Samuel Daniels1, Danielle Robson2, Magdalena Palacz1, Stuart Howell3, Tran Nguyen4, Fariba Behnia-Willison4. 1. Department of Gynaecology, Queen Elizabeth Hospital, Adelaide, South Australia, Australia. 2. Department of Obstetrics & Gynaecology, Royal Prince Alfred Hospital, Sydney, New South Wales, Australia. 3. Basil Hetzel Institute, Adelaide, South Australia, Australia. 4. Department of Obstetrics & Gynaecology, Flinders Medical Centre, Adelaide, South Australia, Australia.
Abstract
BACKGROUND: Uterovaginal prolapse is a prevalent gynaecological issue, which can have a negative impact on the quality of life of women. Hysterectomy and vaginal repair are conventional treatments to address apical prolapse; however, women are increasingly requesting uterine-preserving alternatives. AIMS: This study aimed to evaluate the impact of laparoscopic mesh sacrohysteropexy on symptomatic prolapse from an Australian experience. MATERIALS AND METHODS: This retrospective cohort study presents outcomes of 157 patients who underwent laparoscopic mesh sacrohysteropexy at a private practice in South Australia during 2007-2017. Primary outcome is the success rate according to the pelvic organ prolapse quantification (POP-Q) system. Secondary measures included complication rates and patients identified as having Stages III-IV prolapse and their outcomes. RESULTS: The median age was 58 years (27-86 years), median parity was 2 (0-6), and median body mass index was 26.8 (23-29.9). One hundred and thirty-four women had a laparoscopic hysteropexy and concurrent vaginal prolapse repair and four women had an isolated laparoscopic hysteropexy. The mean pre-operative point C was 0.60. The mean change from pre-operative point C to post-operative point C was 7.6 cm (P < 0.01). Of the 136 patients (98.6%) seen at post-operative 4-6 weeks, all had Stage 0 POP-Q scores. Prolapse recurrence was observed in 22 patients, while 116 patients remained cured at their last follow-up. Prolapse recurrence was associated with anterior vaginal mesh, previous prolapse surgery, pre-operative Stage III-IV disease and number of vaginal deliveries. CONCLUSIONS: Laparoscopic mesh sacrohysteropexy is an effective and safe procedure with a high success rate comparable to available international data.
BACKGROUND: Uterovaginal prolapse is a prevalent gynaecological issue, which can have a negative impact on the quality of life of women. Hysterectomy and vaginal repair are conventional treatments to address apical prolapse; however, women are increasingly requesting uterine-preserving alternatives. AIMS: This study aimed to evaluate the impact of laparoscopic mesh sacrohysteropexy on symptomatic prolapse from an Australian experience. MATERIALS AND METHODS: This retrospective cohort study presents outcomes of 157 patients who underwent laparoscopic mesh sacrohysteropexy at a private practice in South Australia during 2007-2017. Primary outcome is the success rate according to the pelvic organ prolapse quantification (POP-Q) system. Secondary measures included complication rates and patients identified as having Stages III-IV prolapse and their outcomes. RESULTS: The median age was 58 years (27-86 years), median parity was 2 (0-6), and median body mass index was 26.8 (23-29.9). One hundred and thirty-four women had a laparoscopic hysteropexy and concurrent vaginal prolapse repair and four women had an isolated laparoscopic hysteropexy. The mean pre-operative point C was 0.60. The mean change from pre-operative point C to post-operative point C was 7.6 cm (P < 0.01). Of the 136 patients (98.6%) seen at post-operative 4-6 weeks, all had Stage 0 POP-Q scores. Prolapse recurrence was observed in 22 patients, while 116 patients remained cured at their last follow-up. Prolapse recurrence was associated with anterior vaginal mesh, previous prolapse surgery, pre-operative Stage III-IV disease and number of vaginal deliveries. CONCLUSIONS: Laparoscopic mesh sacrohysteropexy is an effective and safe procedure with a high success rate comparable to available international data.
Authors: Deepa Gopinath; Chin Yong; Sam Harding-Forrester; Felix McIntyre; Dean McKenzie; Marcus Carey Journal: Int Urogynecol J Date: 2022-07-26 Impact factor: 1.932