Laparoscopic sacral hysteropexy versus laparoscopic sacral colpopexy plus supracervical hysterectomy in patients with pelvic organ prolapse
Tóm tắt
The choice of whether or not to preserve the uterus in the case of patients with urogenital prolapse who undergo sacral colpopexy is still debated. We compared objective and subjective outcomes of laparoscopic sacral hysteropexy (LSHP) and laparoscopic sacral colpopexy with concomitant supracervical hysterectomy (LSCP/SCH) in patients with symptomatic pelvic organ prolapse. This is a multicenter retrospective cohort study conducted at the Urogynecology Department of the Fondazione Policlinico Universitario A. Gemelli IRCCS of Rome and at the Diaconesses Croix Saint Simon Hospital of Paris. We collected data of 136 patients; 78 underwent LSHP and 58 underwent LSCP/SCH for pelvic organ prolapse between January 2016 and December 2017. Patients of the two groups had similar preoperative characteristics. All patients completed 24-month follow-up evaluation. Overall, anatomical cure rate was 84.6% and 87.9% in the LSHP group and LSCP/SCH group, respectively, without statistically significant differences. In particular, in the LSHP group the anatomical success rate was 94.9%, 92.3% and 92.3% for the apical, anterior and posterior vaginal compartment whereas in the LSHP group LSCP/SCH was 100%, 91.4% and 94.8%, respectively. Subjective success rate was 89.7% among patients who underwent LSHP and 93.1% among women who underwent LSCP/SCH (p = 0.494). The median operative time (OT) was significantly shorter in LSHP. There were no significant differences between the groups in terms of estimated blood loss, conversion to laparotomy and intra- and postoperative complications. Patients’ satisfaction was high in both groups without statistical differences. Both laparoscopic procedures are safe and effective in the treatment of pelvic organ prolapse. LSHP can be offered as an alternative in women who are strongly motivated to preserve the uterus in the absence of abnormal uterine findings.
Tài liệu tham khảo
Haylen BT, Maher CF, Barber MD, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Neurourol Urodyn. 2016;35(2):137–68. https://doi.org/10.1002/nau.22922.
American College of Obstetricians and Gynecologists and the American Urogynecologic Society. Pelvic organ prolapse. Female Pelvic Med Reconstr Surg. 2019;25(6):397–408. https://doi.org/10.1097/SPV.0000000000000794.
Dallenbach P, Kaelin-Gambirasio I, Jacob S, et al. Incidence rate and risk factors for vaginal vault prolapse repair after hysterectomy. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19(12):1623–9. https://doi.org/10.1007/s00192-008-0718-4.
U.S. Food and Drug Administration. (2011) FDA safety communication: update on serious complications associated with transvaginal placement of surgical mesh for pelvic organ prolapse. http://wayback.archive-it.org/7993/20170722150848/https://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm262435.htm. Published July 13, 2011.
U.S. Food and Drug Administration. (2019) Urogynecologic Surgical Mesh Implants. https://www.fda.gov/medical-devices/implants-and-prosthetics/urogynecologic-surgical-mesh-implants. Published April 16, 2019.
Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 2016;10(10):CD012376.
Costantini E, Brubaker L, Cervigni M, et al. Sacrocolpopexy for pelvic organ prolapse: evidence-based review and recommendations. Eur J Obstet Gynecol Reprod BiolOct. 2016;205:60–5. https://doi.org/10.1016/j.ejogrb.2016.07.503.
Gluck O, Blaganje M, Veit-Rubin N, et al. Laparoscopic sacrocolpopexy: a comprehensive literature review on current practice. Eur J Obstet Gynecol Reprod Biol. 2020;245:94–101. https://doi.org/10.1016/j.ejogrb.2019.12.029.
Korbly NB, Kassis NC, Good MM, et al. Patient preferences for uterine preservation and hysterectomy in women with pelvic organ prolapse. Am J Obstet Gynecol. 2013;209(5):470.e1–6. https://doi.org/10.1016/j.ajog.2013.08.003.
Tan-Kim J, Menefee S, Luber K, et al. Prevalence and risk factors for mesh erosion after laparoscopic-assisted sacrocolpopexy. Int Urogynecol J. 2011;22(2):205–12. https://doi.org/10.1007/s00192-010-1265-3.
Bensinger G, Lind L, Lesser M, et al. Abdominal sacral suspensions: analysis of complications using permanent mesh. Am J Obstet Gynecol. 2005;193(6):2094–8. https://doi.org/10.1016/j.ajog.2005.07.066.
Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205. https://doi.org/10.1097/01.sla.0000133083.54934.ae.
Toozs-Hobson P, Freeman R, Barber M, Maher C, Haylen B, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse. Int Urogynecol J. 2012;23:527–35. https://doi.org/10.1007/s00192-012-1726-y.
Srikrishna S, Robinson D, Cardozo L. Validation of the patient global impression of improvement (PGI-I) for urogenital prolapse. Int Urogynecol J. 2010;21:523–8. https://doi.org/10.1007/s00192-009-1069-5.
Lizee D, Campagna G, Morciano A, et al. Laparoscopic sacral colpopexy: how to place the posterior mesh into rectovaginal space? Neurourol Urodyn. 2017;36(6):1529–34. https://doi.org/10.1002/nau.23106.
Panico G, Campagna G, Vacca L, et al. (2020) Minimally invasive surgery in urogynecology: a comparison of standard laparoscopic, minilaparoscopic, percutaneous surgical system and robotic sacral colpopexy. Minerva Med. Apr 8. doi: https://doi.org/10.23736/S0026-4806.20.06561-1.
Ercoli A, Cosma S, Riboni F, et al. Laparoscopic nerve-preserving sacropexy. J Minim Invasive Gynecol. 2017;24(7):1075–7. https://doi.org/10.1016/j.jmig.2017.03.008.
US Food and Drug Administration. (2014) UPDATED laparoscopic uterine power morcellation in hysterectomy and myomectomy: FDA safety communication. https://www.fda.gov/MedicalDevices/Safety/AlertsandNotices/ucm424443.htm. Published December 7, 2016.
Gracia M, Perelló M, Bataller E, et al. Comparison between laparoscopic sacral hysteropexy and subtotal hysterectomy plus cervicopexy in pelvic organ prolapse: a pilot study. Neurourol Urodyn. 2015;34(7):654–8. https://doi.org/10.1002/nau.22641.
Li PC, Ding DC. Outcomes of laparoscopic hysteropexy and supracervical hysterectomy plus cervicopexy: a retrospective study. Tzu Chi Med J. 2020;32:262–6. https://doi.org/10.4103/tcmj.tcmj_131_19.
Meriwether KV, Antosh DD, Olivera CK, et al. Uterine preservation vs hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines. Am J Obstet Gynecol. 2018;219(2):129–146.e2. https://doi.org/10.1016/j.ajog.2018.01.018.
Costantini E, Mearini L, Bini V, et al. Uterus preservation in surgical correction of urogenital prolapse. Eur Urol. 2005;48(4):642–9. https://doi.org/10.1016/j.eururo.2005.04.022.
Gueli Alletti S, Restaino S, Finelli A, et al. (2020) Step by step total laparoscopic hysterectomy with uterine arteries ligation at the origin. J Minim Invasive Gynecol. Jan;27(1):22–23. doi: https://doi.org/10.1016/j.jmig.2019.06.001.
Bojahr B, Tchartchian G, Waldschmidt M, et al. (2012) Laparoscopic sacropexy: a retrospective analysis of perioperative complications and anatomical outcomes. JESLS. Jul-Sep;16(3):428–36. https://doi.org/10.4293/108680812X13462882736132.
Gutman R, Maher C. (2013) Uterine-preserving POP surgery. Int Urogynecol J. Nov;24(11):1803–13 doi: https://doi.org/10.1007/s00192-013-2171-2.
Kalis V, Rusavy Z, Ismail KM. (2020) Laparoscopic sacrohysteropexy: the Pilsner modification. Int Urogynecol J. Jun;31(6):1277–1280. doi: https://doi.org/10.1007/s00192-019-04150-1.
Gagyor D, Kalis V, Smazinka M, et al. Pelvic organ prolapse and uterine preservation: a cohort study (POP-UP study), 21. BMC Womens Health. 2021;(1):72. https://doi.org/10.1186/s12905-021-01208-5.
Turner L, Lavelle E, Lowder JL, et al. The impact of obesity on intraoperative complications and prolapse recurrence after minimally invasive sacrocolpopexy. Female Pelvic Med Reconstr Surg. 2016;22(5):317–23. https://doi.org/10.1097/SPV.0000000000000278.
Frick A, Walters MD, Larkin KS, et al. Risk of unanticipated abnormal gynecologic pathology at the time of hysterectomy for uterovaginal prolapse. Am J Obstet Gynecol. 2010;202:507–e1-4. https://doi.org/10.1016/j.ajog.2010.01.077.
Andy UU, Nosti PA, Kane S, et al. Incidence of unanticipated uterine pathology at the time of minimally invasive abdominal sacrocolpopexy. J Minim Invasive Gynecol. 2014;21(1):97–100. https://doi.org/10.1016/j.jmig.2013.07.008.