Clinical Outcomes of Laparoscopic Sacrocolpopexy for Pelvic Organ Prolapse: A Retrospective Analysis of 500 Cases From a Single Institution

Abstract

(Objectives) Laparoscopic sacrocolpopexy (LSC) is becoming a more popular alternative for pelvic organ prolapse (POP) repair in Japan in the recent years. This study aimed to evaluate the safety and efficacy of LSC. (Patients and methods) This is a retrospective study on all the LSC cases that were performed in Urogynecology center, Kameda Medical Center, Japan from January 2013 to March 2016. Medical records of all the patients were retrieved and details on operating time, estimated blood loss, perioperative complications, anatomical recurrence (postoperative POP-Q stage≥II) rate and reoperation rate were assessed.Our procedure of LSC used two pieces of polypropylene mesh placed on the vesico-vaginal and recto-vaginal space in which the dissection was extended to the level of the bladder neck and levator ani muscle. Subtotal hysterectomy was performed in almost all patients with uterus except in 39 women who chose to preserve their uterus. Additionally, multivariate analysis of risk factors for recurrence-free survival was performed using the Cox regression method. (Results) Five hundred and five patients who were diagnosed as POP (cystocele, rectocele, enterocele, uterine prolapse, vaginal vault prolapse) were included. The mean operating time and estimated blood loss were 236 min and 27.2 ml. There were 2.6% perioperative complication rate and 1.0% severe complication rate (Clavien grade≥IIIa). With a median follow-up of 12 months, anatomical recurrence rate was 8.0%, significant anatomical recurrence (stage≥III) rate was 1.2% and reoperation rate was 1.0%. Preoperative POP-Q stage IV was found as independent risk factors for anatomical recurrence. (Conclusions) The present study demonstrated a relatively low complication rate, low significant anatomical recurrence rate and low reoperation rate. Therefore, LSC is a safe and effective surgical treatment for various types of POP.

Vaginal Stump Prolapse After Bilateral Nephroureteral Hysterectomy

“…LSC became widespread with the technological development of laparoscopes, and after the FDA issued a warning about TVM, the number of facilities performing LSC gradually increased. In Japan, LSC was first covered by health insurance in 2016 and has since become a widespread treatment for POP 10,11) . In the present case, colpocleisis was previously performed twice; however, prolapse recurred.…”

Laparoscopic repair of vesicovaginal fistula caused by radiation therapy: Use of a perirectal fat interposition graft

“…The surgical vision under laparoscopy was superior to that with the naked eye under open laparotomy, which enabled precise suturing. We chose the laparoscopic repair technique because the procedure could be performed in the same field of view as laparoscopic sacrocolpopexy, which has been performed on patients with pelvic organ prolapse in our department 6 . Studies have reported a cure rate of 86–100% following laparoscopic VVF repair 7–9 .…”