New "Wrinkle Method" for Intracorporeal Anterior Vaginal Wall Plication during Sacrocolpopexy.

Sa Ra Lee,Hee Dong Chae,Ju Hee Kim,Sung Hoon Kim

doi:10.3390/jcm10091822

Sa Ra Lee, Hee Dong Chae + Show 2 more

Open Access

https://doi.org/10.3390/jcm10091822

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Abstract

In this study, we introduce a new wrinkle method for intracorporeal anterior vaginal wall plication during sacrocolpopexy for pelvic organ prolapse (POP) aiming to decrease POP recurrence and postoperative vaginal wall mesh erosion. The wrinkle method was performed using robotic sacrocolpopexy (RSC) on 57 symptomatic POP patients. Sixty-six patients underwent conventional RSC before the development of the wrinkle method. Feasibility and perioperative outcomes were compared. The wrinkle method is not time consuming. The total operative time was shorter in the wrinkle group than in the non-wrinkle group; however, this was attributed to lower adhesiolysis in the wrinkle group. No differences were recorded in the mean estimated blood loss and complication rates between the two groups. In conclusion, although we were unable to confirm that the wrinkle method decreased POP recurrence and vaginal wall mesh erosion after RSC because of the short follow-up period, our preliminary findings are positive in terms of safety. Further long-term well designed randomized controlled trials are required to elucidate the benefits of the wrinkle method.

Highlights

Pelvic organ prolapse (POP) is a common condition in older women, with a prevalence of 41–50% in examination, and a probability of 12.6–20% to undergo surgery for POP before the age of 80 years [1,2,3,4,5]
Robotic SC (RSC), has been increasing, and large clinical data indicate that laparoscopic SC (LSC) is replacing open SC as the gold standard procedure as it provides low recurrence rates and low comorbidity rates similar to those of open surgery [9,10,11]
Concomitant hysterectomy, intra-abdominal adhesions, and postoperative pelvic hematoma, lack of surgical experience, and incorrect indication may increase the risk of vaginal mesh erosion after SC [22,23,24,25,26,27]

Summary

Introduction

Pelvic organ prolapse (POP) is a common condition in older women, with a prevalence of 41–50% in examination, and a probability of 12.6–20% to undergo surgery for POP before the age of 80 years [1,2,3,4,5]. Sacrocolpopexy (SC) is a common reconstructive procedure to correct apical POP, which suspends the anterior and posterior vaginal walls to the anterior longitudinal ligament (ALL) of the sacrum using a mesh or graft. Open SC has been the gold standard procedure for patients with apical POP, with long-term cure rates reaching. Surgeons should consider decreasing the mesh erosion risk when using mesh in pelvic reconstructive surgery. Concomitant hysterectomy, intra-abdominal adhesions, and postoperative pelvic hematoma, lack of surgical experience, and incorrect indication may increase the risk of vaginal mesh erosion after SC [22,23,24,25,26,27]. Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations

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Conclusion