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Senkung des mittleren Vaginalkompartiments

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Inkontinenz- und Deszensuschirurgie der Frau

Zusammenfassung

Die vaginale Hysterektomie ist in der Gynäkologie ein Standardeingriff. Nach der Darstellung der Studienlage zur Indikation und Komplikationen wird die Operationstechnik in den einzelnen Operationsschritten erklärt. Auch Uteri mit Myomen können vaginal durch ein Morcellement entfernt werden, als Appendix sind auch die Operationsschritte der vaginalen Adnektomie erläutert. Die abdominale Hysterektomie ist einer der häufigsten operativen Eingriffe weltweit. Ihr Vorteil wird vor allem bei zu erwartenden Adhäsionen oder zusätzlichen Adnextumoren gesehen. Es wird eine völlig neue Präparationsmethode dargestellt, die Elemente der laparoskopischen Hysterektomietechnik mit der Laparotomie verbindet.

Sollte eine vaginale Hysterektomie technisch nicht möglich oder kontraindiziert sein, so stellen laparoskopische Hysterektomieverfahren eine sinnvolle Alternative zu abdominalen Verfahren mit einer deutlich geringeren postoperativen Morbidität dar. Bei vergleichbaren Komplikationsraten zeichnen sie sich allerdings durch eine sehr viel längere Lernkurve aus.

Im Abschnitt Kolpopexie wird schließlich die Wiederherstellung der Aufhängung des vaginalen mittleren Kompartiments durch Fixation des Scheidengrunds beschrieben, entweder von vaginal nach Amreich und Richter am sakrospinalen oder sakrotuberalen Ligament oder von abdominal über 2 lateral gestielte Faszienzügelstreifen aus der Externusaponeurose des M. rectus abdominis. Die Indikation ist der Partial- oder Totalprolaps des Uterus und/oder der Vagina mit Beschwerdesymptomatik.

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Authors and Affiliations

  1. Allee 6, 34560, Fritzlar, Deutschland

    A. Szych

  2. Klinik für Frauenheilkunde und Geburtshilfe, Klinikum Kassel, Mönchebergstraße 41–43, 34125, Kassel, Deutschland

    Th. Dimpfl

  3. Gynäkologische Praxis, Bahnhofstraße 7, 35745, Herborn, Deutschland

    A. Valet

  4. Krankenhaus Sachsenhausen, Schulstraße 31, 60594, Frankfurt, Deutschland

    P. Hessler

  5. Klinik für Gynäkologie, Universitätsklinikum Gießen und Marburg GmbH – Standort Marburg, Baldingerstraße, 35033, Marburg, Deutschland

    M. Kalder

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  1. Klinik für Urologie und Kinderurologie, Universitätsklinikum Gießen und Marburg, Marburg, Germany

    Rainer Hofmann

  2. Klinik für Gynäkologie, Universitätsklinikum Gießen und Marburg, Marburg, Germany

    Uwe Wagner

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Szych, A., Dimpfl, T., Valet, A., Hessler, P., Kalder, M. (2015). Senkung des mittleren Vaginalkompartiments. In: Hofmann, R., Wagner, U. (eds) Inkontinenz- und Deszensuschirurgie der Frau. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-662-43671-4_17

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