Nerve preserving vs standard laparoscopic sacropexy: Postoperative bowel function

Abstract

AIMTo compare our developed nerve preserving technique with the non-nerve preserving one in terms of de novo bowel symptoms.METHODSPatients affected by symptomatic apical prolapse, admitted to our department and treated by nerve preserving laparoscopic sacropexy (LSP) between October, 2010 and April, 2013 (Group A or “interventional group”) were compared to those treated with the standard LSP, between September, 2007 and December, 2009 (Group B or “control group”). Functional and anatomical data were recorded prospectively at the first clinical review, at 1, 6 mo, and every postsurgical year. Questionnaires were filled in by the patients at each follow-up clinical evaluation.RESULTSForty-three women were enrolled, 25/43 were treated by our nerve preserving technique and 18/43 by the standard one. The data from the interventional group were collected at a similar follow-up (> 18 mo) as those collected for the control group. No cases of de novo bowel dysfunction were observed in group A against 4 cases in group B (P = 0.02). Obstructed defecation syndrome (ODS) was highlighted by an increase in specific questionnaires scores and documented by the anorectal manometry. There were no cases of de novo constipation in the two groups. No major intraoperative complications were reported for our technique and it took no longer than the standard procedure. Apical recurrence and late complications were comparable in the two groups.CONCLUSIONOur nerve preserving technique seems superior in terms of prevention of de novo bowel dysfunction compared to the standard one and had no major intraoperative complications.

Functional outcome after laparoscopic nerve‐sparing sacrocolpopexy: a prospective cohort study

“…In their review of the literature on sacrocolpopexy, functional outcomes and mesh placement, they concluded that the placement of the mesh posteriorly at the level of the levator ani muscle might be an explanation for the increased bowel dysfunction rate in those studies. That would support our data with low de novo bowel dysfunction as we place the mesh posteriorly at the level of the perineal body, according to Cosma et al . In our study, we observed a low de novo constipation rate of 5.3% and a significant decrease in the constipation rate of over 50% ( p < 0.004).…”

“…Cosma et al reported the only study regarding bowel function after NS‐SCP . Their small comparative study, with 25 women in the NS‐SCP group compared with 18 women in the standard sacrocolpopexy group, showed no de novo bowel dysfunction based on subjective outcome measures in the NS‐SCP group.…”

“…However, the IHN and its fine fibers are difficult to identify, resulting in iatrogenic lesions, which are often ignored and commonly tolerated, although this can lead to bladder, bowel and sexual dysfunction. To date, there are sparse data regarding how successfully the IHN is preserved during sacrocolpopexy, so avoiding bladder, bowel and sexual dysfunction .…”

Nerve-sparing in Gynecologic Surgery: A Perspective

“…A group of 25 patients undergoing the NS technique was compared with a previous group of 18 patients undergoing the conventional technique to determine de novo bowel dysfunction postoperatively [10]. The NS group had no instances of bowel dysfunction as compared with 4 in the conventional group (p = .02).…”

A simplified fascial model of pelvic anatomical surgery: going beyond parametrium-centered surgical anatomy

“…However, eradication of the endometriosis, urogynecological reconstructive and oncological exenterative surgery, may require dissection planes far from the gynecological parametrial heart of the pelvis and a holistic, wider anatomical knowledge so as to decrease iatrogenic complications (Ceccaroni et al 2012 ; Cosma et al 2017 ).…”