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E Christakis - One of the best experts on this subject based on the ideXlab platform.

  • Pelvic Reconstruction of the retroperitoneum after abdominoperineal resection of the rectum using full-thickness skin grafts
    Techniques in Coloproctology, 2004
    Co-Authors: C Christakis, C Vaklavas, N Kontos, C Chatzidimitriou, K Tzelepi, M Karanikas, E Christakis
    Abstract:

    BACKGROUND To find a safe and effective method of Pelvic Reconstruction after abdominoperineal resection in order to prevent small intestine from descending into the pelvis. This allows safe delivery of optimal doses of radiation therapy, which exceed radiation tolerance of the small intestine, in advanced stages of colorectal cancer. MATERIALS Prospective, ongoing study examining patients who underwent abdominoperineal resection and Pelvic Reconstruction with full-thickness skin grafts. METHODS Nine (9) patients underwent abdominoperineal resection of the rectum and Pelvic Reconstruction with full-thickness skin grafts for colorectal cancer stage C. Subsequently they were referred for adjuvant radiation therapy and followed up regularly for surgical complications and disease recurrence. RESULTS All patients successfully completed postoperative radiation therapy and there were no serious surgical complications pertaining to the initial operation and the skin homeotransplantation. None of the patients needed reoperation, so the long-term outcome of the transplantation was not surgically evaluated. CONCLUSIONS Reconstruction of the peritoneal gap after abdominoperineal resection of the rectum with full-thickness skin graft is a safe and effective method. The small intestine was effectively excluded from the pelvis allowing successful completion of adjuvant radiation therapy with minimal irradiation of the small intestine and effective prevention of radiation enteritis.

  • Pelvic Reconstruction of the retroperitoneum after abdominoperineal resection of the rectum using full-thickness skin grafts.
    Techniques in coloproctology, 2004
    Co-Authors: C Christakis, C Vaklavas, N Kontos, C Chatzidimitriou, K Tzelepi, M Karanikas, E Christakis
    Abstract:

    To find a safe and effective method of Pelvic Reconstruction after abdominoperineal resection in order to prevent small intestine from descending into the pelvis. This allows safe delivery of optimal doses of radiation therapy, which exceed radiation tolerance of the small intestine, in advanced stages of colorectal cancer. Prospective, ongoing study examining patients who underwent abdominoperineal resection and Pelvic Reconstruction with full-thickness skin grafts. Nine (9) patients underwent abdominoperineal resection of the rectum and Pelvic Reconstruction with full-thickness skin grafts for colorectal cancer stage C. Subsequently they were referred for adjuvant radiation therapy and followed up regularly for surgical complications and disease recurrence. All patients successfully completed postoperative radiation therapy and there were no serious surgical complications pertaining to the initial operation and the skin homeotransplantation. None of the patients needed reoperation, so the long-term outcome of the transplantation was not surgically evaluated. Reconstruction of the peritoneal gap after abdominoperineal resection of the rectum with full-thickness skin graft is a safe and effective method. The small intestine was effectively excluded from the pelvis allowing successful completion of adjuvant radiation therapy with minimal irradiation of the small intestine and effective prevention of radiation enteritis.

Yisong Chen - One of the best experts on this subject based on the ideXlab platform.

  • Transvaginal single-port laparoscopic Pelvic Reconstruction with Y-shaped mesh: experiences of 93 cases.
    International urogynecology journal, 2020
    Co-Authors: Xiaojuan Wang, Keqin Hua, Yisong Chen
    Abstract:

    INTRODUCTION AND HYPOTHESIS To demonstrate the outcomes of Pelvic Reconstruction using Y-shaped mesh in patients with multiple-compartment Pelvic organ prolapse via transvaginal single-port laparoscopy. METHODS We conducted a retrospective case series study. Patients diagnosed with severe multiple-compartment prolapse were enrolled between July 1, 2017, and March 31, 2020. Patients underwent transvaginal single-port laparoscopic Pelvic Reconstruction with Y-shaped mesh. Baseline data and perioperative results were collected. Patients were followed up with the POP-Q score, Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12). T-test was used for statistical analysis. RESULTS Operations were successful in all 93 patients without conversion or serious complications. Mean operative time was 132.70 ± 28.02 min and estimated blood loss was 110.65 ± 56.31 ml. VAS pain score was 2.91 ± 1.16 and cosmetic score was 9.20 ± 0.60. During 1-33 months of follow-up, no recurrence or mesh exposure was observed. Five patients suffered from de novo SUI, six had constipation, two had dyspareunia, and one had persistent Pelvic pain. The pre- and postoperative Aa point was +2.13 ± 1.23 vs. -2.91 ± 0.28 (P < 0.05), C point was 2.63 ± 2.41 vs. -6.86 ± 0.69 (P < 0.05), and Ap point was -0.26 ± 1.79 vs. -2.97 ± 0.16 (P < 0.05). The PFDI-20 score was 76.81 ± 32.06 vs. 18.18 ± 20.25 (P < 0.05), while the PISQ-12 score was 34.30 ± 4.17 vs. 37.20 ± 2.60 (P < 0.05), which suggested significant improvements in both physical prolapse and quality of life after surgery. CONCLUSION Transvaginal single-port laparoscopic Pelvic Reconstruction with Y-shaped mesh is a feasible, effective and safe treatment option for severe multiple-compartment prolapse. Patients may benefit from its mild pain level and good cosmetic effect as well as only minor mesh-related complications.

  • Management of Urinary Incontinence before and after Total Pelvic Reconstruction for Advanced Pelvic Organ Prolapse with and without Incontinence.
    Chinese medical journal, 2018
    Co-Authors: Yu Song, Yisong Chen, Xiaojuan Wang, Keqin Hua
    Abstract:

    Background: The effectiveness of an anti-incontinence procedure concomitant with prolapse Reconstruction for Pelvic organ prolapse (POP) in preventing urinary incontinence (UI) after surgery remains controversial. Our study aimed to describe the incidence of pre- and postoperative UI for Pelvic reconstructive surgery and evaluate the management of POP associated with UI. Methods: A total of 329 patients who underwent total Pelvic Reconstruction between June 2009 and February 2015 at a single institution were identified. These patients were divided into two groups (Group A [Prolift Reconstruction]: n = 190 and Group B [modified total Pelvic Reconstruction]: n = 139). Data regarding surgical procedures and patient demographic variables were recorded. Chi-square and Student’s t-tests were used for two independent samples. Results: A total of 115 patients presented with UI preoperatively. The average follow-up time was 46.5 months, with 20 patients lost to follow-up (6.1%). The cure rates of stress UI (SUI), urgency UI (UUI), and mixed UI (MUI) were 51% (30/59), 80% (16/20), and 48% (14/29), respectively. The cure rate of UUI after total Pelvic Reconstruction (80% [16/20]) was higher than that of SUI (50.8% [30/59], χ2 = 5.219, P = 0.03), and the cure rate of MUI (48%, 14/29) was the lowest. The cure rate of patients with UI symptoms postoperatively was lower than that of those with symptoms preoperatively (9.1% [28/309] vs. 16.2% [50/309], χ2 = 7.101, P = 0.01). There was no difference in the incidence of UI postoperatively between Groups A and B (P > 0.05). The cure rate of SUI in patients undergoing tension-free vaginal tape-obturator was not higher than that in those who did not undergo the procedure (42.9% [6/14] vs. 53.3% [24/45], χ2 = 0.469, P = 0.49). There were no differences in the cure rate for POP or UI between these two types of Reconstructions (P > 0.05). Conclusions: No correlation between the incidence of UI and POP was identified. The results suggest that UI treatment should be performed after POP surgery for patients with both conditions. Key words: Pelvic Organ Prolapse; Recurrence; Urinary Incontinence

  • Transvaginal Single-Port Laparoscopy Pelvic Reconstruction with Y-Shaped Mesh.
    Journal of minimally invasive gynecology, 2018
    Co-Authors: Yisong Chen, Keqin Hua
    Abstract:

    Abstract Study Objective To demonstrate a new technique for Pelvic Reconstruction in patients with multiple-compartment Pelvic organ prolapse (POP) using Y-shaped mesh via transvaginal single-port laparoscopy. Design Description and step-by-step demonstration of the procedure using video and still images (Canadian Task Force classification III). Setting It is more and more prudent for Pelvic floor Reconstruction with mesh because of mesh-related complications. Learning from sacrocolpopexy with a lower rate of mesh erosion (3.5%), a new method of Pelvic Reconstruction via natural orifice transluminal endoscopic surgery is feasible. Interventions The patient was a 67-year-old woman with a Pelvic Organ Prolapse Quantification System (POP-Q) stage III anterior compartment, stage III middle compartment, and stage II posterior compartment. Institutional Review Board and Ethics Committee approval was obtained. Vaginal hysterectomy and preventative bilateral salpingo-oophorectomy were performed first. Under laparoscopy, the Pelvic peritoneum on the right side was incised from the promontory to the vault. Once the rectovaginal septum was separated, a 2-cm “window” of the lower posterior vaginal wall was created. Then the Y-shaped mesh (ARTISYN; Ethicon, Somerville, NJ) was fixed to the posterior vaginal and the sacral promontory (S1). After the Pelvic peritoneum was closed, a “window” of lower anterior vaginal wall was made, and the anterior mesh was sutured to the descending ramus of pubis. Finally, the vaginal roof was closed. The operation took roughly 2 hours, and total blood loss was approximately 40 mL. The patient recovered well. No relapse of prolapse, mesh erosion, or any other complications were observed at the 6-month follow-up. Conclusion Transvaginal single-port laparoscopic Pelvic Reconstruction can be considered for patients with total POP. However, additional studies with larger numbers of patients are needed.

Sung Bum Kim - One of the best experts on this subject based on the ideXlab platform.

  • Pelvic Reconstruction Surgery Using a Dual-Rod Technique with Diverse U-Shaped Rods After Posterior En Bloc Partial Sacrectomy for a Sacral Tumor: 2 Case Reports and a Literature Review.
    World neurosurgery, 2016
    Co-Authors: Man Kyu Choi, Sung Bum Kim
    Abstract:

    SpinoPelvic Reconstruction after sacrectomy for a sacroPelvic tumor can result in various complications and requires a highly complicated surgical technique. We report 2 cases of Pelvic Reconstruction surgery using diverse U-shaped rods (USRs) after partial sacrectomy. A partial sacrectomy was performed for 2 different cases: one case was a metastatic sacral tumor and the other was a chordoma. In the first case, Reconstruction was completed with an inner straight rod and an outer USR. The other patient underwent Reconstruction using an inner USR and an outer straight rod. In both cases, there was no instrument failure, and the lumbosacral junction was reconstructed in balance. One of the patients died of metastatic lung cancer, and the other patient is alive and has experienced no other complications. A Pelvic Reconstruction technique using diverse USRs showed good spinoPelvic stability without complications. This technique may be a surgical option for reconstructive surgery after partial sacrectomy. Copyright © 2016 Elsevier Inc. All rights reserved.

  • Pelvic Reconstruction Surgery Using a Dual-Rod Technique with Diverse U-Shaped Rods After Posterior En Bloc Partial Sacrectomy for a Sacral Tumor: 2 Case Reports and a Literature Review.
    World Neurosurgery, 2016
    Co-Authors: Man Kyu Choi, Sung Bum Kim
    Abstract:

    Background SpinoPelvic Reconstruction after sacrectomy for a sacroPelvic tumor can result in various complications and requires a highly complicated surgical technique. We report 2 cases of Pelvic Reconstruction surgery using diverse U-shaped rods (USRs) after partial sacrectomy. Case Description A partial sacrectomy was performed for 2 different cases: one case was a metastatic sacral tumor and the other was a chordoma. In the first case, Reconstruction was completed with an inner straight rod and an outer USR. The other patient underwent Reconstruction using an inner USR and an outer straight rod. In both cases, there was no instrument failure, and the lumbosacral junction was reconstructed in balance. One of the patients died of metastatic lung cancer, and the other patient is alive and has experienced no other complications. Conclusions A Pelvic Reconstruction technique using diverse USRs showed good spinoPelvic stability without complications. This technique may be a surgical option for reconstructive surgery after partial sacrectomy.

C Christakis - One of the best experts on this subject based on the ideXlab platform.

  • Pelvic Reconstruction of the retroperitoneum after abdominoperineal resection of the rectum using full-thickness skin grafts
    Techniques in Coloproctology, 2004
    Co-Authors: C Christakis, C Vaklavas, N Kontos, C Chatzidimitriou, K Tzelepi, M Karanikas, E Christakis
    Abstract:

    BACKGROUND To find a safe and effective method of Pelvic Reconstruction after abdominoperineal resection in order to prevent small intestine from descending into the pelvis. This allows safe delivery of optimal doses of radiation therapy, which exceed radiation tolerance of the small intestine, in advanced stages of colorectal cancer. MATERIALS Prospective, ongoing study examining patients who underwent abdominoperineal resection and Pelvic Reconstruction with full-thickness skin grafts. METHODS Nine (9) patients underwent abdominoperineal resection of the rectum and Pelvic Reconstruction with full-thickness skin grafts for colorectal cancer stage C. Subsequently they were referred for adjuvant radiation therapy and followed up regularly for surgical complications and disease recurrence. RESULTS All patients successfully completed postoperative radiation therapy and there were no serious surgical complications pertaining to the initial operation and the skin homeotransplantation. None of the patients needed reoperation, so the long-term outcome of the transplantation was not surgically evaluated. CONCLUSIONS Reconstruction of the peritoneal gap after abdominoperineal resection of the rectum with full-thickness skin graft is a safe and effective method. The small intestine was effectively excluded from the pelvis allowing successful completion of adjuvant radiation therapy with minimal irradiation of the small intestine and effective prevention of radiation enteritis.

  • Pelvic Reconstruction of the retroperitoneum after abdominoperineal resection of the rectum using full-thickness skin grafts.
    Techniques in coloproctology, 2004
    Co-Authors: C Christakis, C Vaklavas, N Kontos, C Chatzidimitriou, K Tzelepi, M Karanikas, E Christakis
    Abstract:

    To find a safe and effective method of Pelvic Reconstruction after abdominoperineal resection in order to prevent small intestine from descending into the pelvis. This allows safe delivery of optimal doses of radiation therapy, which exceed radiation tolerance of the small intestine, in advanced stages of colorectal cancer. Prospective, ongoing study examining patients who underwent abdominoperineal resection and Pelvic Reconstruction with full-thickness skin grafts. Nine (9) patients underwent abdominoperineal resection of the rectum and Pelvic Reconstruction with full-thickness skin grafts for colorectal cancer stage C. Subsequently they were referred for adjuvant radiation therapy and followed up regularly for surgical complications and disease recurrence. All patients successfully completed postoperative radiation therapy and there were no serious surgical complications pertaining to the initial operation and the skin homeotransplantation. None of the patients needed reoperation, so the long-term outcome of the transplantation was not surgically evaluated. Reconstruction of the peritoneal gap after abdominoperineal resection of the rectum with full-thickness skin graft is a safe and effective method. The small intestine was effectively excluded from the pelvis allowing successful completion of adjuvant radiation therapy with minimal irradiation of the small intestine and effective prevention of radiation enteritis.

Keqin Hua - One of the best experts on this subject based on the ideXlab platform.

  • Transvaginal single-port laparoscopic Pelvic Reconstruction with Y-shaped mesh: experiences of 93 cases.
    International urogynecology journal, 2020
    Co-Authors: Xiaojuan Wang, Keqin Hua, Yisong Chen
    Abstract:

    INTRODUCTION AND HYPOTHESIS To demonstrate the outcomes of Pelvic Reconstruction using Y-shaped mesh in patients with multiple-compartment Pelvic organ prolapse via transvaginal single-port laparoscopy. METHODS We conducted a retrospective case series study. Patients diagnosed with severe multiple-compartment prolapse were enrolled between July 1, 2017, and March 31, 2020. Patients underwent transvaginal single-port laparoscopic Pelvic Reconstruction with Y-shaped mesh. Baseline data and perioperative results were collected. Patients were followed up with the POP-Q score, Pelvic Floor Distress Inventory (PFDI-20) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire short form (PISQ-12). T-test was used for statistical analysis. RESULTS Operations were successful in all 93 patients without conversion or serious complications. Mean operative time was 132.70 ± 28.02 min and estimated blood loss was 110.65 ± 56.31 ml. VAS pain score was 2.91 ± 1.16 and cosmetic score was 9.20 ± 0.60. During 1-33 months of follow-up, no recurrence or mesh exposure was observed. Five patients suffered from de novo SUI, six had constipation, two had dyspareunia, and one had persistent Pelvic pain. The pre- and postoperative Aa point was +2.13 ± 1.23 vs. -2.91 ± 0.28 (P < 0.05), C point was 2.63 ± 2.41 vs. -6.86 ± 0.69 (P < 0.05), and Ap point was -0.26 ± 1.79 vs. -2.97 ± 0.16 (P < 0.05). The PFDI-20 score was 76.81 ± 32.06 vs. 18.18 ± 20.25 (P < 0.05), while the PISQ-12 score was 34.30 ± 4.17 vs. 37.20 ± 2.60 (P < 0.05), which suggested significant improvements in both physical prolapse and quality of life after surgery. CONCLUSION Transvaginal single-port laparoscopic Pelvic Reconstruction with Y-shaped mesh is a feasible, effective and safe treatment option for severe multiple-compartment prolapse. Patients may benefit from its mild pain level and good cosmetic effect as well as only minor mesh-related complications.

  • Management of Urinary Incontinence before and after Total Pelvic Reconstruction for Advanced Pelvic Organ Prolapse with and without Incontinence.
    Chinese medical journal, 2018
    Co-Authors: Yu Song, Yisong Chen, Xiaojuan Wang, Keqin Hua
    Abstract:

    Background: The effectiveness of an anti-incontinence procedure concomitant with prolapse Reconstruction for Pelvic organ prolapse (POP) in preventing urinary incontinence (UI) after surgery remains controversial. Our study aimed to describe the incidence of pre- and postoperative UI for Pelvic reconstructive surgery and evaluate the management of POP associated with UI. Methods: A total of 329 patients who underwent total Pelvic Reconstruction between June 2009 and February 2015 at a single institution were identified. These patients were divided into two groups (Group A [Prolift Reconstruction]: n = 190 and Group B [modified total Pelvic Reconstruction]: n = 139). Data regarding surgical procedures and patient demographic variables were recorded. Chi-square and Student’s t-tests were used for two independent samples. Results: A total of 115 patients presented with UI preoperatively. The average follow-up time was 46.5 months, with 20 patients lost to follow-up (6.1%). The cure rates of stress UI (SUI), urgency UI (UUI), and mixed UI (MUI) were 51% (30/59), 80% (16/20), and 48% (14/29), respectively. The cure rate of UUI after total Pelvic Reconstruction (80% [16/20]) was higher than that of SUI (50.8% [30/59], χ2 = 5.219, P = 0.03), and the cure rate of MUI (48%, 14/29) was the lowest. The cure rate of patients with UI symptoms postoperatively was lower than that of those with symptoms preoperatively (9.1% [28/309] vs. 16.2% [50/309], χ2 = 7.101, P = 0.01). There was no difference in the incidence of UI postoperatively between Groups A and B (P > 0.05). The cure rate of SUI in patients undergoing tension-free vaginal tape-obturator was not higher than that in those who did not undergo the procedure (42.9% [6/14] vs. 53.3% [24/45], χ2 = 0.469, P = 0.49). There were no differences in the cure rate for POP or UI between these two types of Reconstructions (P > 0.05). Conclusions: No correlation between the incidence of UI and POP was identified. The results suggest that UI treatment should be performed after POP surgery for patients with both conditions. Key words: Pelvic Organ Prolapse; Recurrence; Urinary Incontinence

  • Transvaginal Single-Port Laparoscopy Pelvic Reconstruction with Y-Shaped Mesh.
    Journal of minimally invasive gynecology, 2018
    Co-Authors: Yisong Chen, Keqin Hua
    Abstract:

    Abstract Study Objective To demonstrate a new technique for Pelvic Reconstruction in patients with multiple-compartment Pelvic organ prolapse (POP) using Y-shaped mesh via transvaginal single-port laparoscopy. Design Description and step-by-step demonstration of the procedure using video and still images (Canadian Task Force classification III). Setting It is more and more prudent for Pelvic floor Reconstruction with mesh because of mesh-related complications. Learning from sacrocolpopexy with a lower rate of mesh erosion (3.5%), a new method of Pelvic Reconstruction via natural orifice transluminal endoscopic surgery is feasible. Interventions The patient was a 67-year-old woman with a Pelvic Organ Prolapse Quantification System (POP-Q) stage III anterior compartment, stage III middle compartment, and stage II posterior compartment. Institutional Review Board and Ethics Committee approval was obtained. Vaginal hysterectomy and preventative bilateral salpingo-oophorectomy were performed first. Under laparoscopy, the Pelvic peritoneum on the right side was incised from the promontory to the vault. Once the rectovaginal septum was separated, a 2-cm “window” of the lower posterior vaginal wall was created. Then the Y-shaped mesh (ARTISYN; Ethicon, Somerville, NJ) was fixed to the posterior vaginal and the sacral promontory (S1). After the Pelvic peritoneum was closed, a “window” of lower anterior vaginal wall was made, and the anterior mesh was sutured to the descending ramus of pubis. Finally, the vaginal roof was closed. The operation took roughly 2 hours, and total blood loss was approximately 40 mL. The patient recovered well. No relapse of prolapse, mesh erosion, or any other complications were observed at the 6-month follow-up. Conclusion Transvaginal single-port laparoscopic Pelvic Reconstruction can be considered for patients with total POP. However, additional studies with larger numbers of patients are needed.