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Laparoscopic Paravaginal Repair

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Female Genitourinary and Pelvic Floor Reconstruction

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Abstract

The surgical management of anterior compartment prolapse remains a challenge, particularly in women with isolated anterior wall descent. In clinical practice, anterior compartment prolapse usually coexists with a concomitant Level I defect. Surgical correction of descent of the latter is often enough to treat the former as well, while at the same time reducing the risk of prolapse recurrence. The traditional approach of isolated anterior colporrhaphy for midline fascial defects carries a high risk of failure, reported to vary between 30% and 88%. Hence, its role in contemporary practice has been re-evaluated. Following the description of the four anatomic sites of anterior vaginal support defects by Richardson, the technique of paravaginal repair was introduced in an effort to address lateral defects. The procedure was initially performed through a vaginal route; its open abdominal counterpart was described only in 1976, and it has grossly been replaced by the laparoscopic approach in modern clinical practice due to the well-established advantages of laparoscopy with regard to improved visualization, precise dissection and suture placement, and reduced blood loss and postoperative pain. This chapter describes the surgical technique of laparoscopic paravaginal repair as employed in our unit. As with every surgical technique, several modifications have been proposed in an effort to improve outcomes, the main being the tissue used to anchor the pubocervical fascia. Key concepts such as patient selection, preoperative assessment and counselling, safety and efficacy data, as well as alternative surgical options are also presented and remain common irrespective of the surgical technique.

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Author information

Authors and Affiliations

  1. Urogynaecology and Pelvic Floor Unit, University College London Hospital, London, UK

    Nikolaos Thanatsis & Arvind Vashisht

  2. Department of Urogynaecology, The John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK

    Matthew L. Izett-Kay

  3. Nuffield Department of Women’s and Reproductive Health, Women’s Centre, Oxford University, Oxford, UK

    Matthew L. Izett-Kay

Authors
  1. Nikolaos Thanatsis
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  2. Matthew L. Izett-Kay
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  3. Arvind Vashisht
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Corresponding author

Correspondence to Nikolaos Thanatsis .

Editor information

Editors and Affiliations

  1. University of Lisbon, Lisbon, Portugal

    Francisco E. Martins

  2. University of Oslo, Oslo, Norway

    Henriette Veiby Holm

  3. Memorial Sloan Kettering Cancer Center, New York, NY, USA

    Jaspreet S. Sandhu

  4. Eastern Virginia Medical School, Norfolk, VA, USA

    Kurt A McCammon

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Thanatsis, N., Izett-Kay, M.L., Vashisht, A. (2023). Laparoscopic Paravaginal Repair. In: Martins, F.E., Holm, H.V., Sandhu, J.S., McCammon, K.A. (eds) Female Genitourinary and Pelvic Floor Reconstruction. Springer, Cham. https://doi.org/10.1007/978-3-031-19598-3_31

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  • DOI: https://doi.org/10.1007/978-3-031-19598-3_31

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  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-19597-6

  • Online ISBN: 978-3-031-19598-3

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