Trinity Health of New England, Hartford, CT, USA.
University of Pittsburgh Medical Center-Magee-Women's Hospital, Pittsburgh, PA, USA.
Int Urogynecol J. 2020 Oct;31(10):2061-2067. doi: 10.1007/s00192-020-04256-x. Epub 2020 Mar 4.
To determine whether prior prolapse repair has an impact on operative time, surgical complications, and prolapse recurrence with minimally invasive sacral colpopexy (MISC).
This was a retrospective study of all laparoscopic and robotic MISC procedures performed from January 2009 to July 2014 at the University of Pittsburgh Medical Center. Patient demographics, clinical and surgical data were compared in women who underwent MISC for initial repair versus those undergoing MISC for recurrence after prior prolapse surgery. Our primary outcome was operating room (OR) time (skin incision to closure) using linear regression. Logistic regression compared complications (a composite variable considered present if any major complication occurred) and prolapse recurrence (any POP-Q point ≥0 or retreatment).
Of 816 subjects, the mean age was 59.6 ± 8.7, with mean BMI 27.0 ± 3.0 in a primarily Caucasian population (97.8%). Subjects had predominantly POP-Q stage III prolapse (69.9%), and 21.3% reported prior prolapse repair. OR time was 205.0 ± 69.0 min. Prior prolapse repair did not impact OR time (p = 0.25) after adjusting for age, concomitant procedures, POP-Q measurements, changes in OR personnel, case order in the day, and preoperative stress incontinence. Complications occurred in 15.8% but were not impacted by prior prolapse repair (OR = 0.94, 95% CI = 0.53-1.67) after adjusting for potential confounders. During a median follow-up of 31 weeks, 7.8% had recurrence with no impact from prior prolapse surgery (OR = 1.557, 95% CI = 0.67-3.64) after adjusting for potential confounders.
We were unable to demonstrate increased OR time, complications, or prolapse recurrence for MISC based on history of prior prolapse repair. Longer follow-up is needed to confirm the lack of difference in prolapse recurrence rates.
为了确定先前的脱垂修复是否会对微创骶骨阴道固定术（MISC）的手术时间、手术并发症和脱垂复发产生影响。
这是一项回顾性研究，纳入了 2009 年 1 月至 2014 年 7 月在匹兹堡大学医学中心接受腹腔镜和机器人 MISC 手术的所有患者。将接受 MISC 初次修复的患者与先前脱垂手术后复发接受 MISC 的患者进行比较，分析患者的人口统计学、临床和手术数据。我们的主要结局是手术间（OR）时间（皮肤切开至缝合），采用线性回归进行分析。采用逻辑回归比较并发症（如果发生任何主要并发症，则视为存在复合变量）和脱垂复发（任何 POP-Q 点≥0 或再次治疗）。
816 例患者中，平均年龄为 59.6±8.7 岁，主要为白种人（97.8%），平均 BMI 为 27.0±3.0。患者的脱垂程度主要为 POP-Q Ⅲ期（69.9%），21.3%有先前的脱垂修复史。OR 时间为 205.0±69.0 分钟。校正年龄、合并手术、POP-Q 测量、OR 人员变化、日间手术顺序和术前应激性尿失禁等因素后，先前的脱垂修复对 OR 时间（p=0.25）没有影响。并发症发生率为 15.8%，但在校正潜在混杂因素后，先前的脱垂修复并不影响并发症（OR=0.94，95%CI=0.53-1.67）。在中位随访 31 周时，7.8%的患者有复发，而先前的脱垂手术无影响（OR=1.557，95%CI=0.67-3.64），校正潜在混杂因素后。
我们未能证明基于先前脱垂修复史的 MISC 手术时间、并发症或脱垂复发增加。需要更长时间的随访来确认脱垂复发率没有差异。
