Route of hysterectomy during minimally invasive sacrocolpopexy does not affect postoperative outcomes

Introduction. The problem of female genital prolapse (GP) remains in the sportlight of gynecologists, because despite the variety of surgical methods, there are still recurrences of the disease, which are associated not only with the failure of the restored ligaments, fascia, muscles, damaged pelvic floor and perineum, but with the imperfection of the operation. The solution of this problem is especially important in the treatment of patients with extragenital pathology, in particular obesity. The purpose: to optimize the treatment of genital prolapse in obese patients by determining an individual approach to planning surgical treatment taking into account the degree of obesity and concomitant pathology. Materials and methods. We examined 65 patients of which 20 had genital prolapse and obesity (main group), 25 had genital prolapse and normal weight (comparison group), 20 women did not have gynecological diseases and extragenital pathology made up control group. To diagnose obesity and determine its degree we calculated body mass index (BMI). To determine the degree of GP its quantitative assessment was used (POP-Q; 1996). Surgical intervention included transvaginal extirpation of the uterus without appendages, anterior colporrhaphy, colpoperineoraphy with levatoplasty, sacrospinal colpopexy. Transabdominal and laparoscopic colposacropexy in obese women were not used due to the presence of relative contraindications for laparoscopy (cardiovascular disease, respiratory pathology, adhesions, the condition after hernias’ surgery). Therefore, all operations on women with GP and obesity were performed transvaginally due to the inability to perform abdominal access. In comparison group transvaginal surgery was performed. All the groups under study were representative. Before the use of polypropylene mesh "Polymesh" to minimize purulent-septic complications associated with the use of synthetic prostheses aquadissection was performed with 0.9% saline with the addition of 1 g of ceftriaxone per 200 ml. After the operation, the women used suppositories with hyaluronic acid (revitax). Results. The results of surgical treatment have been analyzed and the following data were obtained: recurrences in the main and in the comparison group were 4% (2 women in whom operations were performed with the use of their own tissues without mesh prosthesis). Infectious complications, dyspareunia and pelvic pain were not observed. Conclusions. Surgical treatment of GP in obese women by using polypropylene mesh "Polymesh" for colposacropexy after transvaginal uterine extirpation increases the effectiveness of treatment and redduces the number of recurrences. Hydropreparation of the mesh with an antibacterial agent and postoperative use of hyaluronidase intravaginally helps to reduce purulent-septic complications of surgery and improves the patients’quality of life.

show abstract

“…At plastic correction with own tissues there were two (4%) complications. The data obtained coinside with the data of literature [7,8].…”

Section: Resultssupporting

confidence: 58%

Modern approaches to the treatment of genital prolapse in obese women

Safonov

Лазуренко

Lyashchenko

et al. 2021

J Educ Health Sport

View full text Add to dashboard Cite

show abstract

“…In our cohort, we noted a significant increase in vaginal hysterectomies. The change to this practice pattern should not be surprising: uterovaginal prolapse lends itself to this modality, and available studies at that time demonstrated that vaginal hysterectomy at the time of sacrocolpopexy did not seem to affect prolapse recurrence [10,23]. This practice pattern change was shortlived, however, as our data demonstrated a significant resurgence in laparoscopic-assisted supracervical hysterectomy within 2 years of the morcellator being banned but with permanent adoption of contained tissue extraction in a bag.…”

Section: Figmentioning

confidence: 63%

“…Although previous cervical pathology may influence a surgeon to recommend a total hysterectomy, in the absence of cervical pathology, the main consideration is the risk of mesh exposure. Some data do suggest a higher risk of mesh exposure with total hysterectomy [11], although this is inconsistent and limited to retrospective studies [10,23]. Postoperatively, all patients follow cervical cancer screening guidelines whether they undergo a total or supracervical hysterectomy.…”

Section: Figmentioning

confidence: 99%

“…In 2014, with the FDA's issued warning and subsequent institutional bans on the use of power morcellation, there was a shift in the modality by which hysterectomy was performed across all gynecologic specialties, with an increase in the incidence of laparotomy for hysterectomy [9]. Some pelvic floor surgeons, including those at our center, circumvented the need for morcellation by performing vaginal hysterectomies at the time of sacrocolpopexy with either vaginal or laparoscopic mesh attachment [10]. This change in practice was done without weighing the benefits of avoiding occult malignancy in this patient population with the potential risks, namely postoperative mesh erosion, that may be associated with concurrent total hysterectomy vs supracervical hysterectomy (4.9 vs 0%, p = .03) [11].…”

mentioning

confidence: 99%

See 1 more Smart Citation

Occult Uterine Malignancy at the Time of Sacrocolpopexy in the Context of the Safety Communication on Power Morcellation by the FDA

Chang

Ferrando

2021

Journal of Minimally Invasive Gynecology

Self Cite

View full text Add to dashboard Cite

“…Therefore, increasing the availability of options, that do not necessitate a hysterectomy, gives women viable options to individualize their POP management plan.Nonetheless, one of the important determinants of women's choice about uterine preservation or concomitant hysterectomy is the outcome associated with either procedure [18][19][20]. There is evidence that the route of concomitant hysterectomy during LSC does not seem to be associated with the perioperative or postoperative outcomes [21,22]. However, at present, there is heterogenous information about comparative anatomical and functional outcomes with no comprehensive analysis based on whether the uterus was spared or removed [23][24][25][26].…”

mentioning

confidence: 99%

Pelvic organ prolapse and uterine preservation: A cohort study (POP-UP study)

Gagyor

Kališ

Smazinka

et al. 2021

Preprint

View full text Add to dashboard Cite

Background: Abdominal and laparoscopic sacro-colpopexy (LSC) is considered the standard surgical option for the management of a symptomatic apical pelvic organ prolapse (POP). Women who have their uterus, and for whom an LSC is indicated, can have a laparoscopic sacro-hysteropexy (LSH), a laparoscopic supra-cervical hysterectomy and laparoscopic sacro-cervicopexy (LSCH+LSC) or a total laparoscopic hysterectomy and laparoscopic sacro-colpopexy (TLH+LSC). The main aim of this study was to compare clinical and patient reported outcomes of uterine sparing versus concomitant hysterectomy LSC procedures. Methods: A retrospective analysis of clinical, imaging and patient reported outcomes at baseline, 3 and 12 months after LSH versus either LSCH+LSC or TLH+LSC between January 2015 and January 2019 in a tertiary referral urogynecology center in Pilsen, the Czech Republic. Results. In total, 294 women were included in this analysis (LSH n = 43, LSCH+LSC n = 208 and TLH+LSC n = 43). There were no differences in the incidence of perioperative injuries and complications. There were no statistically significant differences between the concomitant hysterectomy and the uterine sparing groups in any of the operative, clinical or patient reported outcomes except for a significantly lower anterior compartment failure rate (p= 0.017) and higher optimal mesh placement rate at 12 months in women who had concomitant hysterectomy procedures (p = 0.006).Conclusion. LSH seems to be associated with higher incidence of anterior compartment failures and suboptimal mesh placement based on postoperative imaging techniques compared to LSC with concomitant hysterectomy.

show abstract

Route of hysterectomy during minimally invasive sacrocolpopexy does not affect postoperative outcomes

Cited by 24 publications

References 13 publications

Modern approaches to the treatment of genital prolapse in obese women

Modern approaches to the treatment of genital prolapse in obese women

Occult Uterine Malignancy at the Time of Sacrocolpopexy in the Context of the Safety Communication on Power Morcellation by the FDA

Pelvic organ prolapse and uterine preservation: A cohort study (POP-UP study)

Contact Info

Product

Resources

About