Comparison of laparoscopic techniques for apical organ prolapse repair – a systematic review of the literature

Szymczak, Paulina; Grzybowska, Magdalena Emilia; Wydra, Dariusz

doi:10.1002/nau.24115

Cited by 31 publications

(24 citation statements)

References 50 publications

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“…The dissection method of LLMS is similar to that of ventral suspension in pectopexy, which fixes the descending organ to the iliopectineal ligaments using polyvinylidene fluoride monofilament mesh [14][15][16] . In a systematic review by Szymczak P and colleagues, pectopexy showed similar high patient satisfaction as sacrocolpopexy (96.4-97.6% vs. 71.0-100%), although long-term follow-up results are still required 17 . However, the operation field of pectopexy is surrounded by external iliac vessels and the obturator nerve.…”

Section: Discussionmentioning

confidence: 98%

“…The round ligaments can also be folded to an ideal length during suturing if they are too long due to the stretching by descending organs, making tissue remodeling even better. This approach is very different from laparoscopic pectopexy or other types of lateral suspension using mesh, simply creating a new "mesh" ligament without augmentation of the original round ligament 17 . Female sexual dysfunction is common among women with urogynecological conditions 19 and should be managed with a multidisciplinary approach 20 .…”

Section: Discussionmentioning

confidence: 99%

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Laparoscopic Long Mesh Surgery with Augmented Round Ligaments: A Novel Uterine Preservation Procedure For Apical Pelvic Organ Prolapse

Long

Wang

Lin

et al. 2020

Sci Rep

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We aim to assess the surgical outcomes of our novel hysteropexy procedure, laparoscopic long mesh surgery (LLMS) with augmented round ligaments. Twenty-five consecutive women with stage II or greater main uterine prolapse defined by the POP quantification staging system were referred for LLMS. Long mesh is a synthetic T-shaped mesh, with the body fixed at the uterine cervix and the two arms fixed along the bilateral round ligaments. The clinical evaluations performed before and 6 months after surgery included pelvic examinations, urodynamic studies, and questionnaires for urinary and sexual symptoms. After a follow-up time of 12 to 24 months, the anatomical reduction rate was 92% (23/25) for the apical compartment. The average operative time was 65.4 ± 28.8 minutes. No major complications were recognized during LLMS. the lower urinary tract symptoms and scores on the questionnaires improved significantly after the surgery, except urgency urinary incontinence and nocturia. Neither voiding nor storage dysfunction was observed after the operations. All of the domains and total Female Sexual Function Index (FSFI) scores of the 15 sexually active women did not differ significantly after LLMS. The results of our study suggest that LLMS is an effective, safe, and timesaving hysteropexy surgery for the treatment of apical prolapse.Pelvic organ prolapse (POP) refers to the downward displacement of pelvic organs 1 . The lifetime risk of surgery for POP in the general female population is 19% 1 . Uterine prolapse, defined by insufficient apical support, is an important issue in the POP field. An increasing number of women with POP choose not to have a hysterectomy for reasons of personal identity, perceived body image, or childbearing potential 2,3 .We started to perform laparoscopic organopexy with non-mesh genital (LONG) suspension in 2014, as an innovative method for treating uterine prolapse in women who wish to preserve their uteri 4 . The LONG procedure has demonstrated promising preliminary results with a cohort of 40 women and a follow-up period of 12-30 months. The anatomical success rate was 85% with no concerning complications reported 4 .Despite the favorable outcome, some skepticism has been raised regarding the durability of suspension power based solely on the adhesion between the transverse fascia beneath the rectus abdominis muscle and the uterus. Other concerns include the long-term effects of the untreated anterior or posterior compartment and the impacts on subsequent hysterectomy, if needed. Studies with longer follow-up durations are ongoing in order to answer these questions. In addition, we have advanced the search for new solutions with our laparoscopic long mesh surgery (LLMS) with augmented round ligaments.Although sacrocolpopexy has been considered the gold-standard procedure for the treatment of apical prolapse, the long operation time and steep learning curve have restricted its popularity 4,5 . Additionally, most of the data have been related to post-hysterectomy prolapse 5 . Transvaginal mesh...

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Section: Discussionmentioning

confidence: 98%

Section: Discussionmentioning

confidence: 99%

Laparoscopic Long Mesh Surgery with Augmented Round Ligaments: A Novel Uterine Preservation Procedure For Apical Pelvic Organ Prolapse

Long

Wang

Lin

et al. 2020

Sci Rep

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“…LLS procedure is not indicated in the presence of a signi cant apical/posterior defect (enterocele, high rectocele) (16). When simultaneous anterior and posterior compartment repair was performed in the patients undergoing apical compartment defect repair, the risk of reoperation has reduced (17). Lateral arms performing suspension in cases used a T-shaped synthetic mesh graft in the LLS procedure do not ensure the closure of the pouch of Douglas.…”

Section: Discussionmentioning

confidence: 99%

Modified Laparoscopic Lateral Suspension with A 5 Arm Mesh in Pelvic Organ Prolapse Surgery.

Akbaba

2021

Preprint

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Background: The LLS procedure is a laparoscopic technique used to treat pelvic organ prolapse (POP), performed with a T-shaped synthetic mesh graft. The posterior compartment is repaired by using a second mesh or a second procedure like posterior colporrhaphy in the LLS procedure. In laparoscopic lateral suspension (LLS) surgery, we want to repair the defect of the posterior compartment in addition to the apical and anterior compartment by using a 5-arm mesh instead of a T-shaped synthetic mesh graft. In this study, we aim to report clinical results of surgeries performed POP repair with a 5-arm mesh.Method: Data from 37 patients who underwent LLS surgery by using a 5-arm mesh with a diagnosis of advanced stage (≥ stage 3) POP and the defect of the posterior compartment were retrospectively analyzed. The postoperative examination included grading and measurement of the POP-Q stage. Surgical outcomes were reported in pursuance of the International Urogynecological Association recommendations. The results of measurements and examinations, the reoperation rates, the erosion rates, lower urinary tract symptoms (LUTS), and complications were recorded. A p-value of < 0.05 was considered to be statistically significant.Results: There was a significant improvement in POP-Q ≤ −1 score in all treated compartments with an overall objective cure rate of 95.3% for the apical compartment, 86.1% for the anterior compartment, and 91.1% for the posterior compartment. The mean operative time was 96.27±15.81 minutes. The mean length of hospitalization was 2±0.82 days. A significant improvement was observed in symptoms of the vaginal bulge, urinary urgency, incomplete voiding, urinary frequency after surgery. Also, an improvement occurred in defecation symptoms of patients after POP repair. While 13 of the patients (35.1%) were sexually active preoperatively, this rate was determined to be 59.4% (n=22) postoperatively. De novo stress urinary incontinence developed in 7 patients (18.9%) postoperatively. The POP-related quality-of-life score (PQOL) improved significantly after surgery.Conclusion: İn advanced stage POP patients undergoing laparoscopic lateral suspension procedure using a 5-arm mesh, damaged compartments including the posterior compartment can be repaired without the need for an additional procedure and the recurrence rate can be reduced.

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“…The literature considers the sacralcolpopexy as the gold standard for vaginal vault prolapse, with a long-term success rates of > 90% and the most appropriate reconstruction of the physiological axis of the vagina [ 2 ]. Abdominal sacralcolpopexy has long been considered a safe and successful surgical procedure for the prolapse of the vaginal vault and has become the gold standard of care.…”

Section: Introductionmentioning

confidence: 99%

Laparoscopic monolateral suspension for vaginal vault prolapse: a report of an exit surgical strategy during sacralcolpopexy

et al. 2020

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Background Vaginal vault prolapse is the most frequent long-term complication in patients undergoing hysterectomy and sacralcolpopexy is considered the gold standard. We report our surgical strategy maintaining single-arm mesh when the sacral promontory is not accessible to fix the mesh for an unknown sacral osteophytosis during a laparoscopic sacralcolpopexy. This is significant because, to our knowledge, the bone variant as a procedure limiting factor has never been described before. This opens new horizons for the sacralcolpopexy surgery, because it becomes necessary to know of a valid surgical alternative with mesh maintenance if this complication occurs again or to perform an assessment of the accessibility of the sacral promontory immediately after its dissection. Case presentation We present a case of a 75-year-old woman with recurrence of vaginal vault prolapse. A laparoscopic sacralcolpopexy was recommended. During surgery, we found that the procedure was not feasible due to the presence of an unknown osteophytosis of the sacrum which prevented the fixing of the mesh to the sacral promontory. We decided to proceed with a single-arm lateral suspension by using a modified approach of the original technique, maintaining the mesh originally shaped for the sacral colpopexy. At follow-up, the vaginal vault is well suspended. Conclusion This exit strategy may represent a valid surgical alternative when laparoscopic sacral colpopexy is not possible for anatomical variants, allowing to keep the laparoscopic approach using mesh. To our knowledge, cases in which the anatomical bone variant prevented access to the sacral promontory have never been described in the literature, as bone evaluation has never been considered a limiting element of this procedure.

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Comparison of laparoscopic techniques for apical organ prolapse repair – a systematic review of the literature

Cited by 31 publications

References 50 publications

Laparoscopic Long Mesh Surgery with Augmented Round Ligaments: A Novel Uterine Preservation Procedure For Apical Pelvic Organ Prolapse

Laparoscopic Long Mesh Surgery with Augmented Round Ligaments: A Novel Uterine Preservation Procedure For Apical Pelvic Organ Prolapse

Modified Laparoscopic Lateral Suspension with A 5 Arm Mesh in Pelvic Organ Prolapse Surgery.

Laparoscopic monolateral suspension for vaginal vault prolapse: a report of an exit surgical strategy during sacralcolpopexy

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