ผลลัพธ์การผ่าตัดแก้ไขคนไข้ที่มีภาวะอวัยวะอุ้งเชิงกรานหย่อนส่วนบนด้วยวิธี ผ่านกล้องโดยใช้ตาข่ายยึดช่องคลอดกับเอ็นกระดูกสันหลัง
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Abstract
Objective: To evaluate outcomes of laparoscopic sacrocolpopexy (LSC) and sacrohysteropexy (LSH) regardingsuccess rates, recurrence rates, and perioperative complications. Materials and Methods: Retrospective cohort study of women undergoing LSC and LSH for symptomatic pelvic organ prolapse (POP) (≥ stage 2) was conducted at Kameda Medical Center, Japan between July 2013 and June 2015. All procedures were performed by one urogynecologist. Supracervical hysterectomy was performed in all women prior to LSC. Self-cut polypropylene mesh was used for mesh reinforcement. Information regarding patients’ demographics, preoperative assessment, perioperative complications, and surgical outcomes were analyzed. Anatomical success rate was defined as prolapse (points Aa, Ap, and C) located above hymen at 1-year follow-up. Results: LSC was performed in 43 patients while LSH was undertaken in 16. The mean age was 62.8 ± 9.1 years old. Patients undergoing LSC presented more advanced stage prolapse and POP-Q measurements than those in the hysteropexy group. The mean operative time spent for LSH was significantly shorter than the time spent for LSC. Bladder perforation was the only major complication encountered. At 1-year follow-up, significant improvement in POP-Q measurements was demonstrated in all compartments for both groups. The overall success rate was 89.8% (86% LSC and 100% LSH; p value 0.176). The anatomical success specifically for apical compartment was 96.6%. Conclusion: LSC and LSH are feasible and effective procedures for POP repair especially apical compartment. However, high competency in laparoscopy is required to ensure safety and success. Appropriate patient selection for both procedure is a practical point of concern. Long-term follow-up is necessary.
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References
2. Coolen AL, van Oudheusden AM, van Eijndhoven HW, van der Heijden TP, Stokmans RA, Mol BW, et al. A Comparison of Complications between Open Abdominal Sacrocolpopexy and Laparoscopic Sacrocolpopexy for the Treatment of Vault Prolapse. Obstet Gynecol Int. 2013;2013:528636.
3. Ganatra AM, Rozet F, Sanchez-Salas R, Barret E, Galiano M, Cathelineau X,et al. The current status of laparoscopic sacrocolpopexy: a review. Eur Urol. 2009;55(5):1089-103.
4. Higgs PJ, Chua HL, Smith AR. Long term review of laparoscopic sacrocolpopexy. BJOG. 2005 ;112(8):1134-8.
5. Claerhout F, Roovers JP, Lewi P, Verguts J, De Ridder D, Deprest J. Implementation of laparoscopic sacrocolpopexy--a single centre's experience. Int Urogynecol J Pelvic Floor Dysfunct. 2009 ;20(9):1119-25.
6. Mueller ER, Kenton K, Tarnay C, Brubaker L, Rosenman A, Smith B, et al. Abdominal Colpopexy: Comparison of Endoscopic Surgical Strategies (ACCESS). Contemp Clin Trials. 2012;33(5):1011-8.
7. Nosti PA, Umoh Andy U, Kane S, White DE, Harvie HS, Lowenstein L, et al. Outcomes of abdominal and minimally invasive sacrocolpopexy: a retrospective cohort study. Female Pelvic Med Reconstr Surg. 2014;20(1):33-7.
8. Granese R, Candiani M, Perino A, Romano F, Cucinella G. Laparoscopic sacrocolpopexy in the treatment of vaginal vault prolapse: 8 years experience. Eur J Obstet Gynecol Reprod Biol. 2009;146(2):227-31.
9. Akladios CY, Dautun D, Saussine C, Baldauf JJ, Mathelin C, Wattiez A. Laparoscopic sacrocolpopexy for female genital organ prolapse: establishment of a learning curve. Eur J Obstet Gynecol Reprod Biol. 2010;149(2):218-21.
10. Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J. 2016;27(4):655-84.
11. Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev. 20161;10:CD012376.
12. Bradley S, Gutman RE, Richter LA. Hysteropexy: an Option for the Repair of Pelvic Organ Prolapse. Curr Urol Rep. 2018;19(2):15.
13. Gutman R, Maher C. Uterine-preserving POP surgery. Int Urogynecol J. 2013;24(11):1803-13.
14. Tan-Kim J, Menefee SA, Luber KM, Nager CW, Lukacz ES. Prevalence and risk factors for mesh erosion after laparoscopic-assisted sacrocolpopexy. Int Urogynecol J. 2011;22(2):205-12.
15. Visco AG, Weidner AC, Barber MD, Myers ER, Cundiff GW, Bump RC, et al. Vaginal mesh erosion after abdominal sacral colpopexy. Am J Obstet Gynecol. 2001;184(3):297-302.
16. Sabbagh R, Mandron E, Piussan J, Brychaert PE, Tu LM. Long-term anatomical and functional results of laparoscopic promotofixation for pelvic organ prolapse. BJUI. 2010;106(6):861–6.
17. Sergent F, Resch B, Loisel C, Bisson V, Schaal JP, Marpeau L. Mid-term outcome of laparoscopic
sacrocolpopexy with anterior and posterior polyester mesh for treatment of genito-urinary
prolapse. Eur J Obstet Gynecol Reprod Biol. 2011;156(2):217-22.