2725 A New Approach to the Surgical Treatment of Stage III and IV Pelvic Organ Prolapse (POP) - Preliminary Results

Abstract

Study Objective The aim of the study was to present the results of a new surgical technique used for the treatment of stage 3 and 4 Pelvic organ prolapse according to the POP-Q scale. Design Group of 36 women has been qualified for the procedure of suspending the cervix to the rectus abdominis (RA) fascia with the insoluble sutures guided through the fascia via the polypropylene mesh placed above the fascia. The effectiveness of the treatment was assessed both: objectively - on the basis of improvement in gynecological examination - and subjectively using the certified questionnaires: PFDI-20 and POP-QL- 12 months after the surgery. Further control is planned 3 and 5 years after the procedure. Setting The study was conducted within the 2nd Department of Obstetrics and Gynaecology, Medical University in Wroclaw, Poland. Patients or Participants 36 women with the initial diagnosis of severe POP (3rd and 4th stage) has been qualified for the study Interventions The surgery was performed either by laparotomy (20) or laparoscopy (16). The insoluble monofilament suture was used to suspend cervix to the fascia of the RA. and additionally reinforced with polypropylene mesh placed above the fascia. The uterine body was either preserved, or in the case of any pathology, the suspension was preceded by supracervical hysterectomy. Measurements and Main Results Preliminary results are promising - 84.6% of objective and subjective improvement. Six women (16.6%) had a relapse and 4 women (11.1%) required reoperation. Conclusion Presented technique seems to be a safe and effective alternative to other POP treatment methods. It is associated with a negligible complications rate. Laparoscopic approach with it's superiority to laparotomy in some patients and a short learning curve, makes it even safer. Increasing the number of treated patients and continuing follow-up 3 and 5 years after the surgery is planned.