Laparoscopic promontofixation for pelvic organ prolapse: A 10‐year single center experience in a series of 501 patients

Abstract

Objectives:To assess the long-term outcomes of laparoscopic promontofixation (LP) for the treatment of pelvic organ prolapse (POP). Methods: A total of 501 consecutive patients with POP were included in this prospective study. The patients' mean age was 63.23 (36-90) years, their mean body mass index was 25.14 (15-36) and their mean number of deliveries was 3.3 (0-14). A POP grade Ն3 was diagnosed in 70.4% of the patients and 38.9% of them had a history of abdominal surgery. The patients underwent a Bonney test and urodynamic study. In cases of stress urinary incontinence (SUI), the patients underwent the simultaneous insertion of a tension-free vaginal tape. A prolapse quality of life questionnaire was sent to all patients. Results: The mean operative time was 97.4 min (50-210) and there were 1.7% cases of intra-operative complications. The mean hospitalization time was 3.7 days (1-13 days). During the mean follow-up of 20.7 months (3-120), 91 (17.8%) complications were recorded , including constipation (5.5%), SUI (3.5%), vaginal erosion (2.4%), and urge incontinence (2%). Recurrences were recorded in 11.5% of the patients within an average time of 37.2 months. Risk factors for recurrence were the use of the polypropylene mesh compared with the polyester mesh (P < 0.0001), an intra-operative hysterectomy (P = 0.02), and bleeding (P = 0.049). There was a statistical significant (P < 0.001) improvement in most of the symptoms in the prolapse quality of life questionnaire. Conclusions: LP is safe with effective long-term results, with low recurrence and morbidity rates, and a good quality of life.

Laparoscopic sacral colpopexy: how to place the posterior mesh into rectovaginal space?

“…The simple size and the median follow‐up analyzed in this study could be considered the strengths of our paper, considering the existing literature …”

Laparoscopic promontofixation is safe and effective for POP

“…9 Hence, having more data concerning the efficacy and safety of laparoscopic sacro colpopexy, such as that provided by the Bacle et al 2 study, may prove helpful for surgeons. However, the technical challenges associated with laparoscopy may prevent some surgeons from using this approach: specifically, laparoscopic suturing remains a considerable barrier, as well as concern for avoiding the presacral vessels during dissection of the anterior longitudinal ligament.…”

“…Although many experts seem to agree that location and depth of injection has little effect on efficacy, data are available to both confirm and dispute these opinions. [1][2][3] Manecksha et al 4 have reported a clinical trial that used 500 U abobotulinumtoxinA in a setting of refractory idiopathic detrusor overactivity (IDO), where patients were randomized to receive either trigone-sparing bladder injections or bladder injections that included the trigone. The group of patients who received the trigone and bladder injections had a better overactive bladder symptom score (OABSS) at 6 weeks after treatment compared with the trigone-sparing group (P = 0.03).…”

“…However, the increased use of laparoscopy for advanced gynecologic procedures has allowed the repair of apical prolapse to be performed in a minimally invasive fashion. A recent study by Bacle et al 2 demonstrates that good long-term results can be achieved via laparoscopic treatment of POP.…”

“…Another large case series described 363 laparoscopic sacrocolpopexies, 3 and a smaller study with longer-term follow-up reported outcomes up to 5 years. 4 Bacle et al 2 propose that their low complication rate is a result of fixing the posterior mesh to the levator ani muscles rather than to the posterior vagina. The prolapse recurrence rates and mesh erosion rates are similar to previously reported studies, so this modification of the mesh placement may not have significantly affected the outcomes.…”