APICAL SUPPORT AT THE TIME OFANTERIOR PROLAPSE REPAIR
P. SOBARZO1, A.BUSTOS 1, A. RADWELL 1, H. CASTRO 2;
1Unidad Piso Pélvico, Hosp. Las Higueras, Talcahuano,Chile, 2Univ. de Concepcion, Concepcion, Chile.
Introduction: Apical support isconsidered paramount to overall female pelvic organ support.Recurrent anterior compartment prolapse has been attributed to manyfactors, one of which is lack of vaginal apical support.
Objective:The objective of our study is to evaluate the need to perform anapical correction surgery concomitant to the repair of a Stage IIIAnterior Compartment Prolapse when the Apical Prolapse have a point C< or = to -2.
Methods: The study was approved by theInstitutional Review Board of Las Higueras Hospital. Retrospectivestudy with database analysis of all patients without previousprolapse surgeries operated between March 1, 2013 and June 30, 2016.We included all patients with Anterior Compartment Prolapse stage IIIand with Point C (POPQ classification) between -5 and - 2. A completegynecological history, gynecological physical exam and the degree ofprolapse according to POPQ classification were performed in thepreoperative period. Patients were separated into 2 groups: prolapseanterior repair without apical correction (Group A) and with apicalcorrection (Group B). In the postoperative period, a gynecologicalexamination, POPQ classification, symptomatic prolapse and PGI-I(Patient Global Impression of Improvement) was evaluated at 2 weeks,6 months and 12 months postoperatively. Recurrence of anatomicalprolapse was defined as anterior compartment descent beyond the hymen(Ba > 0) according to the POP-Q system. The Patient GlobalImpression of Improvement (PGI-I) score was used to evaluate thepatients’ satisfaction after surgery. Epidemiological, clinical,surgical and follow up data were registered on Google Drive.Statystical analysis was performed with Microsoft Excel. Data arereported as mean ± standard deviation. Differences were tested usingStudent’s t-test for continuous parametric data, p value < 0.05was considered statistically significant.
Results: Duringthe study period, 351 surgeries of genital prolapse were performed.29 patients complete inclusion criteria. 25 (86%) continued follow-upat 6 months. Group A (without apical correction) 13 patients andGroup B (with apical correction) 12 patients. In Group B, 5 (41.7%)Laparoscopic Sacrocolpopexy and 7 (58.3%) Sacrospinous LigamentFixation were performed. At 6 months, 100% of patients in both groupscompleted follow-up. At 12 months 12/13 (92.3%) in group A and 10/12(83%) in group B completed the follow-up. At 6 months in Group A theaverage POPQ was Ba: +1.2, C: -4.9, HT: 3.3 and 2/13 (15.4%) reportedsymptomatic prolapse. In Group B the average POPQ was Ba: -0.3, C:-6.2, HT: 3.6 and 0/12 (0%) reported symptomatic prolapse. At 12months in Group A the average POPQ was Ba: +1, C: -4.6, HT: 3.3 and2/12 (16.7%) reported symptomatic prolapse. In PGI-I, 10/12 (83.3%)reported being excellent, much better or little much better. At 12months in Group B the average POPQ was Ba: -0.3, C: -5.7, HT: 3.1 and1/10 (10%) reported symptomatic prolapse. In PGI-I, 10/10 (100%)reported being excellent, much better or little much better. In groupA, 2 patients (15.4%) were reoperated, who underwent LaparoscopicSacrocolpopexy 15 months after the first surgery and are currentlyasymptomatic. In group B, no patient was reoperated. Anatomicaloutcomes in terms of recurrence of anterior compartment prolapse showstatistically significant differences. The patients’ satisfactionafter surgery and reoperation rate did not show statisticallysignificant differences.
Conclusions: Anterior vaginal wallprolapse is associated strongly with apical prolapse. Anteriorvaginal wall defects stage III without and important apical prolapsethat are surgically repaired require a concomitant repair of theapex.