Laparoscopic Sacralcolpopexy Versus Total Vaginal Mesh For Pelvic Organ Prolapse:a Meta-analysis

Objective:To make a systematic analysis of the efficacy and safety of laparoscopic sacralcolpopexy versus total vaginal mesh for pelvic organ prolapse,which can provide the reference for clinical practice.Methods:Pub Med,EMbase,The Cochrane Library,Web of science,CNKI,VIP and so on searches were supplemented by computer for published randomised controlled trials(RCTs),nonrandomized controlled trials,case control studies,cohort studies from Jan 1994 to Jan2016.Languages was restricted to Chinese and English.Concerning laparoscopic sacralcolpopexy versus total vaginal mesh for pelvic organ prolapse.The reference documents were screened independently by two reviewers,according to inclusion criteria,after evaluating quality and extracting the data,it was adopted by Rev Man5.3,which conducted a meta-analysis.Results:A total of 5 references were selected in the thesis,including overall 675 cases of female patients,332 cases of laparoscopic sacralcolpopexy and 343 cases of total vaginal mesh.Meta-analysis results showed that compared laparoscopic sacralcolpopexy with total vaginal mesh,in laparoscopic sacralcolpopexy:(1)blood loss during surgery was much less with significant differences[MD-88.21ml;95%CI=-123.82—-52.61ml; P < 0.00001];(2)there were no statistic differences in length of hospital stay and operating time;(3)postoperative catheterization time shorter with significant differences[MD-0.39d;95%CI=-0.48—-0.30d;P < 0.00001];(4)objective cure rate were significantly higher[OR=2.23;95%CI=1.33-3.76;Z=3.02;P=0.003],especially had significantly superior performance at POP-Q sites C[MD-0.98cm;95%CI=-1.17—-0.80cm;P <0.00001];(5)the postoperative scores of PGI-C was significantly improved[MD-0.58 分;95%CI=-0.72—-0.44分; P<0.00001];(6)there were no statistic differences in the postoperative scores of PFIQ-7, PFDI-20 and PISQ-12;(7) recurrence rate was lower with significant differences[OR=0.43;95%CI=0.25-0.73;Z=3.15;P=0.002];erosion rate was lower with significant differences[OR=0.35;95%CI=0.14-0.86;Z=2.27;P=0.02];(9)there were no statistic differences in other complications between laparoscopic sacralcolpopexy and total vaginal mesh.Conclusion:Total vaginal mesh and Laparoscopic sacrocolpopexy are both effective and safty treatment for pelvic organ prolapse.Laparoscopic sacrocolpopexy support for vaginal vault is better than that of total vaginal mesh.Compared with TVM,LSC has the advantages in operation subjective satisfaction,blood loss during surgery,postoperative catheterization time,objective cure rate,recurrence rate,erosion rate.The future need more and higher quality RCT results to make the conclusion of Meta analysis more accurate.