Uterine preserving technique in the treatment of pelvic organ prolapse: Laparoscopic pectopexy

Abstract

Objective Apical prolapse constitutes an important part of pelvic organ prolapse. In this study, our aim was to investigate the effectiveness of laparoscopic pectopexy that we made by preserving the uterus in the surgical treatment of apical prolapse. Methods A total of 36 patients with apical prolapse who wanted to preserve their uterus underwent laparoscopic rectopexy. Apical prolapse and sexual function of the patients were evaluated preoperatively and 12 months after surgery using the Pelvic Organ Prolapse Quantification (POP‐Q) scale and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ‐12) sexual questionnaire form. Preoperative medical records and postoperative clinical results were recorded. Results There were no intraoperative or postoperative complications in the patients who underwent laparoscopic pectopexy. The average duration of surgery was 48.7 ± 9.8 min. Two patients had a recurrence of apical prolapse. In the Aa, Ba, C, and D points in the POP‐Q staging, significant changes were observed. Postoperative PISQ‐12 scores improved significantly (p < 0.05). Conclusion Uterine‐preserving laparoscopic pectopexy is a safe, feasible, and effective method for treating pelvic organ prolapse. It also improved the PISQ‐12 and POP‐Q scores in POP patients. Laparoscopic pectopexy may increase a surgeon's technical perspective for pelvic organ prolapse surgery.

Perioperative and Long-Term Anatomical and Subjective Outcomes of Laparoscopic Pectopexy and Sacrospinous Ligament Suspension for POP-Q Stages II–IV Apical Prolapse

“…Abdominal or laparoscopic sacrocolpopexy (SCP) or sacrocervicopexy (SCerP), as well as vaginal USLS, SSLF or SSHP are the most common procedures to support the apical compartment. Laparoscopic pectopexy, which has recently attracted the attention of various authors, should be considered as a surgical option for apical prolapse repair [12,13,17,18,20,21,32]. Due to mesh position in LP and suture placement in SSLF, the risk of de novo constipation rate is negligible as compared to SCP or SCerP [12,13,18].…”

“…Nowadays, a significant group of women expect their uterus to be preserved during surgery. Apart from the anatomical success, protection of the uterus has been reported to improve sexual function, especially in young patients [20]. The advantages of preserving the uterus include maintenance of the pelvic anatomy, preservation of the reproductive function, reduction of intraoperative blood loss, shortened operative time and hospital stay, lower rates of mesh exposure as well as higher self-confidence and sexuality [20,21].…”

“…Apart from the anatomical success, protection of the uterus has been reported to improve sexual function, especially in young patients [20]. The advantages of preserving the uterus include maintenance of the pelvic anatomy, preservation of the reproductive function, reduction of intraoperative blood loss, shortened operative time and hospital stay, lower rates of mesh exposure as well as higher self-confidence and sexuality [20,21]. Additionally, in the absence of concomitant hysterectomy, which is a risk factor for POP in itself, future development of POP can be prevented [22].…”

“…Additionally, in the absence of concomitant hysterectomy, which is a risk factor for POP in itself, future development of POP can be prevented [22]. In a recent study on LP, the authors concluded that preserving the uterus protects against de novo development of rectocele [20]. If the uterus or the uterine cervix are preserved, sacrospinous hysteropexy (SSHP) can be performed [19].…”

Unilateral pectineal suspension – A new surgical approach for apical correction of pelvic organ prolapse

“…It can be performed either transvaginally by sacrospinous fixation, or abdominally or laparoscopically by placing a mesh or biologic graft form the cervix to the anterior longitudinal ligament, or by shortening of the uterosacral ligament. In addition, mesh- supported pectopexy can also be successfully performed preserving the uterus ( Bolovis et al, 2021 ; Salman et al, 2022 ).…”