different options available for vaginal pelvic organ reconstructive surgery

1. Surgical Options in Repairing Anterior Vaginal Wall Prolapse Vaginal Approach

2. Pathogenesis of POP Primary Events Secondary Events

3. bladder vagina

4. Pelvic Organ Prolapse bladder vagina

5. Paravaginal Defect

6. Paravaginal Defect

7. Paravaginal Defect

8. bladder vagina Paravaginal Defect

9. B C D A VPVR VPVR (side specific repair) VPVR (sidespecific repair) Plication “ treating the bulge” Remove/ damage tissue New Anatomy Biomesh SSynthet Synthetic mesh “ Cured” Pelvic Organ Reconstruction Options

10. OptionA: Main aim is to remove the buldge into the vagina. Thus: 1. open vaginal wall over the buldge-stay medial between pubic rami 2. plicate the bladder/rectal wall onto itself 3. remove extra vaginal skin 4. close the vaginal skin defect

11. Option A Plicating the buldge Removing “extra” tissue

12. bladder vagina Paravaginal Defect

13. bladder vagina

14. bladder vagina

15. bladder vagina Why am I not surprised it´s not working?

17. B C D A VPVR VPVR (side specific repair) VPVR (side specific repair) Plication “ treating the bulge” Remove/ damage tissue New Anatomy Biomesh SSynthet Synthetic mesh “ Cured” Pelvic Organ Reconstruction Options

18. bladder vagina Paravaginal Defect

20. bladder vagina Vaginal Paravaginal Repair (VPVR) 4.Suture vesico-vaginal fascia on to obturator membrane 5. Close vaginal skin

21. Problem with VPVR: High reported recurrence rate – same as one will find with any hernia repear using native tissue.

22. B C D A VPVR VPVR (side specific repair) VPVR (sidespecific repair) Plication “ treating the bulge” Remove/ damage tissue New Anatomy Biomesh SSynthet Synthetic mesh “ Cured” Pelvic Organ Reconstruction Options

23. bladder vagina Options C and D

24. bladder vagina Options C and D

27. Biomesh implants Following implantation, tissues adjacent to the SIS matrix begin to deliver cells and nutrients. The body’s tissue grows completely into the surgical site while SIS maintains the needed tissue support. SIS is gradually replaced as the body reinforces and rebuilds the weakened site. Cells rapidly invade the SIS matrix. Capillary growth follows allowing more nutrients and cells to enter the matrix. SurgiSIS, SymphaSIS Option C

28. With compliments by Dr Andri Nieuwoudt www.pelvicorganreconstruction.com

29. OptionD Synthetic Mesh Implants

31. B C D A VPVR VPVR (side specific repair) VPVR (sidespecific repair) Plication “ treating the bulge” Remove/ damage tissue New Anatomy Biomesh SSynthet Synthetic mesh “ Cured” Pelvic Organ Reconstruction Options Success rate Complication risks Repeat surgery routes