Study Of Laparoscopic Sacrocolpopex In Pelvic Organ Prolapse Surgery

Background and ObjectiveThe Pelvic Organ Prolapse(POP) is one kind of The Pelvic Floor Dysfunction diseases in middle-aged women which affects the health and quality of life. It is divided into the following forms:Uterine prolapse, vaginal vault prolapse and vaginal wall prolapse. It can affect the urinary function, bowel function and quality of sex life seriously. Surgery is the main treatment for moderate to severe pelvic organ prolapse.Available studies have confirmed that traditional surgery such as vaginal hysterectomy plus vaginal wall repair has a higher recurrence rate already. Over the past decade, transvaginal mesh repair surgery has been widely used in clinical practice. However, FDA released a Safety Communication of adverse events related to vaginal reconstructive surgical use of synthetic mesh in2008and2011. In August2012, Johnson&Johnson announced a global delisting of the "Prolift". Due to strict limitations of indications, now, the clinical application of TVM is less than before.Sacrocolpopexy was first reported in1962which is used to treat vaginal vault prolapse. Then, in1994, the Laparoscopic sacrocolpopexy on POP treatment was reported. Sacrocolpopexy hangs the vaginal vault on anterior longitudinal ligament of S1by autologous fascia or synthetic mesh. So that the top of vagina is raised, reproductive function is retained and sexual function is reserved. After decades of improvement, Sacrocolpopexy is considered classical gold standard in the treatment of middle pelvic defects.Since2012, our hospital began to conduct LSC to treat severe POP patients. We followed-up all patients undergoing surgery regularly. The main purpose of this study is to analysis the clinical data of LSC in treatment of severe POP; to evaluate the the efficacy of surgery; to provide study data for the selection of the best surgical approach suitable for POP patients and a theoretical reference for improving the safety and effectiveness of the surgery.Materials and MethodsThere are63cases who were admitted to the Gynecology of Second Hospital of Shandong University as "Uterine prolapse with vaginal wall prolapse" from January2012to December2013.Clinical data of them is statistical analyzed by SPSS19.0. Measurement data is expressed by mean±standard deviation (Mean±SD). Index changes and questionnaire score before surgery is paired t test with postoperative data.In this paper, the following aspects are studied:1. From medical records and surgical records, the data of general information, peri-operative indicators and complications were described.2. Clinical review. The POP-Q is an objective assessment to determine the presence of recurrence and judge the anatomic efficacy.3. Patients were followed-up postoperatively. Questionnaires (PFDI-20and PFIQ-7) are used to judge the functional efficacy.4. Patients were followed-up postoperatively. Questionnaire (PISQ-12) is used to judge the sexual life improvement and to assess satisfaction with surgery.5. Patients were followed-up postoperatively. Find out uncomfortable symptoms and complications after surgery and acquire the patient’s subjective satisfaction.Results1. POP-Q indexing of patients before surgery(1)Uterine prolapseⅡ-Ⅳ:33patients, Vaginal vault prolapseⅡ:12patients;(2)Anterior vaginal wall prolapse Ⅱ-Ⅳ:63patients;(3)Posterior vaginal wall prolapse Ⅱ-Ⅳ:27patients.2. The index of operation, peri-operation and complications(1) The mean operative time was (144.92.±32.27) min. The mean blood loss was (49.04±22.11) ml. The mean days in hospital after operation were (5.94±2.60) days. (2) Peri-operative complications:1acute urinary retention,1abdominal fall pain and1muscular venous thrombosis. After received symptomatic treatment, all patients improved and discharged.3. Efficacy, cure rate and satisfaction in the follow-up period(1) Anatomic efficacy. The locations of indication point of POP-Q compared with the preoperative locations are significantly different (P<0.05). Gynecological examination showed that anatomical location has an ideal recovery. The objective cure rate is100%while the subjective cure rate is98.4%. The cure rate of Burch operation is94.44%.(2) Functional efficacy. Scores of PFIQ-7, PFDI-20at1months,3months,6months and1year after the operation compared with the preoperative scores are significantly different (P<0.05). Bowel function, urinary function and quality of life improved significantly.(3) Sexual life. Scores of PISA-12at1year after the operation compared with the preoperative scores are significantly different (P<0.05). Quality of sexual life is improved significantly and sexual satisfaction is increased.4. Medium-term complications in the follow-up1case suffers back pain, after received symptomatic treatment, the pain improved.1case suffers slight lower urinary tract symptoms which have mild impacts on daily life. So far, the patient did not access treatment because the symptoms are not serious.Conclusions1. Indications of LSC can be increased appropriately. LSC can be used to treat uterine prolapse with moderate to severe anterior vaginal wall prolapse.2. LSC has less trauma and faster recovery on patients. But the surgical procedures are complex so that LSC has high requirements for operators.3. LSC can restore organ location. Besides, vaginal length is enough so that sexual satisfaction is high.4. LSC has a high short-term rate and a few peri-operative complications (3cases). Medium-term complications include2cases. But the long-term efficacy and complications still need further follow-up and study.