Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, and laparoscopic pectopexy for apical prolapse

Abstract

Objective:To investigate differences in perioperative complications and short-term outcomes of patients who underwent abdominal sacrocolpopexy / sacrohysteropexy, laparoscopic sacrocolpopexy / sacrohysteropexy, or laparoscopic pectopexy due to apical prolapse.Materials and Methods:A retrospective cohort study was performed on 110 patients who underwent apical prolapse surgery between January 1, 2011, and July 31, 2017. Only symptomatic uterine or vaginal vault prolapse patients with stage 2-4, according to the pelvic organ prolapse quantification system, were included. Baseline and intraoperative variables of groups; perioperative complications, including hemorrhage, urinary, and wound complications, blood transfusion, ileus, and short-term outcomes were compared.Results:A total of 68 abdominal sacrocolpopexies (44 sacrocolpopexies and 24 sacrohysteropexies), 14 laparoscopic sacrocolpopexies (10 sacrocolpopexies and 4 sacrohysteropexies), and 28 laparoscopic pectopexies (16 pectopexies and 12 pectohysteropexies) were analyzed. Baseline characteristics and intraoperative variables were similar. However, the mean operating time was significantly shorter in the laparoscopic pectopexy group (74.9 min) when compared with that of the other groups (p < 0.01). During the six-month follow-up period, no prolapse recurrence and mesh erosion / exposure were observed in any group. De-novo stress urinary incontinence, urgency, and defecation problems, as well as perioperative complication rates, were not statistically significantly different between the groups.Conclusions:Although the complication rates and short-term outcomes were not significantly different between the groups, minimally invasive approaches were associated with reduced procedural-related morbidity. Laparoscopic pectopexy is a promising endoscopic prolapse surgery and can be an alternative technique to sacrocolpopexy.

Comparison of laparoscopic techniques for apical organ prolapse repair – a systematic review of the literature

“…Studies comparing LS and RSC did not show differences between groups in success outcomes. Biler et al, in the study about abdominal sacropexy, LS and pectopexy, found no occurrences of de novo apical prolapse at 6 months follow‐up. In studies regarding pectopexy, we found one (2.3%) relapse of apical prolapse after pectopexy reported by Noe after 21.8 months of follow‐up and none in the initial study by Banerjee .…”

“…On the basis of preoperative data, the following patients were most frequently referred for apical defect repair: POP‐Q ≥ II, postmenopausal, aged 50 to 60 years and BMI ≥ 25 kg/m 2 . The shortest laparoscopic procedure durations were 43.1 minute and 74.9 ± 34.05 minutes . (both for pectopexy); durations also depended on concomitant procedures: posterior and/or anterior defect repair and surgery for urinary incontinence.…”

“…Patients whose quality of life was impaired by POP‐related symptoms, i.e. pressure on the vagina, protrusion, dyspareunia, low back pain, sexual function impairment, and urinary symptoms, such as incontinence, frequency, urgency or retention, were referred for surgical treatment . Coolen et al compared abdominal sacropexy and LS at 12 months postoperatively.…”

“…Wound infection was the most common complication for abdominal sacrocolpopexy . Bowel injury occurred mostly during sacropexy: in 0.69%‐1.9% of patients after LS and in 3.4%‐3.7% after abdominal approach sacropexy …”

“…for LS. As for the remaining studies, the shortest operative time was recorded for pectopexy (74.9 ± 34.05 minutes) and the longest for LLSHE (237.1 ± 57.6 minutes). In a study by Cucinella et al, 20 women underwent RSC and 20 LS.…”