Evaluation On Clinical Effectiveness Of Laparoscopic Sacral Colpopexy

Objective: To evaluate the efficacy and safety of laparoscopic sacralcolpopexy (LSC) in treatment of pelvic organ prolapse (POP).Methods: The clinical data of29cases of severe POP who hadundergone LSC by the same physician in the Second Hospital of HebeiMedical University from November2008to February2014were analyzedretrospectively. The Pelvic Organ Prolapse Quantification (POP-Q)classification was used to evaluate anatomy situation. The short-form of PelvicFloor Distress Inventory (PFDI-20), Pelvic Floor Impact Questionnaire(PFIQ-7) and Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12)were used to evaluate symptoms, health-related quality of life (HRQL) andsexual function. Patients were assessed at1month,6months and12monthsafter surgery, and then yearly. We compared the follow-up results withpreoperative data. The data about operative time, blood loss and so on wererecorded to comprehensively evaluate the surgical safety and hospital costswere recorded to evaluate economic burden for patients.Results: The average operation time was of228.1±35.2minutes (range130～280minutes), blood loss was120.0±76.0ml (range50~400ml), twopostoperative patients (6.9%,2/29) had fever with temperatures higher than38.5℃, postoperative hospitalization time was4.9±1.1days (range4~5days), time of indwelling urinary catheter was3.0±1.1d days (range2~7days),total cost of hospitalization22170.5±5410.3RMB.29patients were followedup for1to64months, with a median follow-up time of14.0months, theanatomical results at6months showed a significant correction (P<0.05)relative to the preoperative values, on all pelvic floor parameters measured.This improvement remained significant after12months (P<0.05). There wasno difference between the results obtained at6months and those at12months. Postoperatively all patients had good apical anatomic support, but onepresented with anterior vaginal wall prolapse Ⅱ degree. The objective curerate was96.6%. The preoperative scores of PFDI-20, PFIQ-7and PISQ-12were101.9±13.4,98.2±11.9and20.6±1.8, respectively. At6months aftersurgery, the scores became38.4±19.7,12.8±6.6and22.7±2.8. At12months,they were39.9±18.7,13.3±6.2and23.4±2.6. There was a significantimprovement on the scores at6months and12months compared with thepreoperative scores, and also on all the scores of the sub-questionnaires ofthem. But there was no difference between results at6months and those at12months. No intraoperative complications such as injuries or hemorrhageoccurred, but one patient experienced the perforation of sacral median vein,which cured with bone wax. In the follow-up period, one patient (3.4%)reported de novo stress incontinence. Five patients suffered from persistentdifficult defecation or constipation at the first1month after the surgery andthree of them were resolved within the first6months after the surgery. Twopatients (6.9%) presented with de novo constipation and one of them wasresolved within the first postoperative3months. Dyspareunia was reported atthis time by one patient (3.4%). The subjective cure rate was86.2%. In thisseries, mesh exposure and erosion rate was none and no injure of surroundingorgans occurred.Conclusions: LSC appears to be a minimally invasive, security andhighly effective procedure for the treatment of severe POP. It can not onlyreach the anatomical replacement stage but also significantly improve thepostoperative symptoms, quality of life and sexual function, allowing highsubjective and objective cure rate.