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.