C Bui1, M Ballester, E Chéreau, E Guillo, E Daraï. 1. Service de Gynécologie-Obstétrique, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Université Pierre-et-Marie-Curie Paris 6, 4 rue de la Chine, 75020 Paris, France.
Abstract
OBJECTIVE: To evaluate the feasibility and morbidity of laparoscopic promontofixation in the cure of genital prolapse. PATIENTS AND METHOD: From March 2001 to January 2009, 101 patients with genital prolapse of grade greater than or equal to 2 (POPQ classification) were operated by laparoscopy. Complications per and postoperative as well as patient satisfaction were assessed. Quality of life was evaluated using the questionnaires Pelvic Floor Distress Inventory (PFDI 20), Pelvic Floor Impact Questionnaire (PISQ 7) and Pelvic Organ Prolaps/Urinary Incontinence Sexual Questionnaire (PISQ 12). RESULTS: The mean operative time was 196 min including the time for hysterectomy done in 83% of cases. The peroperative complication rate was 7% including two bladder and one rectal injuries and 4% of laparoconversion. The postoperative complication rate was 16% corresponding to 3/4 of retention of urine. Two pelvic hematomas were observed. The distance complication rate was 3% corresponding to a vaginal erosion, a spondylodiscitis and a case of persistent pelvic pain requiring removal of material. With a mean follow-up of 30.7 months, 81% patients declared themselves satisfied with the intervention. In intention to treat, the satisfaction rate was only 67.3%. A significant improvement in quality of life was observed using the questionnaire PFDI 20 (p < 0.0001), PFIQ 7 (p < 0.0001) et PISQ 12 (p < 0.001). DISCUSSION AND CONCLUSION: Our results confirm the feasibility of the laparoscopic promontofixation with a quality of life improvement but also highlights the existence of significant morbidity requiring further trials for the choice of surgical approach for the treatment of genital prolapse.
OBJECTIVE: To evaluate the feasibility and morbidity of laparoscopic promontofixation in the cure of genital prolapse. PATIENTS AND METHOD: From March 2001 to January 2009, 101 patients with genital prolapse of grade greater than or equal to 2 (POPQ classification) were operated by laparoscopy. Complications per and postoperative as well as patient satisfaction were assessed. Quality of life was evaluated using the questionnaires Pelvic Floor Distress Inventory (PFDI 20), Pelvic Floor Impact Questionnaire (PISQ 7) and Pelvic Organ Prolaps/Urinary Incontinence Sexual Questionnaire (PISQ 12). RESULTS: The mean operative time was 196 min including the time for hysterectomy done in 83% of cases. The peroperative complication rate was 7% including two bladder and one rectal injuries and 4% of laparoconversion. The postoperative complication rate was 16% corresponding to 3/4 of retention of urine. Two pelvic hematomas were observed. The distance complication rate was 3% corresponding to a vaginal erosion, a spondylodiscitis and a case of persistent pelvic pain requiring removal of material. With a mean follow-up of 30.7 months, 81% patients declared themselves satisfied with the intervention. In intention to treat, the satisfaction rate was only 67.3%. A significant improvement in quality of life was observed using the questionnaire PFDI 20 (p < 0.0001), PFIQ 7 (p < 0.0001) et PISQ 12 (p < 0.001). DISCUSSION AND CONCLUSION: Our results confirm the feasibility of the laparoscopic promontofixation with a quality of life improvement but also highlights the existence of significant morbidity requiring further trials for the choice of surgical approach for the treatment of genital prolapse.