Clinical Efficacy Of Laparoscopic High Level Uterosacral Ligament Suspension In The Treatment Of Pelvic Organ Prolapse

Objective:To observe the efficacy and safety of laparoscopic high-uterosacral ligament suspension(HUS)in the surgical treatment of pelvic organ prolapse patients and its advantages and disadvantages,and to compare the surgical efficacy with conventional surgery in the treatment of pelvic organ prolapse(POP)patients and its effect on the postoperative quality of life and sexual quality of life,with the aim of providing a scientific basis for choosing an effective treatment for female patients with pelvic organ prolapse.Methods:1.The clinical data of patients with pelvic organ prolapse admitted to the Department of Gynecology of Xuancheng City People’s Hospital,Anhui Province,from July 2018 to July 2021 were retrospectively analyzed,and the study group of 29 cases with laparoscopic high sacral ligament suspension and the control group of 35 cases with transvaginal total hysterectomy were selected according to different surgical approaches,and all patients underwent total hysterectomy,anterior vaginal wall repair,posterior vaginal wall repair if necessary etc.2.Subjects:(ⅰ)general information of patients:including mean age,age at menopause,time of prolapse,number of pregnancies and deliveries,Body Mass Index(BMI),history of hypertension,history of diabetes,history of chronic cough,history of chronic constipation,history of stress urinary incontinence,whether ovarian cysts are combined,and preoperative POP-Q score;(ⅱ)surgical conditions:intraoperative bleeding,operative time,postoperative spontaneous urination time,postoperative spontaneous venting time,operative cost,postoperative hospitalization days,recent postoperative patient-related complications(including infection,diarrhea,urinary retention,vaginal stump inflammation,etc.);(ⅲ)postoperative follow-up:POP-Q scores,PFDI-20 scale,PISQ-12 scale at 6 months and 1 year postoperative follow-up of patients.Results:1.There were no statistically significant differences in mean age,age at menopause,time to prolapse,number of pregnancies and deliveries,BMI,history of hypertensive disease,history of diabetic disease,history of chronic cough,history of chronic constipation,history of stress urinary incontinence and whether ovarian cysts were combined,and preoperative POP-Q scores between the two groups(P>0.05),and the groups were comparable.2.There were significant differences in intraoperative bleeding,operative time,operative cost,postoperative hospitalization days,time of spontaneous urination,and time of postoperative venting between the two groups,all of which were statistically significant(P<0.05).The study group had less intraoperative bleeding and shorter hospital stay than the control group,and the time of spontaneous urination and postoperative venting time were better than those of the control group,while the control group had shorter operative time and lower operative cost.3.6.90%(2/29)of the perioperative complications in the study group included symptoms of diarrhea and lumbago;14.29%(5/35)of the perioperative complications in the control group included postoperative infection,urinary retention,vaginal stump infection and lumbago symptoms,which were treated symptomatically and showed reversible improvement.There were no intraoperative injuries to the bladder,ureter,rectum and large blood vessels in both groups,and no serious complications occurred.4.POP-Q scores were performed on all patients before surgery,6 months after surgery,and 1 year after surgery,and the results were analyzed and compared to evaluate the anatomical efficacy of the surgery.The anatomical parameters of pelvic floor function Aa,Ba,C,Ap,and Bp points were significantly improved in both groups at 6 months and 1 year postoperatively compared with preoperative points,and the difference was statistically significant(P<0.05);there was no significant change in vaginal length in the study group before and after surgery,and vaginal length in the control group was shortened after surgery compared with preoperative points.There were no recurrence cases in the study group,and the anatomical cure rate(29/29)was 100%;2 patients in the control group had 2 recurrences 1 year after surgery,and the anatomical cure rate(33/35)was 94.29%.5.Patients in both groups completed the Pelvic Floor Dysfunction Questionnaire(PFDI-20)and the Pelvic Organ Prolapse/Incontinence Sexual Function Questionnaire(PISQ-12)before surgery,6 months after surgery,and 1 year after surgery,respectively,and the differences between the PFDI-20 and PISQ-12 scores in both groups before surgery were not statistically significant after statistical analysis(P>0.05),and the differences between the PDFI-20 and PISQ-12 scores in both groups at 6 months after surgery and 12 months after surgery were statistically significant(P<0.05).20 and PISQ-12 questionnaire scores at 6 months postoperatively and 12 months postoperatively were significantly improved compared with preoperative scores,and the differences were statistically significant(P<0.05),and the differences were not statistically significant at six months postoperatively and one year postoperatively.The results of PDFI-20 and PISQ-12 questionnaires in the study group showed better postoperative quality of life and sexual quality of life than the control group.6.In the study group,there was one case of postoperative groin pain with a subjective cure rate of 96.56%;in the control group,there were two cases of new-onset urinary incontinence and one case of vaginal tingling with a subjective cure rate of 85.71%.Conclusion:1.Laparoscopic high sacral ligament suspension is a surgical procedure with less intraoperative bleeding and faster postoperative recovery compared with traditional surgery,but it is more difficult to operate,more expensive and takes relatively longer time.2.Both laparoscopic high-sacral ligament suspension and traditional negative hysterectomy can restore the pelvic anatomy,but laparoscopic high-sacral ligament suspension can maintain the length of the vagina and the normal physiological axial direction of women,and the effect of apical suspension is better than that of traditional surgery.3.The postoperative quality of life and sexual quality of life were significantly improved in both groups compared with the preoperative period.The surgical results of laparoscopic high sacral ligament suspension were significantly conventional surgery.4.The recurrence rate of laparoscopic high sacral ligament suspension is low,and the recurrence rate of traditional negative total uterine surgery is relatively high.The incidence of long-term complications was significantly higher with conventional negative total uterine surgery than with laparoscopic high sacral ligament suspension.In conclusion,compared with traditional surgery,laparoscopic high sacral ligament suspension applied to POP is safe and effective,has a high anatomical cure rate,can significantly improve patients’ symptoms and improve their quality of life,and can be an ideal surgical procedure for the surgical treatment of patients with moderate to severe POP,especially suitable for younger patients.