Paravaginal Repair: A Laparoscopic Approach
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چکیده
The support of the anterior vaginal wall, with its overlying bladder and urethra, is dependent upon the inherent strength of the pubocervical fascia and its lateral attachment to the pelvic sidewalls. Specifically, the pubocervical fascia is attached to the arcus tendineus fascia pelvis (also termed "the white line"). The arcus tendineus fascia pelvis is a condensation of intervening connective tissue overlying the obturator internus muscle (Fig. I). Upon vaginal inspection the anterior lateral vaginal sulcus shows excellent support when the pubocervical fascia and the arcus tendineus are intact (Fig. 2). Loss of the lateral vaginal attachment to the pelvic sidewall is called a paravaginal defect and usually results in a cystourethrocele, urethral hypermobility, and/or stress urinary incontinence (Fig. 3). Vaginal inspection in patients with bilateral paravaginal defects reveals loss of anterior vaginal wall support with detachment of the lateral sulci, resulting in a displacement cystocele (Fig. 4). White (1) first described the paravaginal repair in 1909, but it did not gain popularity until decades later, when Richardson (2,3) and Shull (4,5) described their abdominal and vaginal approaches to this type of anterior wall repair. Paravaginal defect repair has been described using not only vaginal and open abdominal approaches but also, more recently, via a laparoscopic approach (6-8).
منابع مشابه
Laparoscopic Paravaginal Defect Repair: Surgical Technique and a Literature Review.
Paravaginal defects, commonly seen in patients with anterior vaginal wall prolapse, are due to the detachment of pubocervical fascia from the arcus tendineus fascia pelvis (ATFP), at or near its lateral attachment. The majority of anterior vaginal wall prolapse is thought to be caused by paravaginal defects. Richardson et al. first described and demonstrated the anatomy of the paravaginal defec...
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تاریخ انتشار 2007