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Outcome of laparoscopic sacrocolpopexy with anterior and posterior polypropylene mesh in multicompartment pelvic organ prolapse
IUGA Academy. nomura m. Jun 30, 2018; 212912
Topic: Pelvic Organ Prolapse
Dr. masayoshi nomura
Dr. masayoshi nomura

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413

Outcome of laparoscopic sacrocolpopexy with anterior and posterior polypropylene mesh in multicompartment pelvic organ prolapse

Nomura, J1; Moriyama, S1; Huang, T1; Tokiwa, S1; Sawada, Y1; Hayashi, T1; Shimizu, Y1; Gonocruz, G1; Meutia, A1; Rathih, K1

1: Kameda Medical Center

Objectives: Laparoscopic sacrocolpopexy (LSC) is well known to be an effective method for apical vaginal suspension for pelvic organ prolapse (POP). However, it remains controversial whether LSC with anterior and posterior mesh play a role on supporting anterior and posterior compartments in vagina. The present study is to evaluate the anatomical outcomes of LSC with two separate meshes along the anterior and posterior vaginal walls for multicompartment POP.

Study design: This is a 3-year prospective observational study. A total of 135 patients presented with at least a Stage 2 apical prolapse, with an anterior and a posterior vaginal wall prolapse were included. During three years follow-up, 10 patients were lost to follow-up, and final 125 (92.6%) patients were included for further analysis. Two separate meshes (anterior mesh: average length 6cm, posterior mesh: average length 10cm) were used for LSC. The posterior mesh end was fixed on the levator ani muscles and the anterior mesh end was fixed on the vaginal wall at the level of the bladder neck. In this study, no concomitant surgery was performed. Objective success, subjective success, subjective failure, complication, and reoperation rate were evaluated. Objective success is defined as POPQ Stage 0 or 1 in all compartments and objective failure as Stage 2 or more in any compartment. Subjective success is defined as having no symptomatic bulge not protruding beyond the hymen based on the questionnaire. Subjective failure is defined as a recurrence of symptoms with no objective prolapse.

Results: The objective success rate was 94.4% (118 of 125). Of 7 objective failures, the site of recurrence was 1 in the apical, 4 in the anterior, and 2 in the posterior compartment. The subjective success rate based on patient’s questionnaire was 91.4%. The complication rate was 1.9%. Perioperative complications were 1 case of bladder injury and 2 cases of vaginal injury. Postoperative complications were port site hernia and ileus. During the follow-up, no vaginal mesh exposure and no chronic pelvic pain were seen. The overall reoperation rate was 6.0%. However, re-operation rate for POP was only 0.7% and re-operation for mid-urethral sling was 5.3%.

Conclusions: The present study provided the findings that LSC with anterior and posterior mesh had over 90% objective and subjective success rate and only 0.7% re-operation rate for POP for 3 years follow-up. These findings suggest that the effectiveness of LSC with anterior and posterior mesh on the support of the anterior and posterior compartment for mid-term. LSC with the anterior and posterior mesh can be an option for multiple compartment prolapses.

Disclosure:

Work supported by industry: no, by Jimmy Nomura.

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