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abstract

303 - THE SAFETY, OBJECTIVE AND SUBJECTIVE OUTCOME OF LAPAROSCOPIC SACROCOLPOPEXY WITHOUT RETROPERITONEALISATION OF MESH: A LONG TERM COHORT STUDY

303

THE SAFETY, OBJECTIVE AND SUBJECTIVEOUTCOME OF LAPAROSCOPIC SACROCOLPOPEXY WITHOUT RETROPERITONEALISATIONOF MESH: A LONG TERM COHORT STUDY

W. M. KLERKX, C. VAN DEN AKKER,P. S. SCHOLTEN;
Diakonessenhuis, Utrecht, Netherlands.

Introduction: The laparoscopicsacrocolpopexy (LSC) is performed to provide DeLancey’s level 1support for (recurrent) pelvic organ prolapse. Whether the peritoneumshould be closed over the mesh is a debated issue.Retroperitonealisation of mesh could minimize the risk of adhesionsand bowel obstruction, however peritoneal closure can cause injury tothe ureter and prolongs operation time. Although several studies havebeen conducted on the safety, objective and subjective outcome ofLSC, the effect of mesh retroperitonealisation on complication rateis not yet proven.
Objective: The study aims to analyze thelong-term safety, objective and subjective outcomes of the LSCwithout peritoneal closure of mesh.
Methods: Eligiblepatients underwent a LSC between 2004-2014, were >18 years, andhad good understanding of the language. The LSC procedure wasstandardized, mesh was attached to the vaginal vault withnon-resorbable sutures and tension-free placed on the promontory withtackers. In all procedures, the peritoneum was not closed over themesh. Baseline data of all patients was obtained by a chart research.The Medical Ethics Committee approved the study protocol (R15.076).The retrospectively identified cohort (n=179) was asked toparticipate in the follow-up study. When informed consent wasobtained, questionnaires were sent and patients were asked to visitthe outpatient clinic to perform a physical examination. Thedifferent domains of the questionnaire comprise the quality of life,urogenital symptoms, defecation complaints, incontinence impact, andsexual functioning.
Results: Figure 1 presents theflow-chart of inclusion. Baseline characteristics are described inTable 1. With regard to the safety we identified two patients inwhich a complication could be related to no peritonealisation ofmesh. Both patients had a mechanical ileus caused by theintra-abdominal mesh more than 2 weeks after LSC. They underwent alaparotomy and the mesh was released. Three patients had erosion ofsutures in the bladder, peritoneal closure could provide an extratissue layer between bladder and mesh. The incidence of postsurgicalanterior prolapse (POP-Q stage ≥2) was 32,7%, posterior prolapse38,9% and 1.1% for the apical compartment. However 19 patients hadbothersome complaints for which they had a re-operation, two weretreated with a pessary. The total success rate; no reoperation, nodescend beyond hymen and no bulging symptoms, was 51,3% (n=61/119)with a median follow-up (IQR) of 35 months (18,3-55,0). Regarding thesubjective outcomes; 103 patients filled in their impression ofimprovement, 29 stated their health status as much better (28,2%), 45as better (43,7%), 16 registered no change (15,5%), 8 as worse(7,8%), and 5 patients as much worse 5 (4,9%). In total, 71,9% of thewomen found their condition improved after LSC. The results of theurogenital domains are presented in Table 2.
Conclusions:The safety results of this study is comparable to reports inliterature1-3. Although anatomical recurrence was presentin approximately one third of the patients, only 10,6% had bothersomecomplaints for which they underwent retreatment, and 71,9% of thepatients found their condition improved.
References: EurUrol 2005;47(2):230-6BJOG 2005;112(4):486-9Eur J Obstet GynecolReprod Biol 2009;146(2):227-31


Baselinecharacteristics of the three selected cohorts

Characteristic

Cohort1

Cohort2

Cohort3

Medianage (IQR)

67(60-73)

65(59-71)

66(58-73,5)

Medianbody mass index (IQR)

25,9( 23,3- 28,6)

26,3(23,3-28,7)

26,4(23,3-28,7)

Medianfollow-up in months (IQR)

73(45-98)

35(19-55)

29(15- 47)

Medianparity per patient (IQR)

2(2-3)

2(2-3)

2(2-3)

Abdominalhysterectomy in past

65(36,3%)

41(34,5%)

18(30,5%)

Vaginalhysterectomy in past

110(61,5%)

75(63,0%)

41(69,5%)

Laparoscopicsubtotal hysterectomy concomitantly

4(2,2%)

3(2,5%)

0(0%)

DeLancey’slevel 1 surgery in past

112(62,5%)

77(64,7%)

41(69,5%)

DeLancey’slevel 2 surgery in past

106(59,2%)

73(61,3%)

38(64,4%)

DeLancey’slevel 3 surgery in past

2(1,1%)

2(1,7%)

0(0%)


Urogenitalsubdomain scores filled in before LSC and at follow-up

Subdomains

Medianpreoperative sum score (IQR)

Medianpostoperative sum score (IQR)

p-value

Overactivebladder

33(0-56)

11(0-33)

0,003

Incontinence

16(0- 33)

17(0- 33)

0,84

Obstructivevoiding

0(0-33)

0(0-17)

0,006

Urogenitalpain

17(0-50)

0(0-25)

0,001

Genitalprolapse

67(33-67)

0(0-0)

0,000

RecurrentUTI

1(1-2)

1(1-2)

0,43

Obstipation

0(0-17)

0(0-17)

0,55

Obstructivedefecation

0(0-8)

0(0-8)

0,62

Defecationpain

0(0-0)

0(0-0)

0,87

Fecalincontinence

0(0-0)

0(0-0)

0,64

Flatusincontinence

3(2-4)

2(2-3)

0,02