Morciano Andrea, Marzo Giuseppe, Caliandro Dario, Campagna Giuseppe, Panico Giovanni, Alcaino Simona, Bisanti Tatiana, Ercoli Alfredo, Romualdi Daniela, Scambia Giovanni
Department of Gynaecology and Obstetrics, Pia Fondazione "Card. G. Panico", Tricase, Lecce, Italy.
Department of Gynaecology and Obstetrics, Fondazione Policlinico Universitario "A. Gemelli", Università Cattolica del Sacro Cuore, Rome, Italy.
Arch Gynecol Obstet. 2018 Nov;298(5):939-944. doi: 10.1007/s00404-018-4916-0. Epub 2018 Sep 25.
Laparoscopic sacral colpopexy (LSC) plus supracervical hysterectomy (LSH) for pelvic organ prolapse (POP) is a high-complexity surgical procedure. The aim of the present study was to evaluate a new approach to vaginal-mesh fixation during LSC with continuous locked suture.
This is a prospective randomized double-blinded clinical trial enrolling 90 patients with severe POP from January 2016 to April 2017. Patients underwent LSH plus a "two-meshes" LSC and were randomized, regarding mesh fixation, in Group 1 (extracorporeal interrupted 3-0 delayed absorbable sutures) and Group 2 (running locked 3-0 delayed absorbable suture). Our primary endpoints were the operative times and the secondary endpoints the incidence of intra- or post-operative complications.
A total of 42 patients for group completed the study. Baseline characteristics were similar between the groups. Overall mesh fixation time (24 vs. 39 min; p < 0.01), and operative time (121 vs. 138 min; p < 0.05) resulted significantly lower in Group 2. No differences were found in terms of anatomic failure, vaginal mesh erosion or intra- or post-operative complications.
Laparoscopic continuous locked 3-0 absorbable suture for anterior and posterior mesh fixation during LSC guaranteed a faster and effective alternative to multiple interrupted sutures. The significant operative time reduction linked to this technique should be considered even more helpful when performing a highly complex surgery such as LSC.
腹腔镜骶骨阴道固定术（LSC）联合次全子宫切除术（LSH）治疗盆腔器官脱垂（POP）是一种高复杂性的外科手术。本研究的目的是评估在LSC过程中采用连续锁边缝合进行阴道网片固定的新方法。
这是一项前瞻性随机双盲临床试验，从2016年1月至2017年4月招募了90例重度POP患者。患者接受LSH加“双网片”LSC，并在网片固定方面随机分为第1组（体外间断3-0延迟可吸收缝线）和第2组（连续锁边3-0延迟可吸收缝线）。我们的主要终点是手术时间，次要终点是术中和术后并发症的发生率。
第2组共有42例患者完成了研究。两组之间的基线特征相似。第2组的总体网片固定时间（24分钟对39分钟；p＜0.01）和手术时间（121分钟对138分钟；p＜0.05）明显更低。在解剖学失败、阴道网片侵蚀或术中和术后并发症方面未发现差异。
在LSC过程中，用于前后网片固定的腹腔镜连续锁边3-0可吸收缝线保证了一种比多次间断缝合更快且有效的替代方法。当进行如LSC这样的高复杂性手术时，与该技术相关的显著手术时间缩短应被认为更有帮助。
