Y. TSUjINAKA Rectocele repair using Gynemesh

So, Professor, can you hear us?

Yeah, I can hear you.

Sorry again, but we lost the connection, went down for a while.

So, again, can you start again your presentation whenever you like?

You can go ahead with your lecture.

All right.

Thank you.

All right.

Thank you.

All right.

I'm ready to go.

Okay, you can go whenever you want.

You are on the main screen in the audience.

Thank you.

Thank you for this opportunity to present our recent experience using

Gynemesh in the repair of rectus uterus at our institution. In the past there

were two operative procedures commonly performed for rectus uterus repair

including transvaginal and transanal repairs. Although the transperineal

repair may be yet another option. I have generally abandoned this approach

because in my experience, it is far too painful for patients.

Gynemesh as shown here, here is a non-absorbable falling soft mesh. A

microscope view shows the interlinked structure of the mesh. Recently,

Recently, Gynemesh has been used for the repair of genital organ prolapse or bladder prolapse

in the urogynecology procedures.

Because of the etiology of rectocell, mesh reinforcement of the rectovaginal septum using

Gynemesh may be an effective repair for rectocells.

The following video will present my procedure for rectocele using gyne mesh.

The transvaginal repair for rectocele has become a common procedure in our colorectal center over the last two years.

That means the extent of rectocele is quite important as for other operations.

In particular, the entire perineum, including the deep supratransferred perineal muscles, must be carefully examined.

Saline solution, small amount of epinephrine added is injected to distend the submucosa or tissue

and to reduce the bleeding from the dissection.

A diamond-shaped intrusion is used to resect the vaginal mucosa.

Excision of the marginal mucosa is started at the top of the incision.

The rectal-vaginal septum is usually thin and weak because of the etiology of the rectocele.

Dissection of the space between submucosa of the vagina and the paralectal tissue is

easy but we get carefully performed to prevent bleeding and other complications

here. Dissecting submucosal between sub-tissues. We carefully

performed dissect pain near tissues here. The dissection is ideally as wide as

possible from the top of the left cell to the perineum and laterally should

be extended to the levator muscles on the both sides and the pubic contiguous.

Dysheptic space is irrigated with saline. The Guinness measure is placed into the

the space here we can use the pro pds2 to zero thread the average size of the mesh we use is

five by seven centimeter in our hospital but of course the size of the mesh depends on the size

of the rectocell. The mesh is fixed usually at the top both sides of the

levator muscles and the perineum with a total of about four to eight sutures.

In our cases using gyne mesh, we did not place a fixing suture but we found

that post-peritoneal follow-up after three months in some patients that the

Gynemesh had folded causing patients to have same symptoms they had before the

operation. This may be the cause of recurrent rectal symptoms. The

the intrusion in the vaginal mucosa is close to now being here, meshes is fixed

to the pineum here, and in this case, we perform the anterior levator plasti by

by three sutures.

You can see the provolonectylase and the anterior olivate plasty are up, yeah, three sutures

here.

Here you can see the mesh, and now the rectus tereo disappear, very tight, until wall up.

and this because our will be closed by three zero by cool without any tension

so far we have not any complications such as massive bleeding and abscess or

perforation in 60 cases of lactose will repair using guide image now so this is

post-operative pain on the slide. This slide showed the level of post-operative pain for

three kinds of rectocele repairs, with gynecological repair in green, the transanal repair in red,

and the transvaginal repair in blue. On this scale, the value on the y-axis show the percent

of patients with a low pain score using a visual analog scale. Thus, higher number

shows overall less pain in a group of patients. This is plotted against

post-operative day. As you can see, in the short term, post-operative follow-up,

The patients who underwent the gyne mesh repair have less pain than other patients

who had the other repairs.

Now this is perirectal operative laxative use.

use. This slide compares the perirectal operative laxative use by patients having three kinds

of rectal cell repairs. In the upper set of slides, preoperative graphs, you can see that

all three groups are similar. Red, a lot of use of laxatives are similar with

about 70% of patients use a lot of laxatives on a daily basis as shown in

red. Postoperatively, in the lower set, you can see that the Gynemesh

group reduced the daily use of laxative to just 8% here. The other group almost

like here, similar, but Gynemesh reduced 8%. The other groups are even

20% using a lot of laxative, yet postoperatively. This is a significant

difference here. Now this slide shows the patient overall level satisfaction

judged by just postoperatively. These data show that there is less satisfaction

with the transvaginal repair than with the transanal repair, unfortunately.

For this study, it also shows that the guide mesh repair has a significantly lower satisfaction

rate than the transvaginal repair or trans-analyte repair.

This data suggests that patient selection may be an important factor.

factor. We believe the size of the rectal cell may be a factor as well as the presence

of perineal descent. So, in conclusion, the transvaginal repair of rectal cell using Gynemesh

may have the results that are comparable to or even better than the result with

other established procedures long-term follow-up and follow further studies

will be needed to verify these preliminary result thank you so

So, Professor Tsujinaka, thank you so much for your lecture.

It was really impressive, especially for what is concerning the postoperative pain

and the perioperative laxative use of the patients.

What is your opinion about the less satisfaction of the patient as far as concerned the gynomesh use?

Did you get it, Professor? There is a question from the audience.

Can you tell us something, your opinion about the less satisfaction of Gynomesh, about the patient's satisfaction especially?

Can you hear us, professor?

Yes.

So, what is your opinion about the less satisfaction of the patient about Gynomesh?

Dr. One thing is the patient selection and the other thing is the transvaginal

repair is not feasible for the younger female or some kind of discomfort or might some

some unreliable result after the procedure.

But we have not yet complication after guide name should appear.

So this is only our preliminary report.

or we can define the reason why the patient who underwent

vaginal repair not satisfied the procedure soon in the next study.

Yes, certainly problem is because of youngsters are somehow infected

about the dyspareunia.

Perhaps this is the main problem, and I'm quite sure that you are so right when you speak about there must be a good selection of the patients.

Anyway, Professor, I just want to thank you on behalf of Professor Palathini, and I just want to give you some infos about this Congress that has been seen yesterday.

We have the data of yesterday.

More than 2,500 surgeons were on the hall during the day.

And more than 8,000 people could take a look at the Congress

through the streaming, I mean, through Internet.

So if you look at, if you can go to the Internet and see

www.laparoscopic.it, you can see your lecture as well.

well. And it has been streamed live, of course. So, thank you very much again, Professor.

Yeah, sure, sure. Thank you.

Thank you so much. I hope to see you in the near future in the same screens. Thank you

very much, Professor.

Yeah, next year.

Thank you, bye.

We will see you again.

Thank you, bye bye.

Bye.

Thank you so much.

Bye.