Comparison of first versus second line sacrocolpopexies in terms of morbidity and mid-term efficacy

Abstract

To compare pelvic organ prolapse (POP) recurrence and morbidity between first and second line sacrocolpopexies. We conducted a retrospective chart review of all laparoscopic or robotic sacrocolpopexies for POP-Q stage ≥ 2, with or without a history of previous prolapse repair, performed with a similar technique between January 2012 and June 2019 in 3 European Gynecologic Surgery Departments. Patients were separated into two groups: first line sacrocolpopexy (FLS) and second line sacrocolpopexy (SLS). Each patient from the SLS group was age-matched with a patient from the FLS group. The primary outcome measure was reoperation procedures for recurrent POP defined as a symptomatic POP-Q stage ≥ 2 POP in at least one vaginal compartment. Secondary outcomes included operative time, intraoperative organ trauma, intraoperative blood loss, postoperative POP recurrence (operated on or not), global reoperation and mesh-related complications. During this period, 332 patients were included. After age-matching, 170 patients were analyzed: 85 patients in the FLS and SLS groups, respectively. After a mean follow-up of 3 years, there was no statistically significant difference between the two groups in terms of recurrent POP (9.4% versus 10.6%, p = 0.7), recurrent POP reoperation (3.5% versus 5.9% p = 0.7), mesh-related reoperation (0% versus 2.4%, p = 0.5), global reoperation (3.5 versus 8.2%, p = 0.3), operative time (198 ± 67 min versus 193 ± 60 min, p = 0.5), intraoperative complications such as organ injury (4.7% versus 7.1%, p = 0.7) and blood loss > 500 mL (2.4% versus 0%, p = 0.5). Patients who underwent a first or a second line sacrocolpopexy seemed to have similar rates of prolapse recurrence and complications.

“Less is More, is R-LESS More?”—The Use of Robotic Laparoendoscopic Single-Site Surgery in Gynaecology: A Scoping Review

“…Table 1 (Ref. [19][20][21][22][23][24]) shows the citations of the excluded articles. In terms of general concerns about the safety and usability of single-site surgery, Scheib et al [25] pondered in 2015 if R-LESS done by experienced surgeons was possible and safe.…”

“…There were no significant differences between the three groups in terms of median operating time or estimated blood loss. The robotic group (17.0, range ) and SPL group (16.0 [11][12][13][14][15][16][17][18][19][20][21]) acquired substantially more pelvic lymph nodes than the laparoscopic group (13.0 [3][4][5][6][7][8][9][10][11][12][13][14][15][16][17][18]), p = 0.04. The median number of para-aortic nodes acquired by the three groups, however, did not differ significantly.…”