Success Rates and Outcomes of Laparoscopic Mesh Sacrohysteropexy

Abstract

Study Objective This study aimed to evaluate the impact of laparoscopic mesh sacrohysteropexy on symptomatic prolapse from an Australian experience. Design Retrospective cohort study. Setting Private Practice. Patients or Participants 157 patients with symptomatic prolapse underwent laparoscopic mesh sacrohysteropexy during 2007-2017. Choice of surgery was determined by the patient, after discussion about hysterectomy, future fertility, and uterine conservation. Patients electing for laparoscopic sacrohysteropexy were women with symptomatic prolapse wishing to preseve their uterus and had failed conservative measures. Exclusions to uterine preservation or complex laparoscopic surgery included significant uterine enlargement (>280cc), body mass index (BMI) >35, current cervical smear abnormalities and concomitant medical conditions that would preclude a laparoscopic approach for anaesthetic concerns. Interventions Laparoscopic mesh sacrohysteropexy. Measurements and Main Results The median age was 58 years (27-86 years), median parity was 2 (0-6), and median BMI was 26.8 (23-29.9). 134 women had a laparoscopic hysteropexy and concurrent vaginal prolapse repair and 4 women had an isolated laparoscopic hysteropexy. The mean preoperative point C was 0.60. The mean change from preoperative point C to postoperative point C was 7.6 cm (p < 0.01). Of the 136 patients (98.6%) seen at 4-6 weeks post-operative, all had Stage 0 POP-Q score. Prolapse recurrence was observed in 22 patients, while 116 patients remained cured at their last follow-up. The probability of uterovaginal prolapse recurrence was 0.8 after 24 months utilising a Kaplan-Meier curve. Prolapse recurrence was associated with anterior vaginal mesh, previous prolapse surgery, pre-operative stage III-IV disease and number of vaginal deliveries. Conclusion Laparoscopic mesh sacrohysteropexy is an effective and safe procedure with a high success rate comparable to available international data and should be considered as an alternative to hysterectomy in women with a Stage II or III pelvic organ prolapse. This study aimed to evaluate the impact of laparoscopic mesh sacrohysteropexy on symptomatic prolapse from an Australian experience. Retrospective cohort study. Private Practice. 157 patients with symptomatic prolapse underwent laparoscopic mesh sacrohysteropexy during 2007-2017. Choice of surgery was determined by the patient, after discussion about hysterectomy, future fertility, and uterine conservation. Patients electing for laparoscopic sacrohysteropexy were women with symptomatic prolapse wishing to preseve their uterus and had failed conservative measures. Exclusions to uterine preservation or complex laparoscopic surgery included significant uterine enlargement (>280cc), body mass index (BMI) >35, current cervical smear abnormalities and concomitant medical conditions that would preclude a laparoscopic approach for anaesthetic concerns. Laparoscopic mesh sacrohysteropexy. The median age was 58 years (27-86 years), median parity was 2 (0-6), and median BMI was 26.8 (23-29.9). 134 women had a laparoscopic hysteropexy and concurrent vaginal prolapse repair and 4 women had an isolated laparoscopic hysteropexy. The mean preoperative point C was 0.60. The mean change from preoperative point C to postoperative point C was 7.6 cm (p < 0.01). Of the 136 patients (98.6%) seen at 4-6 weeks post-operative, all had Stage 0 POP-Q score. Prolapse recurrence was observed in 22 patients, while 116 patients remained cured at their last follow-up. The probability of uterovaginal prolapse recurrence was 0.8 after 24 months utilising a Kaplan-Meier curve. Prolapse recurrence was associated with anterior vaginal mesh, previous prolapse surgery, pre-operative stage III-IV disease and number of vaginal deliveries. Laparoscopic mesh sacrohysteropexy is an effective and safe procedure with a high success rate comparable to available international data and should be considered as an alternative to hysterectomy in women with a Stage II or III pelvic organ prolapse.