Pelvik Organ Prolapsus Cerrahisi
Özet
Pelvik organ prolapsusu (POP), pelvik taban desteğinin kaybıyla vajinal yapıların yer değiştirmesidir ve risk faktörleri arasında genetik, yaş, parite ile menopoz yer alır. POP yönetiminde konservatif (yaşam tarzı, egzersiz, pesser) ve cerrahi tedavi seçenekleri mevcuttur. Cerrahi müdahaleler obliteratif ve rekonstrüktif prosedürler olarak ikiye ayrılır. Obliteratif cerrahiler (kolpokleizis), seksüel inaktif ve komorbiditeleri olan yaşlı hastalar için uygun, yüksek başarı ve memnuniyet oranlarına sahip yöntemlerdir. Rekonstrüktif cerrahiler ise anterior, posterior ve apikal kompartman defektlerini anatomik olarak düzeltmeyi hedefler. Geleneksel olarak rekonstrüktif yaklaşımlarda birincil yöntem histerektomi olsa da, son yıllarda doğurganlığın, cinselliğin ve özsaygının korunması amacıyla uterus koruyucu cerrahiler (histeropeksi teknikleri) popülarite kazanmıştır. Vajinal veya minimal invaziv abdominal (laparoskopik/robotik) yollarla yapılan bu ameliyatlar, daha kısa operasyon süresi ve daha az kan kaybı sunmaktadır. Ayrıca vajinal onarımlarda doğal doku kullanımı ön plandadır; çünkü FDA, yüksek komplikasyon ve reoperasyon oranları nedeniyle POP tedavisinde transvajinal mesh kullanımını durdurmuştur. Son yıllarda lateral süspansiyon ve pektopeksi gibi yenilikçi teknikler de alternatif olarak gelişmektedir.
Pelvic organ prolapse (POP) is the displacement of vaginal structures following the loss of pelvic floor support, with risk factors including genetics, age, parity, and menopause. Conservative (lifestyle changes, exercises, pessaries) and surgical options are available for POP management. Surgical interventions are divided into obliterative and reconstructive procedures. Obliterative surgeries (colpocleisis) are suitable for sexually inactive elderly patients with comorbidities, offering high success and satisfaction rates. Reconstructive surgeries aim to anatomically correct anterior, posterior, and apical compartment defects. While hysterectomy has traditionally been the primary method in reconstructive approaches, uterus-preserving surgeries (hysteropexy techniques) have gained popularity recently to maintain fertility, sexuality, and self-esteem. These surgeries, performed via vaginal or minimally invasive abdominal (laparoscopic/robotic) routes, offer shorter operation times and less blood loss. Furthermore, the use of native tissue is preferred in vaginal repairs, as the FDA has halted the use of transvajinal mesh for POP treatment due to high complication and reoperation rates. In recent years, innovative techniques such as lateral suspension and pectopexy have also emerged as alternatives.
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