CERVICAL PRESERVATION COULD AVOIDMESH EXTRUSION IN LAPAROSCOPIC SACROPEXY PROCEDURE
L. Y. WU1, F. CHUANG1, K. HUANG 1, Y. CHANG 2;
1Dept.of OBS and GYN, Kaohsiung Chang Gung Mem. Hosp., Kaohsiung, Taiwan,2Kaoshiung Chang Gung Mem. Hosp., Kaoshiung, Taiwan.
Introduction: Laparoscopicsacrocolpopexy, sacrohysteropexy or sacrocervicopexy is one of thesurgical methods for pelvic organ prolapse. When considering thiskind of pelvic reconstruction surgery, to preserve uterus or not isour concern.
Objective: In this study, we’d like tocompare the clinical outcome of sacrocolpopexy to sacrohysteropexyand sacrocervicopexy.
Methods: This is a retrospectivestudy and we enrolled the patients who received pelvic organreconstruction surgery with laparoscopic sacrocolpopexy,sacrohysteropexy or sacrocervicopexy with Y-shaped mesh from July,2012 to August, 2015. Total 60 patients were available to becollected with complete parameters we tried to analyze. The patientsunderwent sacrocolpopexy were labeled as group A while others wereclassified to group B. Baseline characteristics, blood loss,operative time, length of hospital stay, POP-Q measurements,recurrence of pelvic organ prolapse (which was defined as POP-Q stage>=2) and complications were collected and compared between thesetwo groups.
Results: Twenty-five patients underwentsacrocolpopexy while 35 patients underwent sacrohysteropexy orsacrocervicopexy. The mean follow-up period of two groups were 15.6and 13.8 months, respectively. The mean age were 49.4 and 50.8 yearsold, respectively, without significant difference. POP-Q measurements(Aa, Ba, C, Ap, Bp) improved significantly (P < 0.001) in bothgroups. In group A, there was one recurrent POP who had cystocelestage 2 to 3 around thirty-seventh months after the sacrocolpopexy.Group B also had one recurrence with uterine prolapse stage 2 to 3,which was found around seventh month postoperatively. Group A hadsignificant more mesh exposure (N=6; 24.0%, and 4 of them receivedremoval of mesh) while only 2 people (5.7%) had mesh exposure ingroup B (p=0.040). Other incidence of related adverse eventssuch as transient buttock pain, de novo stress incontinence, urinaryretention, and dyspareunia were similar in these twogroups.
Conclusions: In this study, we found that theefficacy was similar whether we anchored Y-shaped mesh on vaginalvault or cervix. However, more mesh exposure occurred when weperformed sacrocolpopexy. Therefore, to preserve uterus or cervixmight be a better choice than sacrocolpopexy.
References:1. Olsen, A.L., et al., Epidemiology of surgically managed pelvicorgan prolapse and urinary incontinence. Obstetrics &Gynecology, 1997. 89(4): p. 501-506.
2. Costantini, E., et al.,Sacrocolpopexy for pelvic organ prolapse: evidence-based reviewand recommendations. European Journal of Obstetrics &Gynecology and Reproductive Biology, 2016. 205: p. 60-65.3. Pan, K.,et al., Laparoscopic sacral hysteropexy versus laparoscopicsacrocolpopexy with hysterectomy for pelvic organ prolapse.International Urogynecology Journal, 2016. 27(1): p. 93-101.