Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, and laparoscopic pectopexy for apical prolapse (original) (raw)
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International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics, 2016
To assess the safety and efficacy of a modified technique of bilateral abdominal sacrocolpopexy in which both uterosacral ligaments are replaced with polyvinylidene fluoride mesh to provide support to the cervix (cervico-sacropexy [CESA]) or vaginal vault (vagino-sacropexy [VASA]). A retrospective observational study was undertaken of women with posthysterectomy vault prolapse or recurrent apical prolapse following previous prolapse repair who underwent bilateral sacrocolpopexy between July 1, 2013, and December 31, 2014, in a tertiary referral unit in the UK. Before surgery and 3 months afterwards, prolapse was assessed using the Pelvic Organ Prolapse Quantification scale and functional outcomes were recorded using the International Consultation on Incontinence Questionnaire for vaginal symptoms and urinary incontinence. Fifty women were included. At 3 months, 47 (94%) patients reported no bulge symptoms and the mean point C was -7.6. Complications comprised bladder injury in 1 (2%...
Long-term outcomes and predictors of failure after surgery for stage IV apical pelvic organ prolapse
International Urogynecology Journal, 2017
Introduction and hypothesis The aim of this study was to compare outcomes after uterosacral ligament suspension (USLS) or sacrocolpopexy for symptomatic stage IV apical pelvic organ prolapse (POP) and evaluate predictors of prolapse recurrence. Methods The medical records of patients managed surgically for stage IV apical POP from January 2002 to June 2012 were reviewed. A follow-up survey was sent to these patients. The primary outcome, prolapse recurrence, was defined as recurrence of prolapse symptoms measured by validated questionnaire or surgical retreatment. Survival time free of prolapse recurrence was estimated using the Kaplan-Meier method, and Cox proportional hazards models evaluated factors for an association with recurrence. Results Of 2633 women treated for POP, 399 (15.2%) had stage IV apical prolapse and were managed with either USLS (n = 355) or sacrocolpopexy (n = 44). Those managed with USLS were significantly older (p < 0.001) and less likely to have a prior hysterectomy (39.7 vs 86.4%; p < 0.001) or prior apical prolapse repair (8.2 38.6%; p < 0.001). Median follow-up was 4.3 years [interquartile range (IQR) 1.1-7.7]. Survival free of recurrence was similar between USLS and sacrocolpopexy (p = 0.43), with 5-year rates of 88.7 and 97.6%, respectively. Younger age [adjusted hazard ratio (aHR) 1.55, 95% confidence interval (CI) 1.12-2.13; p = 0.008] and prior hysterectomy (aHR 2.8, 95% CI 1.39-5.64; p = 0.004) were associated with the risk of prolapse recurrence, whereas type of surgery approached statistical significance (aHR 2.76, 95% CI 0.80-9.60; p = 0.11). Conclusions Younger age and history of prior hysterectomy were associated with an increased risk of recurrent prolapse symptoms. Notably, excellent survival free of prolapse recurrence were obtained with both surgical techniques.
Journal of Obstetrics, Gynecology and Cancer Research
Background & Objective: Pelvic organ prolapse (POP) is accompanied by a remarkable decline in the quality of life. Determining the best surgical approach for women with POP is difficult because of outcome variations. We compared the outcomes of pelvic organ prolapse (POP) treatment by abdominal sacrocolpopexy (ASC) and vaginal sacrospinous ligament suspension (SSLS) for advanced apical prolapse beyond the level of the hymen (stage≥ II). Materials & Methods: This retrospective study was conducted on a case series of 58 ASC and 48 SSLS surgeries, which were performed through the posterior approach for advance prolapse during January 2019-April 2020. Pelvic Floor Disability Index (PFDI-20) questionnaire was completed both at the first visit and a year postop. All patients were visited ten days after the procedure and re-visited after 2, 4, 6, and 12 months. Results: Of a total of 106 women, 80 cases completed the study (n=40 in each group). Within-group analysis showed that the overall score of PFDI-20 and its subscales decreased in both evaluated groups after surgery (P<0.001). However, the between-group analysis revealed that this reduction in the ASC group was statistically significant in the total score of PFDI, POPDI-6, and UDI-6 subscales (P<0.05). In addition, vaginal length was demonstrated to improve in both groups, which was statistically significant in the ASC group (P=0.001). The stage of prolapse was improved in both groups (P<0.001), and it was more significant in the ASC group (P=0.049). There was no statistically significant difference between the SSLS and ASC in terms of the rate of satisfaction (93% vs. 100%; P=0.241). Conclusion: According to our findings, ASC and SSLS diminished the symptoms of POP. The surgery approach should be chosen based on the condition of patients, POP stage, and the experience of surgeons.
International Journal of Women's Health, 2023
Background: Pelvic organ prolapse (POP) is a medical condition that profoundly impacts women's quality of life. Unfortunately, the literature lacks long-term predictors and risk factors for its recurrence. This study aims to assess the efficacy and safety of Sacrocolpopexy/Sacrohysteropexy and to identify the predictors of recurrence in a Saudi setting. Methods: In a retrospective cohort study, all patients who underwent Sacrocolpopexy (n=144) and Sacrohysteropexy (n=56) between 2009-2021 were followed up. Electronic medical records were examined to collect data on the following: Patient characteristics [age, parity, BMI, and past medical and surgical history], prolapse-related characteristics/symptoms, Surgery-related characteristics [type and approach of surgery, mesh type, and concomitant surgery], and Outcome characteristics. Postoperative anatomical success and failure rates were determined according to the Baden-Walker classification. Logistic regression analysis was applied to identify the predictors of overall anatomical failure of Sacrocolpopexy. Significance was considered at p<0.05. Results: Success rates of 96.8%, 99.4%, and 85.2% were detected in the anterior, apical, and posterior vaginal prolapse, respectively, with an overall success rate of 83.1%. The overall failure rate was 15.9%, with an incidence density of 5.98 per 100 women-years. The onset of failure in 27 failure cases ranged from 40 days to 11.5 years postoperative. After adjustment for the possible potential confounders, older age (OR=1.06, 95% CI:1.01-1.13, p=0.03) and the presence of diabetes (OR=4.93, 95% CI:1.33-18.33, p=0.02) were the only significant predictors of operation failure. As for complications, six cases (3.6%) required reoperation, two cases (1.2%) had a bowel obstruction two and seven years after surgery, and one patient (0.6%) had vaginal mesh exposure. Conclusion: The outcomes of Sacrocolpopexy/Sacrohysteropexy in our study are comparable to those in previous studies. Diabetes and elder age at the time of the surgery played a role in predicting recurrence. Sacrocolpopexy has a long-term profile of safety and efficacy. These findings could be key to stratifying surgical plans for pelvic organ prolapse cases.
Sacrocolpopexy for pelvic organ prolapse: evidence-based review and recommendations
European journal of obstetrics, gynecology, and reproductive biology, 2016
Sacrocolpopexy is considered a reference operation for pelvic organ prolapse repair but its indications and technical aspects are not standardized. A faculty of urogynecology surgeons critically evaluated the peer-reviewed literature published until September 2015 aiming to produce evidence-based recommendations. PubMed, MEDLINE, and the Cochrane Library were searched for randomized controlled trials published in English language. The modified Oxford data grading system was used to access quality of evidence and grade recommendations. The Delphi process was implemented when no data was available. Thirteen randomized, controlled trials were identified, that provided levels 1 to 3 of evidence on various aspects of sacrocolpopexy. Sacrocolpopexy is the preferred procedure for vaginal apical prolapse (Grade A), monofilament polypropylene mesh is the graft of choice and the laparoscopic approach is the preferred technique (Grade B). Grade B recommendation supports the performance of conc...
Asian Journal of Endoscopic Surgery, 2020
Introduction: Natural orifice transluminal endoscopic surgery has been used for gynecologic operations in recent years. The aim of the study is to describe our initial experience using vaginal-assisted natural orifice transluminal endoscopic surgery (vNOTES) for apical pelvic organ prolapse repair. Methods: After patients underwent vaginal hysterectomy, vNOTES sacrocolpopexy (n = 4) or vNOTES high uterosacral ligament suspension (n = 7) were performed to treat symptomatic apical pelvic organ prolapse. Sociodemographic and clinical characteristics, Pelvic Organ Prolapse Quantification results, and recorded surgical data (eg, duration of surgery, intraoperative complications, additional prolapse and incontinence surgeries) were obtained from patient files and the hospital's database. Information from postoperative follow-up visits, including complications and anatomical results, were also recorded. Results: The mean age of the patients was 60.7 ± 9.1 years. The mean total operative time was 121.3 ± 22.7 minutes. The mean operative time for vaginal hysterectomy, vNOTES sacrocolpopexy, and vNOTES uterosacral ligament suspension was 46 ± 11.9, 65 ± 38, 25 ± 8.2 minutes, respectively. There were no intraoperative and postoperative complications observed. The mean postoperative 24-hour visual analog scale score was 3.5 ± 1.9 for vNOTES sacrocolpopexy patients and 3.2 ± 0.9 for vNOTES uterosacral ligament suspension patients. Only one patient in the vNOTES sacrocolpopexy group had a recurrence; she experienced stage 2 anterior compartment prolapse 8 months after surgery. Conclusion: As a treatment for apical pelvic organ prolapse, vNOTES is a feasible approach in both sacrocolpopexy and uterosacral ligament suspension.
Neurourology and Urodynamics, 2019
Aims: Apical defect is a pelvic organ prolapse disorder, with 5%-15% prevalence. The aim of the study was to investigate methods of laparoscopic repair of apical defect and compare them with other techniques (open, vaginal, and robotic). Methods: A systematic search of the literature was conducted in MEDLINE/ PubMed and ClinicalTrials.gov databases using the following key words: apical prolapse and treatment procedures. The search was limited by using the humans filters. Only articles published in English between 2010 and 2018 were considered. Two independent authors reviewed the publications for inclusion on the basis of the following criteria: (a) use of laparoscopic techniques, and (b) apical support loss as indication for surgery. Results: A total of 1002 papers were initially identified; 24 studies fulfilled the inclusion criteria. Four main laparoscopic procedures were found. The reported anatomical success rate (POP-Q < II stage) was 77%-100%, with patient satisfaction for pectopexy, laparoscopic sacropexy (LS), lateral ligament suspension and laparoscopic uterosacral ligament suspension (LUSLS) of 96.4%-97.6%, 71.0%-100%, 66.7%-87.8%, and 95%-95.5%, respectively. Major complications included hemorrhage, bladder, ureter, and/or bowel injuries were rare. Prolapse recurrences after LUSLS and LS were reported in 13.2% and 10.4% of patients, respectively; with reoperation rate for LS 2.2%-12.8%. Conclusions: Most studies reported anatomical and subjective outcomes, with follow-up ranging from 1 month to >7 years. Success rates for laparoscopic and abdominal corrections of apical defect were similar; laparoscopy was superior in terms of perioperative blood loss, length of hospital stay, and recovery. K E Y W O R D S apical prolapse, laparoscopic lateral suspension, laparoscopic uterosacral ligament suspension, minimally invasive surgery, pectopexy, pelvic organ prolapse, sacropexy 1 | INTRODUCTION Pelvic organ prolapse (POP) is a worldwide health problem, the prevalence of which ranges from 10% in younger women to 50% in postmenopausal women. 1-6 Apical defect, the least frequent of all POP types, has been reported in 5%-15% of women. 7 DeLancey established three levels of support for proper position of the pelvic organs:
Female pelvic medicine & reconstructive surgery, 2016
To determine the rate of perioperative complications and cost associated with Mayo-McCall culdoplasty (MMC), open abdominal sacrocolpopexy (ASC), and robotic sacrocolpopexy (RSC) for posthysterectomy vaginal vault prolapse. We retrospectively searched for the records of patients undergoing posthysterectomy apical vaginal prolapse surgery (MMC, ASC, or RSC) between January 1, 2000, and June 30, 2012, at our institution. For all patients identified, perioperative complications, length of hospital stay, and inpatient costs to patients were abstracted from the medical records and compared by procedure. Inverse-probability-of-procedure weighting using propensity scores was used to obtain less-biased comparisons of outcomes between procedures. A total of 512 patients met the inclusion criteria (174 MMC, 237 ASC, and 101 RSC). Using inverse-probability weighting, the MMC group had a significantly lower intraoperative complication rate (3.3% vs 11.6% for ASC, 3.4% vs 24.1% for RSC), median ...
A case series of laparoscopic Pectopexy in management of apical prolapse in Indian patients
Background: Uterovaginal prolapse is a common problem seen in Indian women affecting women in both young as well as old age. It may also occur in post hysterectomy cases. Laparoscopic pectopexy is a proposed new technique of apical prolapse repair. There are no Indian studies being done on this latest technique till date. Objective: To present a case series of laparoscopic pectopexy, a new technique of apical prolapse repair in Indian patients a new techniqueincentre and to assess its efficacy. Materials and Methods: Twelve patients of apical prolapse either uterovaginal or vault prolapse were included in study. Laparoscopic cervico-or colpopectopexy was done using iliopectineal ligaments on both sides of pelvic side walls. The perioperative and short term results were observed and recorded. Results: Laparoscopic pectopexy was done in our twelve cases which included 8 uterovaginal and 4 vault prolapse. The mean effective blood loss was less than 10 ml and average operative time was around 96 minutes. There were no intraoperative complications in any of our patients. In no case conversion to laparotomy was neededN. In follow up there were no major gastrointestinal, urinary complications with no de novo cystoceles or recurrence or stress urinary incontinence with excellent patient satisfaction. Conclusion: Laparoscopic pectopexy is a new technique in a surgeon's armamentarium that can be used more safely, effectively and easily as compared to sacrocolpopexy in management of apical prolapse. Introduction Pelvic organ prolapse is a common health problem affecting about 30% of women between 20-59 years of age and more than half of this are over 50 years of age which may lead to unnecessary increase in hysterectomies [1, 2, 3] Pelvic organ prolapse may seriously influence the physical, psychological and social well-being of affected women. This condition may present with symptoms of pelvic heaviness, protrusion of vagina or dyspareunia. Women may also have associated altered bowel and bladder symptoms like constipation, urinary incontinence or retention. Incidence in Indian women is underreported because of hesitancy in discussing problems like urinary incontinence and prolapse uterus by our women. Surgery is the definitive treatment for symptomatic apical prolapse. The goals for surgical management of apical prolapse are to relieve all symptoms and restore normal functional anatomy with no recurrence. Sacrocolpopexy either done abdominally or laparoscopically is being considered the gold standard technique for repair of apical prolapse for both uterovaginal and vault prolapse till now [4, 5]. Laparoscopic route is definitely better as it provides advantage of minimal invasion, less blood loss and rapid postoperative recovery. In sacrocolpopexy a mesh is placed between the sacrum and vagina or cervix which narrows the pelvis due to post op adhesions. Many studies have clearly mentioned that sacropexy is associated with defecation disorders, constipation, small bowel obstruction [5, 6]. Pelvic organ prolapse is more common in obese patients in which this technique may be less feasible due to restricted accessibility in posterior compartment [7]. Moreover technically this technique require high surgical expertise as it require dissection close to vital structures leading to injury of right ureter and sometimes life threatening bleeding from presacral vessels [8, 9]. In 2007, Guntner Noe introduced a new technique of pectopexy which uses iliopectineal ligaments which are being used over a long time for Burch operation and the iliopectineal ligament is considered stronger than anterior longitudinal ligament [10, 11] .
Facts, Views and Vision in ObGyn, 2021
Introduction: Vaginal sacrospinous fixation and sacrospinous hysteropexy (SSF/SSHP) are highly effective procedures for apical compartment prolapse. The established technique is the posterior vaginal approach. The alternative anterior approach through an anterior vaginal incision, although occasionally mentioned in the literature, is less well established. However, this approach is a more appropriate route if posterior vaginal surgery is not indicated. The aim of this paper is to review surgical outcomes of anterior approach in our centre and to compare outcomes of SSF vs SSHP. Methods: Retrospective case note review of 60 patients who underwent anterior SSF for prolapse between 2009-2017 was performed. Preoperative and postoperative symptoms and findings were recorded. Anterior SSF involved an anterior vaginal incision and paravaginal access to the ligament for dissection and fixation to either the cervix or vault. Results: SSF was performed in 39 patients, out of which 8 underwent...