Surgical outcomes of laparoscopic sacrocervicopexy using a vaginally assisted d-shaped mesh in advanced stage pelvic organ prolapse patients with preservation of the uterus or cervix
IUGA Academy. Temtanakitpaisan T. Jun 30, 2018; 212807; 487 Topic: Pelvic Organ Prolapse
Dr. Teerayut Temtanakitpaisan
Dr. Teerayut Temtanakitpaisan

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487

Surgical outcomes of laparoscopic sacrocervicopexy using a vaginally assisted d-shaped mesh in advanced stage pelvic organ prolapse patients with preservation of the uterus or cervix

Temtanakitpaisan, T1; Wu , K2; Lee, C2

1: Faculty of Medicine, Khon Kaen University; 2: Department of Obstetrics and gynecology, Linkou Chang Gung Memorial Hospital, Taoyuan, Taiwan

Introduction: Sacrocolpopexy is a surgical procedure for treating apical uterovaginal prolapse. It was first described in 1962 and has a long-term success rate of 78-100%. In addition, sacrocolpopexy can be conducted laparoscopically. Laparoscopy is a minimally invasive approach that has become widely popular since the US FDA released their statement regarding the use of synthetic mesh in vaginal procedures. This approach has resulted in less blood loss, higher hemoglobin concentrations, and shorter hospital stays than laparotomy, while boasting promising short-term outcomes that are similar to those of laparotomic procedures. However, advanced laparoscopic skills are required for suturing and extensive dissection. We, thus, developed a simplified technique of performing surgery via both laparoscopic and vaginal approaches.

Objective: To evaluate the surgical outcomes of laparoscopic sacrocervicopexy using a vaginally assisted d-shaped mesh in advanced pelvic organ prolapse patients while preserving the uterus or cervix

Methods: Fifteen patients with advanced stage pelvic organ prolapse who underwent laparoscopic sacrocervicopexy using a vaginally assisted d-shaped mesh from April 2014 to June 2017 were enrolled. The operative procedure was divided into two parts. The first was a laparoscopic procedure to create the retroperitoneal tunnel from the sacral promontory to the cul-de-sac, and the next step was the vaginal operation. Circumferential incision of the cervix was performed and the vaginal wall was pushed up for mesh placement as Figure. The polypropylene mesh was made into a “d” shape. The end tail of the prepared mesh was folded and placed into the peritoneal cavity via posterior colpotomy incision. It was then sutured laparoscopically to the anterior longitudinal ligament of the sacral promontory. The medical records were retrospectively reviewed for surgical outcomes.

Results: The mean age and BMI +SD of the participants were 62.7 +7.1 years and 25.2 +3.3 kg/m2, respectively. The median parity was three (2, 3). Thirteen of the patients were menopausal (86.7%). In all cases, patients underwent concomitant surgeries. The mean operative time, changes in hemoglobin levels, and length of hospital stay +SD were 244.7 +48.7 minutes, -2 +0.7 g/dl, and 3.7 +0.9 days, respectively. The median amount of blood loss was 100.0 (50.0, 100.0) ml. There were no cases in which the patient received a blood transfusion or in which there were immediate complications after surgery. The procedures were accomplished without necessitating conventional laparotomy. The median follow-up time was 3.0 (2.0, 3.0) months and no mesh erosion or recurrent prolapse was detected during the follow-up period. However, three patients who underwent concomitant laparoscopic Burch colposuspension or laparoscopic paravaginal repair had voiding difficulty; one had excessive vaginal discharge, and one suffered from pain during defecation. All complications were resolved through conservative treatment.

Conclusions: Laparoscopic sacrocervicopexy using a vaginally assisted d-shaped mesh is a safe and effective procedure for correcting apical defects in advanced-stage pelvic organ prolapse while preserving the uterus or cervix intact.

Reference:

  1. Journal of minimally invasive gynecology. 2014
  2. Obstetrics and gynecology. 2004
  3. Obstetrics and gynecology. 2017

Disclosure:

Work supported by industry: no.

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