Short-Term Safety And Efficacy Analysis Of Linear Laparoscopic Pectopexy

Objective:The short-term safety and efficacy of linear laparoscopic pectopexy in the treatment of patients with pelvic organ prolapse(POP)were discussed through the comparison of preoperative and postoperative evaluation indexes,so as to provide a more optimized surgical method for the clinic.Methods:Between June 1,2019 and May 31,2022,96 patients with symptomatic uterine prolapse with POP-Q score ≥Ⅱ who with or without of anterior and posterior vaginal prolapsewere enrolled at the First Hospital of Shanxi Medical University.All enrolled patients received linear laparoscopic pectopexy.General data such as age,height,weight,body mass index(BMI),maternal history,menopause,stage of prolapse,medical and surgical complications,surgical duration,intraoperative blood loss and postoperative indentation days were collected.The enrolled patients were followed up for at least 6months.During postoperative follow-up,we adopted POP-Q score and the length and width of the anterior vaginal wall which were measured from a three-dimensional model of the anterior vaginal wall which was conducted based on Magnetic Resonance Imaging(MRI)to evaluate the surgical effect.Pelvic floor distress inventory 20(PFDI-20),pelvic floor impact questionnaire short form 7(PFIQ-7)and pelvic organ prolapse/urinary incontinence sexual questionnaire 12(PISQ-12)were used to evaluate the effect of surgery.The recurrence rate and postoperative complications of pelvic organ prolapse were observed.Results:Preoperative POP-Q score of 96 patients: C(2.69±3.11),D(1.72±2.71),which was found that the patients receiving this operation mainly had middle pelvic defects.Operation time: 135-325 min,average time:(187.53±38.83)min,intraoperative blood loss: 20-100 ml,average blood loss:(54.22±29.49)ml,postoperative indenture catheter days: 2-12 days,average(5.72±1.75)days.There were no secondary injuries of bladder,intestine,ureter and great blood vessel during the operation.After the operation,the 3patients could not autonomously urinate after the catheter was removed on the 3rd and5 th day respectively,and the catheter was kept in indwelling later.All the patients could autonomously urinate after the catheter was removed on the 12 th day after the operation.The postoperative follow-up time was 6-12 months,and there were no serious complications during the follow-up.5 patients had new polypoid at the broken end of vagina after the operation,and no patients had new urinary incontinence.Comparison of POP-Q scores before surgery and 6 and 12 months after surgery: Comparison of POP-Q scores before surgery and 6 months and 12 months after surgery had statistical difference(P < 0.05).Comparison of PFDI-20 scores and PFIQ-7 scores before surgery and 6months after surgery had statistical difference(P < 0.05).76 patients resumed sex at least3 months after surgery.Comparison of PISQ-12 scores before surgery and 12 months after surgery had statistical difference(P < 0.05).Among them,29 patients underwent MRI examination of female pelvic floor muscle,and the length and width(2 points)of anterior vaginal wall in MRI images before and after surgery at rest and preoperative and postoperative MRI images at Valsalva anterior vaginal wall width(2 points)was compared had statistical difference(P < 0.05).At rest anterior vaginal wall width(1 point)comparison and at Valsalva anterior vaginal wall length comparison anterior vaginal wall width(1 point)comparison,there wasn’t a statistical difference.Conclusion:After linear laparoscopic pectopexy,patients’ pelvic floor structure recovered well,and the patients show high subjective satisfaction,fewer complications,low recurrence rate,which confirmed the surgery is safe and feasible within short-term observation.