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311 - ANATOMICAL OUTCOMES COMPARED BETWEEN OPEN AND LAPAROCOPIC SACRAL COLPOPEXY AT 24 MONTHS FOLLOW UP

311

ANATOMICAL OUTCOMES COMPARED BETWEENOPEN AND LAPAROCOPIC SACRAL COLPOPEXY AT 24 MONTHS FOLLOW UP

C. RONDINI1, M. URZUA1, J. ALVAREZ 2, F. KAPLAN 3, H.BRAUN 3;
1Hosp. Padre Hurtado, Santiago,Chile, 2Urogyneccology department, Hosp. Padre Hurtado,Santiago, Chile, 3Hosp. padre hurtado, santiago, Chile.

Introduction: Abdominal sacralcolpopexy for the surgical management of apical prolapse is stillconsidered the gold standard over vaginal repairs. The morbidityassociated to the laparotomy sometimes limits its, this can sometimebe overcome with the laparoscopic approach however it is technicallymore challenging. Recent randomized control trials have shown thatboth approach have similar anatomical results, even though it wasbelieved the later had better surgical access and the ability ofreaching a further caudal dissection on both the anterior andposterior compartment. 1, 2
Objective: The aimof this study is to compare outcomes of open versus laparoscopicsacral colpopexy at 24 months follow up.
Methods:A retrospective cohort study of all female patients who underwent asacral colpopexy in our unit between the years 2010-2016 wasperformed. Baseline demographic information, clinical history andsurgical information were obtained from medical records and thehospital database. None of these patients underwent a transvaginalprolapse repair at the time of sacral colpopexy. Patients wereevaluated at 3, 6- 12- months and yearly thereafter. Surgical successwas defined as the anterior and posterior compartment descending nofurther than the vaginal introitus. Success for the apicalcompartment, however was considered to be POP Q point C notdescending further than 1/3 the total vaginal length. Success rateswere compared using Kaplan-Meir survival curves, Long-rank p <0.05 was considered significant.
Results: Eighty patientsunderwent a laparoscopic approach (LSC) and 119 open sacral colpopexy(ASC). Baseline demographic information such as age, BMI, stageIII-IV prolapse at the time of surgery, rate of concomitant sub-totalhysterectomy at the time surgery time were comparable on both groups(Table No 1). The mean follow-up was comparable between de groups(16.01 vs 16.16, p=0.940) At the 24-month follow-up, 6 patients inthe ASC group and 5 in the LSC group had anatomical failures of theapical compartment. This difference was not statistically significantLong-Rank p=0.895. Vaginal length in both groups was comparable (8.93cm ± 0.8 vs 9.14 cm ± 0.9, p=0.129). Anatomical failure of theanterior compartment was higher in the ASC group, 16 vs., 8 patientsin the LSC group, however, it didn’t reach statistic significant(Long-rank p=0.07). This was also seen on the posterior compartmentwith 16 patients with anatomical failure vs., two in the LSC. Thisdifference was significant (LogRank = p 0.003). Surgical times weresignificantly higher in the LSC group 182.04 ± 45.23 min vs 96.81min ± 28.54 (p=0.001). Hospital stay and post- operativecomplications rate were higher in the ASC group.
Table 1.Demographic and Baseline information.


ASC

LSC

PValue

Age(years)

57.2±9.1

55±7

0.296

Parity

3.5±1.6

3.2±1.3

0.769

BMI

27.9±7.1

28.7±3.6

0.360

PreviousProlapse surgery (%)

27.7

19.0

0.160

Concomitanthysterectomy (%)

42.0

43.8

0.809

POPStage III-IV %

49.6

38.8

0.132


Table 2. Surgical comparisonbetween ASC vs., LSC


ASC

LSC

PValue

Surgicaltime (min)

96.81min ± 28.54

182.04± 45.23

0.001

Hospitalstay (days)

3.0±0.7

2.2±0.5

0.001

Intraoperativecomplications (%)

5.0

1.3

0.155

Postoperativecomplications (%)

16.8

3.8

0.005


Conclusions: Open abdominaland laparoscopic sacral colpopexy have similar anatomical results forthe apical compartment, however the laparoscopic approach has betteranterior and posterior compartment results with fewer post operativecomplications.
References: Reference:

  1. IntUrogynecol J (2013)24:377-384

  2. IntUrogynecol J. (2013) 24:1883-1891