Hauptthema 2: Podiumsgespräch: Kritische Bilanz der operativen Gynäkologie

Summary Many procedures like surgery for vaginal atresia, metroplasty for septate uterus, myomectomy, tubal sterilisation, cervicopexy for prolaps of the uterus, vaginopexy for posthysterectomy vaginal prolaps, endometriosis of the pouch of Douglas, pelvic abscess, CIN, VAIN after hysterectomy, vesicovaginal fistula and rectovaginal fistula may be performed by the abdominal as well as by the vaginal route. For hysterectomy, the operative approach depends on the indication for which the uterus is removed, the size and mobility of the uterus, additional pathology like cystocele, rectocele or urinary incontinence and the width of the vagina. Both the abdominal and the vaginal approach have advantages and disadvantages. The mortality and morbidity are comparable although there are differences in the rates of various complications. Stress urinary incontinence is usually best treated by a suprapubic suspension procedure; cystocele and rectocele must be corrected vaginally. If severe stress incontinence is combined with marked relaxation of the vaginal wall a combination of an abdominal and a vaginal procedure is necessary. In conclusion, many procedures may be performed either abdominally or vaginally depending on the surgeons training, preferences and experience. Under certain circumstances, however, one or the other approach is preferable or even mandatory.