Pelvic organ prolapse surgical training program in Bangladesh and Nepal improves objective patient outcomes
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ORIGINAL ARTICLE
Pelvic organ prolapse surgical training program in Bangladesh and Nepal improves objective patient outcomes Barbara Hall 1
&
Judith Goh 2,3,4,5,6 & Maqsudul Islam 7 & Anubha Rawat 1
Received: 10 July 2020 / Accepted: 2 October 2020 # The Author(s) 2020
Abstract Introduction and hypothesis The DAK Foundation (Sydney) has facilitated pelvic organ prolapse (POP) repairs performed by local gynecologists for underprivileged women in Bangladesh and Nepal since 2014. Initially, there was no long-term patient follow-up. When 156 patients were examined at least 6 months after their surgery, an unacceptably high rate of prolapse recurrence and shortened vaginas was identified. This demonstrated the need for surgical up-skilling in both countries. Our hypothesis is that the introduction of a surgical training program in low-resource countries can significantly improve patient outcomes after pelvic floor surgery. Methods One-on-one surgical re-training was undertaken to up-skill the gynecologists in fascial vaginal repair and vaginal apical reconstruction utilizing sacrospinous fixation (SSF). Following the surgical up-skilling, a further 289 women (between 6 and 18 months post-operatively) were examined to determine patient outcomes. Outcome measures were: 1. Prolapse recurrence: POPQ (pelvic organ prolapse quantification [1]) ≥ stage 2 2. Vaginal length < 4 cm Results Prior to implementation of the surgical training program, 76% of patients had recurrent prolapse ≥ stage 2, and 56% had a vagina < 4 cm in length. Following the training program, prolapse recurrence was reduced to 45% with significant reductions in the apical, anterior and posterior compartments. The incidence of unacceptable vaginal shortening was 4%. We could not rely on patient symptoms to determine whether they had recurrences. Conclusion Clinical patient follow-up to determine surgical outcome is essential in low-resource settings. We have demonstrated that surgical up-skilling in vaginal hysterectomy, vaginal repair and introduction of SSF were necessary to achieve acceptable prolapse recurrence rates in our programs in Bangladesh and Nepal. Keywords Low-resource settings . Pelvic organ prolapse . Sacrospinous fixation . Surgical training . Surgical outcomes . Vaginal repair
* Barbara Hall [email protected] 1
DAK Foundation, Sydney, Australia
2
Greenslopes Private Hospital, Brisbane, Australia
3
Gold Coast University Hospital, Gold Coast, Australia
4
Griffith University School of Medicine, Gold Coast, Australia
5
QE2 Hospital, Brisbane, Australia
6
Griffith University, Gold Coast, Australia
7
Impact Foundation, Dhaka, Bangladesh
Introduction Pelvic organ prolapse (POP) has a profound impact on the quality of life of women—especially women in low-resource countries. Limited evidence currently exists regarding the rate of POP in such women; however, the rate of major prolapse seems to be higher than in higher resource countries. This is probably due to differences in lifestyle, nutrition and parity. A 2016 study of w
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