Wioletta
K. Szepieniec graduated medicine from the Jagiellonian University in Krakow and
did her specialization in gynecology and obstetrics in Germany where she worked
for 10 years. Her main focus over the years and still to today is urogynecology
but also breast surgery and aesthetic gynecology. In 2014 she moved to Poland
where she has continued her work in urogynecology and operative gynecology. She
is currently senior doctor of the Department of Gynecology and Urogynecology at
Andrzej Frycz Modrzewski Krakow University
Introduction and
methods: The aim
of this study
is to show
a novel approach
of the repair
of the lateral
paravaginal defect causing
the cystocele. The
extraperitoneal
(preperitoneal) approach has
its advantages and
can be used
in patients with
comorbidities and in
obese patients. The
main advantage of
this procedure is
omitting of the
pneumoperitoneum and of the Trendelenburg
position during the
operation. The avoiding
of peritoneal adhesions
is also important.
Results: This
study presents the
first results of
this novel approach
on 27 patients.
All of the
patients have a
cystocele POP Q
2 and 59%
of them concomitant
stress urinary incontinence
due to lateral
defect of the
vesico-vaginal fascia. Mean operation time was 80 minutes. After
the operation by all of
the patients was
achieved the reduction
of the cystocele
to POP Q
I or 0.
Follow-up after 6
months revealed only
1 recurrence of
the cystocele. Quality
of life was
controlled with PIFQ
Questionnaire and revealed
a statistical improvement
from average 6,8
point before operation
to average 0,7
points after (p<0,05).
Conclusion: Preperitoneal
laparoscopic lateral defect
repair is a
relatively fast operation.
It is feasible
also for obese
women and for
patients with cardiac
risk, because of
the omitted Trendelenburg
position and pneumoperitoneum. Postoperative
can be achieved
a very satisfied
effect with the
reduction of patient’s
complaints and reduction
of the cystocele.