Clinical Efficacy Of Laparoscopic Pectopexy In The Treatment Of Middle Pelvic Organ Prolapse

Objective:To investigate the clinical efficacy of Laparoscopic Pectopexy in the treatment of middle pelvic organ prolapse.Methods:The clinical data of 87 patients with middle pelvic organ prolapse POP-Q stage≥II admitted to the Department of Gynecology of the Second Hospital of Jilin University from January 2021 to December 2021 were collected.All the 87 patients underwent total vaginal hysterectomy during Laparoscopic Pectopexy due to older age and no fertility requirements.The operation process was performed by the same senior doctor.The general data of the selected subjects such as age,menopausal years,number of pregnancies,number of births,height,weight,BMI,combined medical and surgical diseases,and perioperative conditions such as intraoperative blood loss,operation time,whether additional surgery and its type,postoperative hospital stay,postoperative fever and lower extremity venous thrombosis were collected in details.The preoperative and postoperative pelvic organ prolapse quantitation(POP-Q)parameters including Aa,Ba C,Ap,Bp and TVL were compared to evaluate the overall objective cure rate and postoperative recurrence rate.To compare the subjective satisfaction of Pelvic Floor Impact Questionnaire-7(PFIQ-7)before and after surgery.Results:1.General Information: The average age of 87 subjects was(62.48±8.11)years(41-76 years),the average duration of disease was 7 days to 40 years,the average number of pregnancies was(2.5±1.1)times(1-5 times),the average number of births was(1.7±0.8)times(1-4 times),and the average height was(160.24±5.35)cm(150-174cm).The average body weight was(62.34±8.17)kg(46-85kg),and the average body mass index(BMI)was(24.29±3.06)kg/m2(18.36-32.81kg/m2).2.Perioperative conditions : All 87 patients underwent Vaginal Hysterectomy and Laparoscopic Pectopexy due to older age and no fertility needs.77 patients underwent traditional anterior vaginal wall repair because of vaginal anterior wall prolapse of Ⅲ degree and above,and 87 patients underwent traditional posterior vaginal wall repair vaginal due to posterior vaginal wall prolapse of grade Ⅱ or above.In addition to the above,additional procedures were added according to the preoperative examination results and intraoperative findings.There was no intestinal,bladder,obturator nerve injury,pelvic hematoma and other complications during the operation in 87 subjects.The mean operation time of 87 patients was(176.1±30.2)minutes(range,125-328 minutes).The average postoperative hospital stay was(6.9±1.9)days(4-18 days).One patient was hospitalized for 18 days because of short-term postoperative vaginal bleeding,and one patient was hospitalized for 7 days because of postoperative lower extremity venous thrombosis.The mean blood loss was(59.66±20.43)ml(30-150ml).3.Objective and subjective indexes were used to evaluate the efficacy of surgery:postoperative follow-up time was 12 months and 18 months after surgery.According to the results of POP-Q score before and 12 months after surgery:[Aa:(2.23±0.69)cm vs(-2.26±0.34)cm],[Ba:(3.78±1.62)cm vs(-2.17±0.33)cm],[C:(3.88±1.58)cm vs(-6.41±0.55)cm],[Ap:(1.53±0.80)cm vs(-2.22±0.34)cm],[Bp:(2.38±1.53)cm vs(-2.23±0.39)cm],[TVL:(7.76±0.46)cm vs(7.54±0.41)cm],except TVL,the other points were statistically different before and 12 months after operation.According to the POP-Q score before and 18 months after surgery,the results of each indicator point position were as follows:(Aa:(2.23±0.69)cm vs(-2.29±0.42)cm),(Ba:(3.78±1.62)cm vs(-2.21±0.32)cm),(C:(3.78±1.62)cm vs(-2.21±0.32)cm),(3.88±1.58)cm vs(-6.38±0.54)cm],[Ap:(1.53±0.80)cm vs(-2.23±0.41)cm],[Bp:(2.38±1.53)cm vs(-2.31±0.38)cm],[TVL:(7.76±0.46)cm vs(7.61±0.45)cm],except TVL,the other points were statistically different before and 18 months after operation.There was no significant difference between 12 months and 18 months after operation.The results of PFIQ-7 questionnaire before surgery were compared with those of PFIQ-7 questionnaire 12 months and 18 months after surgery,and the difference was statistically significant.There was no significant difference in PFIQ-7questionnaire score between 12 months and 18 months after surgery.In this study,74.7% of the patients had no or less sexual activity after menopause,the pelvic organ prolapse/urinary incontinence sexual questionnaire-12(PISQ-12)was not collected.4.Postoperative complications and recurrence: One patient had mesh exposure within half a year after operation,and was given mesh trimming in the outpatient department under sterile conditions,and recovered after local vaginal medication.Six patients developed de novo stress urinary incontinence after surgery,but none of them were treated due to mild symptoms.Four patients developed chronic pelvic pain after operation,but did not receive treatment because of mild symptoms.Three patients had vaginal bleeding symptoms during 18-24 months after operation,and the cause was vaginal inflammation leading to a small amount of vaginal bleeding,which was cured after active treatment.So far,there is no recurrence of prolapse and defecation disorder.Conclusion:1.The clinical efficacy of Laparoscopic Pectopexy in the treatment of middle pelvic organ prolapse is significant,and the operation is safe and effective.For patients with severe POP,Laparoscopic Pectopexy plus anterior and posterior vaginal wall repair can effectively improve the anatomical recovery and clinical efficacy.2.Due to the risks of infection,mesh exposure and erosion after the application of synthetic mesh in Laparoscopic Pectopexy,the incidence of postoperative complications can be effectively reduced by reasonable and appropriate selection of repair materials and following the surgical points.3.In order to effectively reduce the incidence of de novo stress urinary incontinence after laparoscopic Pectopexy,it is necessary to strictly screen for occult stress urinary incontinence before surgery,and prophylactic anti-urinary incontinence surgery can be considered for patients with high risk of de novo stress urinary incontinence.Staged surgery can be considered for patients with low predicted risk to avoid overtreatment.