Surgical Treatment of Important Pelvic Organ Prolapse in a Patient with Severe Systemic Disease: A Case Report

  • Marco Gentile Obstetrics and Gynecology Unit, Department of Mother and Child, ULSS 9 “Scaligera", Legnago 37045, Verona, Italy
  • Mariaconcetta Zinna Obstetrics and Gynecology Unit, Department of Mother and Child, ULSS 9 “Scaligera", Legnago 37045, Verona, Italy
  • Antonio Costanza Obstetrics and Gynecology Unit, Department of Mother and Child, ULSS 9 “Scaligera", Legnago 37045, Verona, Italy
  • Giacomo Miola Anesthesiology and Intensive Care Unit, Emergency Department, ULSS 9 “Scaligera”, Legnago 37045, Verona, Italy
  • Andrea Remo Pathology Unit, Service Department, ULSS 9 “Scaligera”, San Bonifacio 37047, Verona, Italy
  • Marco Torrazzina Obstetrics and Gynecology Unit, Department of Mother and Child, ULSS 9 “Scaligera", Legnago 37045, Verona, Italy
Keywords: POP, anesthesia, hysterectomy, sacrospinous

Abstract

Pelvic Organ Prolapse (POP) is a common disease and the surgical treatment ranges from traditional vaginal techniques to abdominal approach using mesh. We present a case of a woman with severe POP and with severe systemic disease treated with vaginal surgical approach under regional anesthesia. A 56-years-old woman presented to our hospital with a POP.  The patient had HIV infection and chronic hepatitis C with liver fibrosis. She had a previous STEMI and a subsequent NSTEMI. The surgery performed was vaginal hysterectomy with bilateral salpingo-oophorectomy, anterior and posterior vaginal repair, right sacrospinous ligament fixation, under regional anesthesia. Prevalence of POP ranges from 10% to 24% and vaginal correction of defects is a common procedure, but Cochrane review stated that abdominal mesh surgery should be considered the gold standard for the treatment  but this surgery needs general anesthesia. Because the recurrence of prolapse after vaginal hysterectomy and sacrospinous ligament fixation occured in approximately 25%, this technique could be useful in patients with systemic disease under regional anesthesia and a multidisciplinary approach is essential.

References

. Wu, J.M., Hundley, A.F., Fulton, R.G. and Myers, E.R. (2009) Forecasting the prevalence of pelvic floor disorders in U.S.Women: 2010 to 2050. Obstet Gynecol 114: 1278_1283.

. Maher C, Feiner B, Baessler K, Schmid C. Surgical Management of Pelvic Organ Prolapse in Women. Cochrane Database Syst Rev 2013 Apr 30;(4)

. Gilleran JP, Johnson M, Hundley A. Robotic-assisted laparoscopic mesh sacrocolpopexy. Ther Adv Urol. 2010 Oct-Dec; 2(5-6): 195–208.

. Sinha R, Gurwara AK, Gupta SC, Laparoscopic Surgery Using Spinal Anesthesia. JSLS. 2008 Apr-Jun; 12(2): 133–138.

. Onafowokan O, Asemota O. Vaginal hysterectomy using local anesthesia and analgesics. Trop J Obstet Gynaecol 2016; 33 (3): 270-273

. Martín Del Olmo JC, Toledano M, Martín Esteban ML, Montenegro MA , Gómez JR, Concejo P et al. Outcomes of Laparoscopic Management of Multicompartmental Pelvic Organ Prolapse. Surg Endosc. 2019; 33 (4): 1075-1079

. Samuelsson EC, Victor FT, Tibblin G, Svärdsudd KF. Signs of genital prolapse in a Swedish population of women 20 to 59 years of age and possible related factors. Am J Obstet Gynecol. 1999; 180:299–305

. Barber MD. Pelvic organ prolapse. BMJ. 2016; 354: i3853

. Van Zanten F, Brem C, Lenters E, Broeders IAMJ, Schraffordt Koops SE. Sexual Function After Robot-Assisted Prolapse Surgery: A Prospective Study. Int Urogynecol J. 2018; 29 (6), 905-912

. Rosati M, Bramante S, Bracale U, Pignata G, Azioni G. Efficacy of Laparoscopic Sacrocervicopexy for Apical Support of Pelvic Organ Prolapse. JSLS Apr-Jun 2013;17(2):235-44.

. Rajan D, Varghese P, Roy M, Roy K, David A. Is Performing Sacrospinous Fixation With Vaginal Hysterectomy and McCall's Culdoplasty for Advanced Uterovaginal Prolapse Preferable Over McCall's Culdoplasty Alone? J Obstet Gynaecol India 2020 Feb;70(1):57-63

. Ganatra AM, Rozet F, Sanchez-Salas R, et al. The current status of laparoscopic sacrocolpopexy: a review. Eur Urol. 2009; 55:1089 –1105.

. Freeman RM, Pantazis K, Thomson A, Frappell J, Bombieri L, Moran P et al. A Randomised Controlled Trial of Abdominal Versus Laparoscopic Sacrocolpopexy for the Treatment of Post-Hysterectomy Vaginal Vault Prolapse: LAS Study. Int Urogynecol J. 2013; 24 (3): 377-84

. Eichelsbacher C, Ilper H, Noppens R, Hinkelbein J ,Loop T. Rapid Sequence Induction and Intubation in Patients With Risk of Aspiration : Recommendations for Action for Practical Management of Anesthesia. Anaesthesist 2018 Aug;67(8):568-583

. Yuzkat N, Soyoral L, Cegin MB, Ozkan B, GoktasU. The Role of Surgical Diagnosis in The Choice of Anesthetic Technique. Eur J Gen Med 2016;13(2):158-160

. Pranoto I. The Evaluation of Vaginal Hysterectomy Using Spinal Anaesthesia. J Med Sci. 2007; 39 (2)

. Gupta P. Transvaginal Sacrospinous Ligament Fixation for Pelvic Organ Prolapse Stage III and Stage IV Uterovaginal and Vault Prolapse. Iran J Med Sci 2015 Jan;40(1):58-62

. Singh RK, Saini AM, Goel N, Bisht D, Seth A. Major laparoscopic surgery under regional anesthesia: A prospective feasibility study. Med J Armed Forces India. 2015 Apr; 71(2): 126–131

Published
2020-09-02
Section
Articles