Évolution des pratiques dans la chirurgie du prolapsus au sein d’une école vaginaliste sur la période 2010–2015

Abstract

ObjectivesTo determine whether the 2011 FDA alert and French Guidelines have impacted the routine surgical practice in the management of pelvic organ prolapse in a “vaginalist” team over the period 2010–2015. MethodsRetrospective study involving all patients undergoing surgical management of anterior and/or apical symptomatic pelvic organ prolapse during the civil years 2010 and 2015. Both naive and relapsed prolapses were eligible. ResultsOverall, 338 patients were included: 187 in 2010 and 151 in 2015. Among patients with naive prolapse, we observed a significant increase in the number of laparoscopic sacrocolpopexies (11.1% in 2010 versus 34.4% in 2015, P=0.001) and a significant decline in the use of native tissue repair (67.6% in 2010 versus 39% in 2015, P=0.001). While the number of transvaginal meshes did not decline over the study period, their indications displayed a significant evolution towards a restricted use to advanced stages. We did not observe any difference regarding the treatment of recurred pelvic organ prolapse. Vaginal route remained the preferred approach in this indication. ConclusionIn our “vaginalist” team, routine practice has significantly evolved over the period 2010–2015, resulting in a diversification of the healthcare offer. This paradigm shift towards pluripotency is mandatory, since patients’ preference should also drive the choice of both surgical route and technique.