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