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Vaginal Surger y for Pelvic Orga n Prolapse Stephen B. Young, MD KEYWORDS  Pelvic organ prolapse  Reconstructive surgical procedures  Hysterectomy  Vaginal  Cystocele  Rectocele The art and science of vaginal reconstructive surgery has evolved during the past 2 centuries. The first vaginal hysterectomy was performed for malignancy by Langenbeck in 1813,1 although there is much controversy surrounding this. The surgical treatment of prolapse developed through multiple varied operations in the second quarter of the nineteenth century. Early procedures were somewhat or fully obliterative. The lytrorhaphie—removing long more prominent were largely occlusive and included e vertical vaginal strips and placing several supportive sutures, cauterization of the vagina, episiorrhaphy—where dependent parts of the labia majora were removed and the raw surfaces united resulting in almost complete vulvar occlusion, perineorrhaphy, and cervical amputation, finally full cervical removal with bladder displacement.1 In America, the first vaginal hysterectomy for prolapse was performed by Samuel Choppin in New Orleans in 1861. Before the introduction of general anesthesia and aseptic technique, these early procedures were limited. Operations had to be brief as pain was not fully alleviated. A general imprimatur reigned against entering the peritoneal cavity for fear of peritonitis. Gradually, over the next 100 years, as the theory of pelvic organ prolapse etiology and pathophysiology developed, and more definitive curative surgical procedures could be performed safely, the operations that became popular in the early part of the twentieth century were established. These include procedures such as the standard anterior colporrhaphy with Kelly plication suture for cystocele and urinary incontinence. For several decades, vaginal hysterectomy has been generally accepted as the approach of choice for removal of the benign uterus. Ribeiro and colleagues,2 in an randomized control trial (RCT) published in 2003 concluded, ‘‘vaginal hysterectomy presents superior results in terms of operative time and inflammatory response Division of Urogynecology & Reconstructive Pelvic Surgery, Department of Obstetrics & Gynecology, UMass Memorial Medical Center, University of Massachusetts Medical School, 119 Belmont Street, Worcester, MA 01605, USA E-mail address: Obstet Gynecol Clin N Am 36 (2009) 565–584 doi:10.1016/j.ogc.2009.08.013 0889-8545/09/$ – see front matter ÂŞ 2009 Elsevier Inc. All rights reserved.

Vaginal Surgery for Pelvic Organ Prolapse

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