Perioperative and Long-Term Anatomical and Subjective Outcomes of Laparoscopic Pectopexy and Sacrospinous Ligament Suspension for POP-Q Stages II–IV Apical Prolapse

Abstract

The aim of this paper was to analyze perioperative and long-term outcomes in 114 women undergoing surgery for POP-Q ≥ 2 apical prolapse: sacrospinous ligament colpo/hysteropexy (SSLF/SSHP)—61; laparoscopic pectopexy (LP)—53. Validated questionnaires (PGI-I, ISI, #35 EPIQ, PFIQ-7, PFDI-20) were completed at baseline and follow-up. POP-Q stages II, III and IV were diagnosed in 1 (0.9%), 84 (73.7%) and 29 (25.4%) patients, respectively. Mean operative time and hospital stay were 151.8 ± 36.2 min/2.6 ± 1.1 days for LP and 69 ± 20.4 min (p < 0.001)/2.7 ± 1.0 days for SSLF. Severe intraoperative complications occurred in two (1.8%) patients. Mean follow-up was 26.9 ± 12 and 37.3 ± 17.5 months for LP and SSLF, respectively. At follow-up, significant improvement for all POP-Q points was observed in both groups (p < 0.001). Shortening of total vaginal length was found in both groups, but predominantly in SSLF patients (p = 0.01). The sensation of vaginal bulge (EPIQ) was reduced, and total PFDI-20 and PFIQ-7 scores improved (p < 0.04) in both groups. Subjective success was reported by 40 (75.5%) LP and 44 (72.1%) SSLF patients. ISI detected no deterioration in urinary incontinence. PGI-I, PFDI-20, #35 EPIQ, PFIQ-7 and ISI did not differ between the groups. In conclusion both, SSLF and LP for apical prolapse generate good anatomical and subjective outcomes, with protective effect on the anterior compartment observed for LP.

Laparoscopic Pectopexy versus Vaginal Sacrospinous Ligament Fixation in the Treatment of Apical Prolapse

“…One incidence of persistent thigh pain was reported by Feiner et al and which gradually settled after 12 months [14]. A similar rate was reported by Szymczak et al's [8] study within 30 days of discharge from the hospital. At follow-up visits, three (5%) patients reported persistent buttock pain [11].…”

“…Native tissue repair in vaginal surgery removes mesh-related complications such mesh erosion and infection. This is crucial for women who are at an increased risk of mesh erosion, such as those who smoke, take immunosuppressive medications, or have uncontrolled diabetes [6,8].…”

“…The mesh is fixed with this technique using the iliopectineal ligament on both sides. According to research by Cosson and colleagues, the sacrospinous ligament and the arcus tendineus of the pelvic fascia are statistically substantially weaker than the iliopectineal ligament [8,9]. A protective effect against de novo central and lateral cystocele has been reported as an important advantage of LP [5].…”

Editorial: Changing backgrounds and groundbreaking changes: Gynecological surgery in the third decade of the 21st century

“…Dällenbach compares the LLS vs. laparoscopic sacrocolpopexy for apical pelvic organ prolapse, and postulates the LLS as the new "gold standard". We are confident that this not entirely uncontroversial opinion can stimulate scientific debate and sharpen the senses of clinicians regarding the best current treatment for POP (4,6).…”

“…In the third decade of the 21st century, gynecological surgeons are faced with new technical developments but also with new expectations. The surgical evolution is reflected by individualized approaches to patients and treatments (1), increasing role of "omics" and advanced imaging methods for surgical decisions (2,3), the substantial shift from vaginal to laparoscopic concepts in urogynecology (4)(5)(6), increasing role of the robotic-assisted surgery or increased awareness about surgical complications and their prevention (7).…”