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Biomedical subjects

G Crépin

Publications and source records attributed to G Crépin.

At least 19 recordsLinked to original sources
PubMed2006

[MRI evaluation of surgical pelvic floor repair].

OBJECTIVE: To bring to the fore the differences in terms of anatomical restoration between the abdominal and vaginal approach of pelvic floor repair. We compared the short-term anatomical results of the sacropexy and the sacrospinous fixation and paravaginal repair. PATIENTS AND METHODS: Magnetic Resonance Imagery (MRI) allowed us to obtain a reproducible and objective comparison of location of the various pelvic organs. Forty-three patients benefited from a MRI a pre- and postoperative evaluation according to the position of organs with regard to the pubo-coccygeal line. We noted cystocele, hysterocele or enterocele when the bladder, the uterine cervix, or the Douglas' cul-de-sac came under this line during efforts of push. We measured length modifications and lateral and anteroposterior vaginal axis. RESULTS: After the surgery, we noted that all pelvic organs were found above the reference line. On the other hand, bladders are significantly situated less high after vaginal pelvic floor repair. There is no postoperative difference as regards of the vaginal wall location. The lengths and vaginal axis are comparable in pre- and postoperative evaluation. DISCUSSION AND CONCLUSION: In our study, the anatomical results of pelvic floor repair performed by vaginal or abdominal route are short-term comparable and the vaginal approach is not responsible for decrease of length or vaginal reorientation. Standardized and longer term evaluated, the MRI can represent an objective and reproducible help to the staging of pelvic floor dysfunction.

Female↗
PubMed2004

[Previous caesarean section is an operative risk factor in vaginal hysterectomy].

OBJECTIVE: We describe the intra and postoperative frequency of complications in vaginal hysterectomies for benign disorders in patients with a history of caesarean section. PATIENTS AND METHODS: Since 1996, 963 hysterectomies have been performed in our institution. 76.94% were performed exclusively by vaginal route (n = 741), 10.1% (n = 98) were by laparoscopic-assisted vaginal route and 12.9%, by pure abdominal route. We compared two groups of patients who underwent vaginal hysterectomy, with or without history of caesarean section. In each group we recorded the characteristics of the population and compared the intra and postoperative data, such as bladder or digestive tract wounds and haemorrhages. We used analysis of variance tests to compare means, chi2-tests and Fisher's exact tests for comparisons of numbers. A probability of P < 0.05 was adopted as the limit of significance. RESULTS: The frequency of haemorrhages was significantly higher in the patients with a history of caesareans. Bladder and intestine injury rates are significantly higher in the previous caesarean section group, but not significant for the bowel injuries. We compared the cumulative frequency of complications between the two groups. In the group with previous caesarean section, we recorded 18.3% of intra operative complications. In the group without history of caesarean section, we recorded 3.58% of complications. There is a significant difference between the cumulative frequency of complications in the two populations of patients in favour of the sub group without a history of caesarean scar (P < 0.0001). DISCUSSION AND CONCLUSION: A history of single or multiple previous caesarean section increases the intra operative risk in vaginal hysterectomies. The surgeon must take into account the history of caesarean section and be attentive to the previous operating time of the bladder and uterine region especially at the time of opening the anterior peritoneal cul-de-sac. Nevertheless, uterine scarring as a sequel to caesareans must not be a contraindication to the vaginal route.

Adult↗
PubMed2003

Long-term results of the Burch procedure combined with abdominal sacrocolpopexy for treatment of vault prolapse.

The aim of the study was to determine the long-term results of Burch procedures combined with vault prolapse repair by abdominal sacrocolpopexy. Between 1986 and 1997 82 women (mean age 46.0 years, range 27-79) underwent sacrocolpopexy combined with a Burch procedure. All patients presented with urinary incontinence and vault prolapse. The surgery consisted of a Burch procedure using non-absorbable suture material, and abdominal sacrocolpopexy with a non-absorbable mesh. The mesh was placed anteriorly and posteriorly in 66 cases, posteriorly (rectovaginal) in 12, and anteriorly (vesicovaginal) in 4. Additional procedures included hysterectomy (34 cases), enterocele repair (79 cases), and posterior repair with perineorrhaphy (65 cases). Failure was defined as the presence of persistent or worsened postoperative stress urinary incontinence (SUI). At a mean follow-up of 86 months (range 24-133) 34% (28/82) of patients were dry, and another 46% (38/82) were improved compared to their preoperative status. The postoperative SUI rate (persistent, worsened) after the placement of a single anterior mesh (4 failures out of 4) was higher than the postoperative SUI rate after combined meshes (41 failures out of 66) (log rank P = 0.05). All the patients with a history of prior surgery had worsened or persistent stress urinary incontinence (7/7), but 63% (47/75) of those with no prior surgery for stress urinary incontinence had worsened or persistent stress urinary incontinence (log rank P = 0.01). One case of recurrent rectocele was observed (after 20 months) and treated by transvaginal Richter sacrospinous fixation. At a mean follow up of 7 years, the Burch procedure combined with abdominal sacrocolpopexy appears to be less effective than previously published long-term results for the Burch procedure alone.

Adult↗
PubMed2003

[Epithelial inclusion cyst formation after buried vaginal mucosa. Diagnosis and management].

OBJECTIVES: Surgical treatment in which a vaginal mucosa island is buried leads to a risk of epithelial inclusion cyst formation. The aim of this study is to describe this complication, assess incidence, precise facilitating factors and discuss treatment. PATIENTS AND METHOD: This study concerned 84 patients operated on between January 1996 and December 1998. They were treated with modified vaginal wall sling procedure. Fifty women were post-menopausal and 22 had estrogenotherapy. All patients had post-operative surveillance. The mean post-operative follow-up was 19 months (range: 1-68 months). Epithelial inclusion cyst formation diagnosis reposed exclusively on clinical assessment.Results. - Seven out of the 84 patients (8.3%) were diagnosed with epithelial inclusion cyst formation within 19 months of their operation (range: 3-34 months). Out of the seven patients, four were post-menopausal and three had received estrogenotherapy for many years. In six cases, epithelial inclusion cyst was symptomatically revealed by perineal pain or dysuria. These cases were successfully treated by cyst marsupialisation without recurrent incontinence. DISCUSSION AND CONCLUSION: The results of this short study show that epithelial inclusion cyst formation is a specific complication of surgical procedures burying a full thickness of vaginal mucosa and that estrogen impregnation seems to be the main facilitating factor. Successful treatment of symptomatic cases of epithelial inclusion cyst can be achieved by marsupialisation.

Adult↗
PubMed2003

[Peritoneovaginal fistula after vaginal hysterectomy].

Peritoneovaginal fistula is a rare complication of hysterectomy. A patient with pelvic pain and vaginal discharge due to peritoneovaginal fistula, 6 months after hysterectomy, is presented. The laparoscopic approach with an intravaginal blue-test, provided the evidence of the peritoneovaginal fistula. The transvaginal approach offered a surgical closure of the fistula and a resolution of the symptoms. In addition, we have reviewed the literature, the symptoms, the differential diagnosis and the management of this problem.

Diagnosis, Differential↗
PubMed2003

[Comparative analysis of rate scales of urinary incontinence in women].

OBJECTIVE: Rate scales are used to analyse urinary incontinence. There are many scales making it difficult to compare the different studies of urinary incontinence. The purpose of this study was to evaluate and compare the rate scales pertaining specifically to urinary incontinence. PATIENTS AND METHOD: A review of the literature was performed for publications specifically addressing rate scales of urinary incontinence. Each scale was evaluated using the following four criteria: principal characteristics (reference source, number of items addressed, scoring method, language), objectives (type of incontinence, severity and quality of life measures), psychometric properties (scientific validity, reliability and responsiveness) and linguistic validation. RESULTS: Thirteen scales were identified. These were divided into two groups: (1) those based on "classifications" and (2) those based on specific questionnaires. Scales based on classifications were not precise and are never scientifically validated. Scales based on questionnaires were more elaborate and more detailed; nevertheless, the study of their psychometric properties was often incomplete. DISCUSSION AND CONCLUSION: Classification-based rate scales are inadequate to analyse urinary incontinence. Questionnaire-based rate scales are superior, but at minimum, they should address the previously stated objective and psychometric criteria. The choice of questionnaire should depend on whether it is to be used in clinical practice or for research protocol.

Female↗
PubMed2003

[Mechanical properties of biological or synthetic implants used to treat genital prolapse and stress incontinence in women : what is the ideal material?].

INTRODUCTION: Many surgical techniques proposed for genital prolapse or stress incontinence use prosthetic material to reinforce native tissues. Most of the synthetic meshes used have been designed for hernia repair. MATERIAL AND METHOD: We study the biomechanical properties of human Alloderm or animals tissues like Pelvicol and of synthetic resorbable and permanent meshes. We report the results from the literature. We report the results of a personal study of the biomechanical properties of synthetic meshes. RESULTS: The literature on biomechanical properties of biological or synthetic meshes and their evolution after implantation is sparse. Biogyn ITY or Prolène are the only meshes without spatial orientation. Their resistance to rupture and mechanical properties are variable and seem poor for Biogyn W8 et Mersuture. DISCUSSION: Reviewing the literature we discuss the ideal properties for synthetic meshes used for cure of genital prolapse.

Animals↗
PubMed2003

[Biomechanics of stress distribution and resistance of biological tissues: why use prostheses for the treatment of genital prolapse?].

BACKGROUND: Solidity and elasticity are the two main biomechanical properties of pelvic tissues involved in surgical cure of genital prolapse-prevertebral, pectinate, and sacrospinal ligaments, tendinous arcs of the pelvic fascia, vaginal tissue. We report data in the literature and personal studies concerning these autologous biological tissues. MATERIAL AND METHODS: The resistance of pelvic tissues was tested on 29 cadavers. Measurements were also made on two 2-cm samples of vaginal tissue obtained during vaginal route surgery for prolapse cure in 20 menopaused women. Stress tests were conducted to determine resistance and level of rupture. RESULTS: There was a wide variability in ligament resistance, ranging from a minimum of 22 Newtons to a maximum to the order of 200 Newtons. Results varied greatly from one woman to another and also between the two sides in the same woman. The prevertebral ligament exhibited the greatest resistance. The pectinate ligament was significantly more resistant than the sacrospinal ligaments and the tendinous arcs of the pelvic fascia. There was a significant relationship between the subjective assessment of ligament quality and objective measurements of resistance. For vaginal tissues, resistance varied greatly from 12 Newtons to a maximum to the order of 76 Newtons. Flexion values ranged from 14 to 130 Newtons. CONCLUSION: Our findings illustrate pelvic tissue failure observed in patients with genital prolapse. Individual maximal resistance of the pelvic ligaments is vary variable, between ligaments and between subjects, and even between sides in a given subject. Pelvic ligaments used for cure of genital prolapse are moderately resistant with wide interindividual variability. The mechanical properties of vaginal tissue are also very variable, illustrating why these tissues may exhibit a certain resistance against dissociation when exposed to loading but much less resistance when exposed to traction by a surgical suture. These findings suggest a revision of classical surgical procedures.

Age Factors↗
PubMed2003

[Promontofixation procedure: use of non-absorbable sutures or Tackers?].

AIM: Description and evaluation of ligamentopexy techniques using strings and spiral staples. MATERIAL AND METHODS: We first describe the ligamentopexy procedure using non-absorbable sutures before comparing this technique to the use of Tacker type staples. We describe the advantages and disadvantages of this procedure in terms of surgical technique, secondary complications and biomechanical strength. RESULTS: For our team, recommendable attitude is to use non-absorbable sutures for the fixation to the prevertebral ligament. The main advantages of the use of staples are the ease and facility for learning the technique. The risk of spondylodiscitis is rare but enhanced by the deeper penetration of the staples into the intervertebral discs. In terms of resistanc, promontofixation using sutures is much stronger compared to staples. CONCLUSION: The use of sutures for promontofixation, in laparoscopy, is preferred to the utilization of staples type Tacker. These staples should be used when there is a risk of needle stitches for the patient.

Cadaver↗
PubMed2001

The vaginal patch plastron for vaginal cure of cystocele. Preliminary results for 47 patients.

OBJECTIVE: We describe a new surgical technique (the vaginal plastron) for the treatment of cystocele by the vaginal route. The technique is based on bladder support by a vaginal strip (6-8cm in length and 4cm in width), isolated from the anterior colpocele, left attached to the bladder, associated with a suspension of this strip by its fixation to the tendinous arch of the pelvic fascia by six lateral sutures (three on each side of the plastron). The vaginal plastron is then covered by tucking it under the anterior colporraphy. STUDY DESIGN: We evaluated the short-term functional and anatomical results of the first 47 patients to have undergone this treatment between October 1997 and June 1998. The average age of the patients was 69 years. Cystoceles were associated with urinary stress incontinence in 38.3% of cases, with hysterocele or prolapse of the vaginal dome in 87.2% of cases, with an elytrocele in 19.1% of cases and a rectocele in 70.2% of cases. Of the 45 patients having had a hysterectomy combined with the vaginal plastron or in their past history, 44 (99.77%) had a Richter sacro-spino-fixation and 17 (38%) had a Campbell procedure combined with the vaginal plastron. All patients underwent a posterior perineorraphy with myorraphy of the elevators. RESULTS: Average follow-up was 16.4 months with extremes of 6-26 months and concerned 46 patients (one patient was unavailable). Ninety-three percent of the cystoceles were considered treated. One case of imperfect anatomical outcome was noted (persistence of stage 1 cystocele in one patient) together with two other cases of failure of the treatment of cystocele (relapse to stage 2 cystocele). CONCLUSION: Proposed as a curative treatment of cystocele and combined with the Richter fixation, the plastron provides a surgical solution to the problem of cystocele relapse arising after vaginal treatment of prolapse by sacro-spino-fixation alone (10-20% according to Richter). Short-term results are encouraging, however, medium- to long-term results (36-60 months) are necessary in order confirm the usefulness of this surgical technique.

Female↗
PubMed2001

Anatomic study of arcus tendineus fasciae pelvis.

OBJECTIVE: To describe the anatomy of the arcus tendineus fasciae pelvis. MATERIAL AND METHODS: Two fixed female cadaver pelvises (88 and 66 years old) were dissected. RESULTS: The arcus tendineus fasciae pelvis is a 10-cm-long fibrous thickening of the pelvic fascia which is medial to the obturator internus muscle and lateral to the peritoneum. It is inserted on the ischiatic spine and courses downward and anteriorly to the pubovesical ligament. The posterior third of the arcus tendineus fasciae pelvis is fused with the posterior third of the arcus tendineus musculus levatoris ani, forming a curve with upward and anterior concavity. This portion of the arcus tendineus is thick and easy to recognise upon palpation. It is located 1cm slightly above and anterior to the ischiatic spine and 2 cm from of the pudendal vessels, which course around the posterior inferior margin of the ischiatic spine. The superior margin of the median part of the arcus tendineus fasciae pelvis is crossed laterally by vessels for the obturator internus muscle arising from the internal iliac vessels. CONCLUSION: In genital prolapse cure, sutures must be placed through the anterior or median parts of the arcus tendineus fasciae pelvis. In any case, they must remain anterior to the posterior part of the arcus tendineus fasciae pelvis to avoid injury to the pudendal vessels.

Aged↗
PubMed2001

Vaginal, laparoscopic, or abdominal hysterectomies for benign disorders: immediate and early postoperative complications.

OBJECTIVE: hysterectomy for benign disorders is usually well tolerated, but complications do occur. The aim of this retrospective study is to document such complications. PATIENTS AND METHODS: between March 1991 and December 1998, 1604 patients (mean age: 46 years) underwent hysterectomy for benign disorders. Peroperative and early postoperative complications were recorded for the 1248 vaginal hysterectomies (8%), 190 laparoscopically assisted vaginal hysterectomies (12%), and 166 abdominal hysterectomies (10%). RESULTS: none of the patients died. There were 15 bladder (0.9%) and one ureter injury (0.06%) with no significant difference between routes. Intestinal injuries (0.6%) overall were more common when laparotomy was performed (2.4%). In 45 patients (2.8%), bleeding exceeded 500 ml. The rates were vaginal hysterectomy (2%, P<0.001), laparotomy (6.7%), and laparoscopy (5.3%). The overall reoperation rate of 0.8% does not differ with the type of the procedure. CONCLUSION: Per and early postoperative complications after hysterectomy remain important and patients should be aware of them. In order to control complications and decrease the morbidity, a high-risk population should be defined based on the patients' history of pelvic surgery and endometriosis, on their parity and the size of their uterus. For these patients, the most appropriate route should be preferred and complications should be assessed using different tests and subsequently treated during the same procedure.

Abdomen↗
PubMed2001

[Cure of cystocele with vaginal patch].

OBJECTIVE: To describe an original technique for transvaginal cystocele repair and to report the anatomical and functional results of the first 47 patients operated by this technique. The operation combines suspension, by six sutures to the tendinous arches of the pelvic fascia, of a vaginal patch measuring 6 to 8 cm long by about 4 cm wide left in contact with the cystocele. The vaginal patch is then buried under the anterior colporraphy suture. Spinal fixation, hysterectomy, levator myorrhaphy or urinary incontinence repair are also performed as necessary. METHODS: Descriptive retrospective study of 47 patients undergoing transvaginal repair of prolapse between October 1997 and June 1998. All patients presented external prolapse with grade III cystocele, associated with urinary incontinence in 38.3% of cases and hysterocele or vaginal prolapse in 87% of cases. The mean age of the patients was 69 years. The uterus was preserved in two cases, but hysterectomy was performed in the other 45 patients, together with Richter spinal fixation in 44 cases An associated levator myorrhaphy was performed in every case. RESULTS: The mean follow-up was 16.4 months (range: 6 to 26 months) in 46 patients. The cystocele was considered to be cured in 93% of patients, one patient had an asymptomatic grade I cystocele and surgery was unsuccessful in two patients who developed recurrent grade II cystocele. CONCLUSION: The technique presented here is a curative treatment for grade III cystocele in menopaused women associated with Richter spinal fixation, and prevents the risk of cystocele described after transvaginal treatment of prolapse by spinal fixation alone (10 to 20%). The short-term results are encouraging, but they need to be confirmed by a follow-up of at least 5 years.

Aged↗
PubMed2001

[Vaginal hysterectomy in nulliparous women: indications and limitations].

OBJECTIVE: The aim of our study was to determine whether nulliparity is a limiting factor for vaginal hysterectomy performed for benign lesions. PATIENTS AND METHODS: We conducted a prospective study in 1604 patients who underwent hysterectomy for a benign lesion between 1991 and 1998. We studied a subgroup of this population constituted by 128 nulliparous women, i.e. 8% of the patients. RESULTS: Vaginal hysterectomy was performed at first intention in 54.7% of the cases, after laparoscopic preparation in 14%, and by first intention laparotomy in 31.3% for each type of approach we compared: history of pelvic surgery, duration of the operation, final weight of the uterus, peroperative complications, association or not with adnexectomy in patients aged 45 years or older, frequency of a reduction procedure in the vaginal group and duration of hospitalization. CONCLUSION: Nulliparity is not a contraindication for vaginal hysterectomy which can be proposed as a first intention procedure, sometimes in association with laparoscopic preparation in case of prior pelvic surgery or concomitant adnexal disorders.

Contraindications↗
PubMed2001

[Hysterectomy for benign lesions: what remains for the abdominal route?].

OBJECTIVE: We conducted a prospective study to assess what indications remain for abdominal hysterectomy for benign conditions. PATIENTS AND METHODS: Four hundred fifty-three hysterectomies were performed for benign conditions between April 4, 1996 and December 14, 1998 in our unit. Abdominal hysterectomy was chosen for large uteri, when vaginal access was unusable, or in case of suspected post-operative pelvic adhesions. RESULTS: We performed 330 vaginal hysterectomies (72.85%), 71 laparoscopy-assisted vaginal hysterectomies (15.6%) and 52 abdominal hysterectomies (11.4%). In 10 cases, laparoconversion was required when a vaginal or a laparoscopy-assisted hysterectomy was complicated by pelvic adhesions or poor vaginal access. Mean operative time for abdominal hysterectomy was 130 minutes and mean blood loss was 504 ml. Mean uterus weight was 612 g and mean hospital stay 6.4 days. We had 6 complications (11.53%) (one bladder injury, one ilial injury and four cases of intraoperative hemorrhage). DISCUSSION: Our experience showed that the rate of complications is greater with laparoscopic hysterectomy due to patient selection and should be performed by trained surgeons.

Adnexal Diseases↗