メッシュを用いた骨盤臓器脱の新手術―Tension free vaginal mesh（TVM）法と腹腔鏡下腟仙骨固定術
New Surgical Procedures for Pelvic Organ Prolapse: Insertion of a Tension-free Vaginal Mesh and Laparoscopic Sacrocolpopexy
Division of Reproductive Medicine, Perinatology and Gynecologic Oncology, Graduate School of Medicine, Nippon Medical School
Department of Obstetrics and Gynecology, Nippon Medical School
Pelvic organ prolapse is characterized by a lack of pelvic floor support causing the pelvic organs and vaginal wall to protrude. For many decades, suture repair techniques have been the primary choice of surgical treatment when indicated. Traditional surgical techniques are, however, frequently associated with high rate of anatomical recurrence. Since 2004, vaginal mesh surgery with a tension-free vaginal mesh has emerged as an effective method of pelvic floor reconstruction, applicable to most types of pelvic organ prolapse. Gynemesh®, a thin, highly porous synthetic polypropylene prosthesis, is inserted as a hammock under the bladder, applied laterally on the arcus tendineus fascia pelvis, and retained by 2 nonsecured bilateral transobturator arms. A posterior interrectovaginal prosthesis is inserted in front of the rectum and applied laterally on the levatores ani and is retained by bilateral lateral arms secured to the median part of the sacrospinous ligament. Laparoscopic sacrocolpopexy is another new procedure for the treatment of pelvic organ prolapse. This method is especially suitable for patients younger than 50 years. Because of possible complications, surgeons must learn the technical details of these procedures before performing them and choose the best surgical method according to patient's age, symptoms, and complications.
日医大医会誌 2010; 6(4), 174-177
pelvic organ prolapus, mesh method, TVM method, LSC
Shigeo Akira, Department of Obstetrics and Gynecology, Nippon Medical School, 1-1-5 Sendagi, Bunkyo-ku Tokyo 113-8603, Japan