| Background and aimPelvic organ dysfunction is common in women which includes Urinary Incontience(UI), Pelvic Organ Prolapse(POP) and chronic pelvic pain. POP and UI often coexist. Meanwhile, the middle compartment prolapse(uterine and vault prolapse) is the most common defect in POP. There are about 30-50% women who will have uterine or vaginal prolapse in their lives[1, 2] and the morbidity will increase with age, which influences the physical and psychological health of women seriously. The uterine or vaginal vault prolapse or the formation of enterocele and Douglas hernia are the characteristics of the defect of middle pelvic tissue. With the increase of women’s health consciousness and the pursuit of life’s quality, a fair amount of patients require surgical treatment actively. While surgery is the major treatment for POP, there are so many surgeries can be applied to treat POP that there is not a gold standard operation. Owing to the individualed aetiological agent and clinical manifestation, it is a big challenge for gynaecologists to choose a suitable surgery. The issues such as low cure rate, high recurrence rate and limited improvement of the quality of life postoperatively exist in current clinical sugeries for POP. Unfortunately, there were about 29% patients should accept reoperations after initial surgery for POP[3]. Open abdominal sacrocolpopexy(ASC) is recognized as the gold standard for post-hysterectomy apical prolapse[4-6], and it results in a better anatomical repair. However due to the long operative time, the long length of stay in hospital and the long time for recovery postoperatively, surgeons wanted to develop a minimally invasive laparoscopic approach and the laparoscopic sacrocolpopexy(LSC) was used to be alternative to ASC, which has similar outcomes to abdominal sacrocolpopexy[7-10]. After mesh was applied to treat vaginal prolapse for the first time successfully in 2004, Prolift system(repair for total pelvic floor, anterior and posterior wall) was developed to treat vaginal prolapse by nine French scientists. Prolift was applied to patients who need the reinforcement of organizations and fascia structures of pelvic floor, which can be used as a mechanical support or repair the fascia defects of materials. According to the characteristics of Asian, the single strand woven polypropylene mesh system was modified for a specific shape which was similar to " dragonfly " by Chinese scholars. The modified total pelvic floor reconstruction combining with Chinese women’s characteristics was more suitable for our country, which makes full use of the mesh and saves cost. Although both LSC and the modified total pelvic floor reconstruction have more than 3 years’ experiences, but there is few control research of comparing the two kinds of operations directly.We retrospectively analyze the clinical data of these two methods. This study was to provide effective evidence for surgeons to implement individualized therapeutic schedule for patients who have POP.MethodsThe medical records of patients with POP-Q stage 2 and stage 3 prolapse[11] of uterus who were treated with laparoscopic sacral hysteropexy or LSC(defined as the observational group) and reconstruction using modified total vaginal mesh(the control group) between January 2008 to December 2012 at the Department of Obstetrics and Gynecology in the Southwest Hospital were reviewed retrospectively. The data of 166 patients were reviewed including 57 subjects who received the laparoscopic sacral hysteropexy or LSC and 55 subjects who received the reconstruction using modified total vaginal mesh.Outcome data included:(1)The objective success: defined as less than stage 1 prolapse at all vaginal sites as scored by the POP-Q system.(2) Subjective satisfaction: patients were considered satisfied if they answered ‘‘very much better scores 1’’ or “much better scores 2’’ on the PGI-C scale [12].(3) Preoperative symptom change was assessed using change in total scores and symptom subscale scores of the PFDI-20[13], PFIQ-7[14] and PISQ-12 questionnaires[15] according to the medical records and patients’ responses. And the same questionnaires was completed postoperatively.(4) Complications and erosion rate.1. Indexes between groupsThe laparoscopic sacral hysteropexy /sacrocolpopexy group resulted in less mean blood loss, less postoperative catheterization time and shorter length of hospital stay when compared to the modified total pelvic floor reconstruction group. After a mean period of 42 months’ follow-up, there was no statistical difference between the two groups in objective success rate and subjective satisfaction(P﹥0.05), although the mean score of PGI-C was significantly better in the laparoscopic sacral hysteropexy /sacrocolpopexy group. There was no statistical difference in mean scores of PFDI-20 or PFIQ-7 between the two groups preoperatively or postoperatively; however, the mean socre of PISQ-12 were significantly better in the laparoscopic sacral hysteropexy /sacrocolpopexy group both preoperatively and postoperatively(P <0.01) and the improved scores(betweent postoperative and preoperative) was significant more in the laparoscopic sacral hysteropexy /sacrocolpopexy group(P <0.01). There was no statistical difference in recurrent porlapse and intraoperative/postoperative complications between the two groups(P﹥0.05).2. The comparison in each group respectively.When relate to preoperative scores of POP-Q and questionnaires in each group, respectively, the mean scores of POP-Q, PFIQ-7, PGI-C, PFDI-20, and PISQ-12 were significantly improved postoperatively(P <0.01).ConclusionBoth kinds of surgeries resulted in safe and effective outcomes. But relative to the modified total pelvic floor reconstruction, laparoscopic sacral hysteropexy /sacrocolpopexy resulted in not only less mean blood loss, postoperative catheterization time and length of hospital stay, but also better scores of PGI-C and PISQ-12. Therefore, the laparoscopic sacral hysteropexy /sacrocolpopexy is more ideal for uterine or vaginal prolapse. |
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