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abstract

309 - OUTCOME OF WOMEN WHO RECEIVED LAPAROSCOPIC SURGERY FOR PELVIC ORGAN PROLAPSE

309

OUTCOME OF WOMEN WHO RECEIVEDLAPAROSCOPIC SURGERY FOR PELVIC ORGAN PROLAPSE

S. CHAN1, R. CHEUNG2;
1Department of Obstetrics andGynaecology, The Chinese Univ. of Hong Kong, Shatin, Hong Kong,2Department of Obstetrics & Gynecology, The ChineseUniv. of Hong Kong, Hong Kong, Hong Kong.

Introduction: Suspension ofmiddle compartment is an important procedure to treat pelvic organprolapse. Laparoscopic sacrocolpopexy is one of the treatment optionsfor vaginal vault prolapse. Its role in prophylactic treatment inwomen with uterine prolapse is uncertain. Another option for womenwho want to preserve their uterus is laparoscopichysterocolposacropexy.
Objective: To review theperi-operative and medium term outcome of women who receivedlaparoscopic sacrocolpopexy or hysterocolposacropexy.
Methods:This is an analysis of a prospectively collected database.Demographic data, symptoms and POPQ findings have been collected.Generally, laparoscopic sacrocolpopexy (Lap SC) was offered to womanwith vaginal vault prolapse. In woman with stage III/IV uterineprolapse, aged <65 and sexually active, option of vaginalhysterectomy with concomitant laparoscopic sacrocolpopexy (VH+LapSC)was offered. Laparoscopic hystercolposacropexy (Lap HSC) was offeredif women requested for uterine preservation. Concomitant continencesurgery would be performed if women were diagnosed urodynamic stressincontinence. Operative and peri-operative information werecollected. After surgery, women were followed-up in 3-4 months andthen annually. Symptoms of prolapse and urinary incontinence, andsubjective satisfaction on the surgery were asked; POPQ assessmentfor recurrence was performed during the follow-up. Recurrence ofprolapse was defined as recurrence of ≥ stage II prolapse. If awoman had received operation for the recurrence, the latest findingsbefore that surgery were regarded as the outcome of that woman.Ethics approval was obtained from local institute.
Results:In all, 126 women had received one of the three types of surgery;another 19 women who had robotic assisted laparoscopic sacrocolpopexywere not included. Their characteristics, peri-operative informationand complications were listed in table 1. There were lowperi-operative complication rates. Four women had the operation donewithin 3 months and no follow-up data was available. The meanfollow-up duration was 20-43 months. Overall, 15.6%, 4.2% and 7.1%who had Lap SC, VH+Lap SC and Lap HSC, respectively, had recurrenceof prolapse. And 23.8%, 16.7% and 20%, respectively, had de novostress urinary incontinence. However, overall, only 2 and 4 womenrequired re-operation for prolapse or stress incontinence. 9.1% ofwomen in VH+Lap SC group had mesh exposure; and 4.5% requiredout-patient excision of exposed part of mesh. The overall rate ofpatient’s satisfaction for all three operations wasgood.
Conclusions: Lap SC, VH and Lap SC, and Lap HSC aretreatment options for women with vaginal vault prolapse or uterineprolapse. There were low peri-operative complications andre-operation rate. Overall patient’s satisfaction was high.However, long term result is needed.
References:

Table1. Baseline characteristics of women received laparoscropicsurgery for pelvic organ prolapse

Baselinecharacteristics


LapSC group (n=64)

VH+ Lap SC group (n=48)

LapHSC group (n=14)

P-value

Ageat surgery (years)


63.5(7.5)

60.8(5.0)

49.5(8.5)*,**


Parity


3.1(1.4)

2.6(1.0)

2.1(1.1)*


Overallstaging of prolapse

II

27(42.2%)

1(2.1%)

10(71.4%)

<0.005


III

29(45.3%)

29(60.4%)

2(14.3%)



IV

8(12.5%)

18(37.5%)

2(14.3%)


Stagingof middle compartment

II

34(53.1%)

5(10.4%)

10(71.4%)

<0.005


III

22(34.4%)

25(52.1%)

2(14.3%)



IV

8(12.5%)

18(37.5%)

2(14.3%)


Previouspelvic floor repair surgery


32(50%)

0

0

<0.005

Previouscontinence surgery


11(17.2%)

0

0

0.003

Lap=laparoscopy,PFR=pelvic floor repair, POP=pelvic organ prolapse, SUI=stressurinary incontinence, VH=vaginal hysterectomy
*P<0.05 whencompared with Lap SC group, **P<0.05 when compared with VH+LapSC group


Table2. Details of operation of women who received laparoscopic surgeryfor pelvic organ prolapse

Indexoperation


LapSC group (n = 64)

VH+ Lap SC group (n = 48)

LapHSC group (n = 14)

Concomitantoperation

LaparoscopicPFR

4(6.3%)

0

0


VaginalPFR

54(84.4%)

48(100%)

11(78.6%)

Concomitantcontinence operation

Lapcolposuspension

5(7.8%)

0

0


TVT-O

11(17.2%)

9(18.8%)

4(28.6%)

Operativetime (minutes)


207.7(53.0)

245.4(45.2)*

226.4(42.4)

Bloodloss (ml)


133(75)

210(128)*

150(121)

Intra-operativecomplications

Conversionto laparotomy

2(6.3%)

0

0


Bladderinjury

2(6.3%)

0

0


Uretericinjury

0

1(2.1%)

0


Table3. Outcome of women who follow-up at least 3 months afterlaparoscropic surgery for POP

Outcome(N = 121)


LapSC group (n = 63)

VH+ Lap SC group (n = 44)

LapHSC group (n = 14)


Durationfrom surgery (months)


43.3(27.1)

20.4(19.0)

27.6(10.9)


Recurrenceof POP


10(15.6%)

2(4.2%)

1(7.1%)

0.054

Involvedcompartment

Anterior

8(12.6%)

2(4.25)

0



Middle

0

0

1(7.1%)



Posterior

2(3.2%)

0

0


Timeof recurrence (n = 13) (months)


range3-36

range12 - 22

15


Denovo SUI


5/21(23.8%)

3/18(16.7%)

1/5(20%)


Mesherosion / exposure


0

4(9.1%)

0


Re-operation

Forprolapse

2(3.2%)

0

0



ForSUI

3(4.9%)

1(2.1%)

0



Mesherosion

0

2(4.5%)

0