Arunachalam Divya, Hale Douglass S, Heit Michael H
From the Division of Female Pelvic Medicine and Reconstructive Surgery, Indiana University School of Medicine, Indianapolis, IN.
Female Pelvic Med Reconstr Surg. 2018 Mar/Apr;24(2):183-187. doi: 10.1097/SPV.0000000000000538.
The aim of this study was to determine the value of posterior compartment surgery during concomitant mesh-augmented apical suspension by comparing obstructed defecatory symptoms after laparoscopic sacrocolpopexy (LSC) with LSC with posterior repair (LSC + PR) and laparoscopic sacrocolpoperineopexy (LSCP) procedures.
This was a retrospective cohort study of women who underwent LSC, LSC + PR, and LSCP between July 2007 and July 2016 at a tertiary referral center in Indianapolis, Ind. Our primary outcome was differential change in Colorectal-Anal Distress Inventory (CRADI-8) and Colorectal-Anal Impact Questionnaire (CRAIQ-7) scores between the groups including patient-specific symptoms of splinting, straining, incomplete emptying, and pain with defecation. Our secondary outcomes were the rates of postoperative persistent, new, and resolved obstructed defecation symptoms. Anatomic outcomes were also compared between the groups as measured by change in Pelvic Organ Prolapse Quantification System points Ap, GH, and PB.
A total of 312 women were included in the study (47 LSC, 133 LSC + PR, and 132 LSCP), with a median follow-up time of 366 days. The majority of patients who underwent surgery had stage III pelvic organ prolapse (61%). Baseline demographics were similar between groups, including preoperative CRADI-8 and CRAIQ-7 scores. All surgical groups demonstrated improvement in CRADI-8 and CRAIQ-7 scores postoperatively (P < 0.001). However, despite differential change in Pelvic Organ Prolapse Quantification System points Ap, GH, and PB, there was no change in CRADI-8 and CRAIQ-7 scores or rates of persistent, new, and resolved symptoms of splinting to defecate, incomplete emptying, and pain with defecation between the groups. The only factor that seemed to be differentially improved by the addition of a posterior compartment repair was postoperative straining. There was a greater rate of de novo straining in the LSC group compared with LSCP (P = 0.01) (LSC + PR v LSCP, P = NS, for both).
We cannot recommend posterior compartment surgery as providing any patient-centered benefit beyond improved cosmesis because the addition of perineal body stabilization either before (LSCP) or posterior repair after (LSC + PR) concomitant mesh-augmented apical suspension did not differentially affect bowel symptoms compared with LSC alone.
本研究旨在通过比较腹腔镜骶骨阴道固定术（LSC）、LSC联合后路修补术（LSC + PR）和腹腔镜骶骨会阴固定术（LSCP）术后的排便梗阻症状，确定在同时进行网片增强顶端悬吊术时后路腔室手术的价值。
这是一项对2007年7月至2016年7月期间在印第安纳州印第安纳波利斯市一家三级转诊中心接受LSC、LSC + PR和LSCP手术的女性进行的回顾性队列研究。我们的主要结局是各治疗组之间结直肠肛门困扰量表（CRADI - 8）和结直肠肛门影响问卷（CRAIQ - 7）评分的差异变化，包括特定患者的屏气、用力、排空不全和排便疼痛症状。次要结局是术后持续性、新发和缓解的排便梗阻症状发生率。还比较了各治疗组之间通过盆腔器官脱垂定量系统Ap、GH和PB点变化测量的解剖学结局。
共有312名女性纳入研究（47例行LSC，133例行LSC + PR，132例行LSCP），中位随访时间为366天。大多数接受手术的患者为Ⅲ期盆腔器官脱垂（61%）。各治疗组之间的基线人口统计学特征相似，包括术前CRADI - 8和CRAIQ - 7评分。所有手术组术后CRADI - 8和CRAIQ - 7评分均有改善（P < 0.001）。然而，尽管盆腔器官脱垂定量系统Ap、GH和PB点有差异变化，但各治疗组之间CRADI - 8和CRAIQ - 7评分以及屏气排便、排空不全和排便疼痛的持续性、新发和缓解症状发生率均无变化。唯一似乎因增加后路腔室修补术而有差异改善的因素是术后用力排便。与LSCP组相比，LSC组新发用力排便的发生率更高（P = 0.01）（LSC + PR与LSCP组相比，两者P值均无统计学意义）。
我们不建议将后路腔室手术作为除改善美观外能带来任何以患者为中心益处的手术，因为与单纯LSC相比，在同时进行网片增强顶端悬吊术之前（LSCP）或之后（LSC + PR）增加会阴体固定对肠道症状没有差异影响。
