Laparoscopic Reconstructive Surgery is Superior to Vaginal Reconstruction in the Pelvic Organ Prolapse

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Abstract

Background: Our purpose was to provide the clinical advantages of the laparoscopic approach compare to the vaginal approach in correcting uterine and vaginal vault prolapse.

Methods: Between June 2007 and June 2011, 174 women were admitted to HUMC (Hallym University Medical Center) and underwent pelvic reconstructive surgery for prolapsed vaginal vault and uterus. Upon retrospective review of the medical records, 174 of the patients who had symptoms of pelvic organ prolapsed and Baden-Walker prolapse grade ≥ 2 were selected and divided into two groups as follows: vaginal approach group (n=120) and laparoscopic approach group (n=54). We compared the results of clinical outcome by analyzing Student's t-test and χ ²-test or the Fisher exact test as appropriate.

Results: There were significant difference in success rates without reoperation for recurrence as 91.7% (vaginal approach group, n=110) vs 100% (laparoscopic approach group, n=54), p=0.032. Mean follow-up duration was 31.3 ± 7.6 months for vaginal approach group and 29.7 ± 9.7 months for laparoscopic approach group. The Foley catheter indwelling duration (4.7± 1.9 vs 3.4±2.1 days, p< 0.001) and the length of postoperative hospitalization (6.4 ± 2.1 vs 5.0 ± 1.9 days, p <0.001) were significantly longer in vaginal approach group, whereas the operative time was significantly longer (108.2 ± 38.6 vs 168.3 ± 69.7 minutes, p <0.001) in laparoscopic approach group.

Conclusions: Our result suggest there is significantly lower recurrence rate requiring reoperation and less catheterization time but increased operative time for laparascopic sacrocolpopexy.

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Most cited references 39

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Abdominal sacrocolpopexy: a comprehensive review.

Halina M. Zyczynski, , Linda Brubaker … (2004)

To summarize published data about abdominal sacrocolpopexy and to highlight areas about which data are lacking. We conducted a literature search on MEDLINE using Ovid and PubMed, from January,1966 to January, 2004, using search terms "sacropexy," "sacrocolpopexy," "sacral colpopexy," "colpopexy," "sacropexy," "colposacropexy," "abdominal sacrocolpopexy" "pelvic organ prolapse and surgery," and "vaginal vault prolapse or surgery" and included articles with English-language abstracts. We examined reference lists of published articles to identify other articles not found on the electronic search. We examined all studies identified in our search that provided any outcome data on sacrocolpopexy. Because of the substantial heterogeneity of outcome measures and follow-up intervals in case studies, we did not apply meta-analytic techniques to the data. Follow-up duration for most studies ranged from 6 months to 3 years. The success rate, when defined as lack of apical prolapse postoperatively, ranged from 78-100% and when defined as no postoperative prolapse, from 58-100%. The median reoperation rates for pelvic organ prolapse and for stress urinary incontinence in the studies that reported these outcomes were 4.4% (range 0-18.2%) and 4.9% (range 1.2% to 30.9%), respectively. The overall rate of mesh erosion was 3.4% (70 of 2,178). Some reports found more mesh erosions when concomitant total hysterectomy was done, whereas other reports did not. There were no data to either support or refute the contentions that concomitant culdoplasty or paravaginal repair decreased the risk of failure. Most authors recommended burying the graft under the peritoneum to attempt to decrease the risk of bowel obstruction; despite this, the median rate (when reported) of small bowel obstruction requiring surgery was 1.1% (range 0.6% to 8.6%). Few studies rigorously assessed pelvic symptoms, bowel function, or sexual function. Sacrocolpopexy is a reliable procedure that effectively and consistently resolves vaginal vault prolapse. Patients should be counseled about the low, but present risk, of reoperation for prolapse, stress incontinence, and complications. Prospective trials are needed to understand the effect of sacrocolpopexy on functional outcomes.

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Anatomic aspects of vaginal eversion after hysterectomy.

John DeLancey (1992)

Our aim was to understand how vaginal eversion after hysterectomy differs from other forms of prolapse. The role of individual structures involved in vaginal support was studied by pelvic dissection of 61 cadavers. Serial cross sections from 13 additional cadavers were examined. The upper third of the vagina (level I) is suspended from the pelvic walls by vertical fibers of the paracolpium, which is a continuation of the cardinal ligament. In the middle third of the vagina (level II) the paracolpium attaches the vagina laterally to the arcus tendineus and fascia of the levator ani muscles. The vagina's lower third fuses with the perineal membrane, levator ani muscles, and perineal body (level III). Dissection reveals that the paracolpium's vertical fibers in level I prevented prolapse of the vaginal apex and vaginal eversion. The paracolpium in level I forms the critical factor that differentiates vaginal eversion from posthysterectomy cystocele-rectocele or enterocele in which the vaginal apex remains well suspended.

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Cost of pelvic organ prolapse surgery in the United States.

L L Subak, Renilde van den Bossche, L Elaine Waetjen … (2001)

To estimate the annual direct cost to society of pelvic organ prolapse operations in the United States. We multiplied the number of pelvic organ prolapse operations identified in the 1997 National Hospital Discharge Survey by national average Medicare reimbursement for physician services and hospitalizations. Although this reimbursement does not estimate the actual cost, it is a proxy for cost, which estimates what society pays for the procedures. In 1997, direct costs of pelvic organ prolapse surgery were 1012 million dollars (95% confidence interval [CI] 775 dollars, 1251 million), including 494 dollars million (49%) for vaginal hysterectomy, 279 million dollars (28%) for cystocele and rectocele repair, and 135 million dollars (13%) for abdominal hysterectomy. Physician services accounted for 29% (298 million dollars) of total costs, and hospitalization accounted for 71% (714 million dollars). Twenty-one percent of pelvic organ prolapse operations included urinary incontinence procedures (218 million dollars). If all operations were reimbursed by non-Medicare sources, the annual estimated cost would increase by 52% to 1543 million dollars. The annual direct costs of operations for pelvic organ prolapse are substantial.

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Author and article information

Journal

Journal ID (nlm-ta): Int J Med Sci

Journal ID (iso-abbrev): Int J Med Sci

Journal ID (publisher-id): ijms

Title: International Journal of Medical Sciences

Publisher: Ivyspring International Publisher (Sydney )

ISSN (Electronic): 1449-1907

Publication date Collection: 2014

Publication date (Electronic): 10 August 2014

Volume: 11

Issue: 11

Pages: 1082-1088

Affiliations

1. Department of Obstetrics and Gynecology, Hallym University Sacred Heart Hospital, Hallym University Medical Center (HUMC), Seoul, Korea;

2. Department of Obstetrics and Gynecology, Hankang Sacred Heart Hospital, Hallym University Medical Center (HUMC), Seoul, Korea;

3. Department of Obstetrics and Gynecology, Kangnam Sacred Heart Hospital, Hallym University Medical Center (HUMC), Seoul, Korea.

Author notes

✉ Corresponding author: Hong-bae Kim, Department of Obstetrics and Gynecology, Hallym University Medical Center (HUMC), Seoul, Korea. Address: Kangnam Sacred heart hospital,#948-1, Dae-lim Dong, Yeoung-deungpo Ku, Seoul, Korea. E-mail: drhbkim@ 123456hallym.or.kr Fax: 82-2-849-4469 Tel: 82-2-829-5163.

Conflict of Interest: The authors have declared that no conflicts of interest exist.

Article

Publisher ID: ijmsv11p1082

DOI: 10.7150/ijms.9027

PMC ID: 4147633

SO-VID: 87761557-f4a7-44ab-b8ca-6421f61f8d02

Copyright © © Ivyspring International Publisher. This is an open-access article distributed under the terms of the Creative Commons License (http://creativecommons.org/licenses/by-nc-nd/3.0/). Reproduction is permitted for personal, noncommercial use, provided that the article is in whole, unmodified, and properly cited.

Laparoscopic Reconstructive Surgery is Superior to Vaginal Reconstruction in the Pelvic Organ Prolapse

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International Journal of Applied Technology in Medical Sciences

Most cited references 39

Abdominal sacrocolpopexy: a comprehensive review.

Anatomic aspects of vaginal eversion after hysterectomy.

Cost of pelvic organ prolapse surgery in the United States.

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