LAPAROSCOPIC SACRALCOLPOPEXY VERSUSPERMANENT SUTURE FOR VAGINAL APICAL REPAIR: A RETROSPECTIVE COHORTSTUDY OF ANATOMICAL RESULTS
J. ALVAREZ1, C.RONDINI 2, M. J. URZUA 3, O. STORME 1,M. MONROY 1;
1Urogyneccology department,Hosp. Padre Hurtado, Santiago, Chile, 2Hosp. PadreHurtado, Santiago, Chile, 3hospial padre hurtado,santiago, Chile.
Introduction: Pelvic organprolapse reconstructive surgery is among the most common procedures awoman will undergo throughout her lifetime. As technology increasesand laparoscopy becomes more available, laparoscopic sacralcolpopexyis considered by many as the new gold standard for the treatment ofapical prolapse. However many surgeon preferred the vaginal route dueto its shorter operative time and apparent lower complications.Recent data have shown the importance of using permanent sutures whensuspending the apex in vaginal surgery.
Objective: The aimof the study is to compare anatomical results between laparoscopicsacralcolpopexy versus apical rehabilitation repair with permanentsutures.
Methods: We reviewed medical records of women whounderwent surgery for pelvic organ prolapse between January 2011 andDecember 2015 at a single tertiary referral center. Proceduresincluded were laparoscopic sacralcolpopexy or sacrocervicopexy, highuterosacral vault suspension and modified McCall`s culdopalsty. Forthe vaginal group only patients who underwent apical suspension withProlene® sutures were included. Sacrospinous ligament suspension,vaginal mesh repair and colpocleisis patients were excluded. Weanalyzed pre- and post-operative POP-Q evaluations as well asdemographic data and surgical times. To plot survival curves failurein the apical compartment was considered a decent of the apex below1/3 total vaginal length. For the anterior and posterior compartmentwe consider failure as decent at or beyond the hymenealring.
Results: One hundred and thirty two records wereavailable for review, 72 in the laparoscopic group and 60 in thevaginal route group. Demographic variables such as age, parity andBMI were comparable in both groups. Both groups had a similar followup time of 16 months. We found significant differences in the averagePOP Q measurements during follow up between both groups. For theanterior compartment (POP-Q Ba) the laparoscopic group -2.6 cm vs thevaginal route - 2.0 cm (p value = 0.001); Posterior compartment(POP-Q Bp) -2.6 vs., -2.0 (p value = 0.001); and the apicalcompartment -7.6 vs., -5.9 (p value 0.001). However we did not findsignificant difference between both groups when comparingKaplan-Meier Survival curves for the apical or anterior compartment.In the anterior compartment 19 out of 57 failed (33.3%) in theProlene group vs., 10 out of 75 (13.3%) in the LSC group log rank0.034. For the apical compartment 13 out of 56 (13.2%) failed in theProlene and 4 out of 75 (5.3%) in the LSC group log rank0.014.
Conclusions: Laparosopic sacralcolpopexy is quicklybecoming the new old standard for apical surgery however the vaginalroute continuous to be a viable option specially when suspending theapex with permanent sutures.
Table1: Demographic and Baseline POP Q
Table2: Post-Operative average POP Q at the latest follow up andsurgical time