effect of Plication on paravaginal defect
Pull direction in prolapse
Correcting the mechanical deffect
Vicryl Maxon Ti-Cron Placing 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 (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 Correcting the collagen deffect by bridging with SIS
Left paravaginal defect
Placing of sutures on left ATFP
Placing suture on edge of Vesico vaginal septum
Incorporating the pubo vesical fassia
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 tied
Side specific repair: plicating to sides using sidewall placed sutures
Inferior border of repair Residual High transverse deffect Sutures on uterosacrals Comparing before and after
Closing HTD
before after
Bolstering with Surgi. SIS
Baie Dankie! AJ Nieuwoudt www. pelvicorganreconstruction. com
- Colporrhaphy
- Sss similarity theorem
- Similarity theorem examples
- Sss similarity examples
- Triangle similarity theorems
- Purandare's dilator
- Ayre spatula diagram
- Base excision repair
- Rec a
- Nursing intervention for cord prolapse
- Support of uterus diagram
- Uterus displacement
- Vagina prolapse
- Intervertebral disc prolapse
- ÿout
- Left uterine displacement
- Vaginal pessary
- Bulbocavernosus reflex
- Types of uterine prolapse
- Prolapsed umbilical cord
- Perfect competition side by side graphs
- Tea side by side
- M&a process timeline