Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Roma, Italy.
Fondazione Policlinico Universitario A. Gemelli IRCCS, UOC Uroginecologia e Chirurgia Ricostruttiva del Pavimento Pelvico, Dipartimento di Scienze della Salute della Donna e del Bambino e di Sanità Pubblica, Roma, Italy.
Eur J Obstet Gynecol Reprod Biol. 2020 May;248:222-226. doi: 10.1016/j.ejogrb.2020.03.025. Epub 2020 Mar 20.
Pelvic organ prolapse (POP) recurrence in transvaginal mesh surgery patients has become increasingly common, due to widespread mesh use before the FDA alert. The aim was to assess feasibility, effectiveness and safety of laparoscopic sacral colpopexy (LSCP) in recurrent POP after previous vaginal surgery with polypropylene mesh.
Medical records of 20 patients with ≥ stage 2 POP recurrence, who underwent LSCP from January 2015 to July 2018, were retrospectively analyzed in a monocentric observational study. We analyzed operative time, intraoperative complications - defined as bowel, bladder, ureteral, or vascular injuries, post-operative complications - assessed with Clavien-Dindo's classification, and postoperative patient satisfaction - evaluated with the Patient Global Impression of Improvement questionnaire. Pre- and postoperative data were compared using t-test.
All women presented apical prolapse recurrence regardless of mesh type implanted and most of them involved the posterior compartment. No perioperative complications or cases of mesh extrusion, de novo urinary stress, urge incontinence, dyspareunia were recorded. At 12-month follow-up the POP-Q examinations demonstrated a statistically significant improvement of all parameters with a complete resolution of bulge, voiding and storage symptoms in all patients.
LSCP suggests safety, feasible and efficacy in the treatment of recurrent POP after prior transvaginal polypropylene mesh surgery. We suggest to conduct a prospective research with larger sample size to gain further insights.
由于在 FDA 警示之前广泛使用网片，经阴道网片修补术后的盆腔器官脱垂（POP）复发越来越常见。本研究旨在评估腹腔镜骶骨固定阴道前壁修补术（LSCP）治疗先前经阴道聚丙烯网片修补术后 POP 复发的可行性、有效性和安全性。
对 2015 年 1 月至 2018 年 7 月接受 LSCP 的 20 例≥2 期 POP 复发患者的病历进行回顾性分析，该研究为单中心观察性研究。我们分析了手术时间、术中并发症（定义为肠、膀胱、输尿管或血管损伤）、术后并发症（采用 Clavien-Dindo 分类评估）和术后患者满意度（采用患者总体改善情况问卷调查评估）。使用 t 检验比较术前和术后数据。
所有女性均存在顶脱垂复发，不论植入的网片类型如何，大多数患者涉及后盆腔。未发生围手术期并发症或网片挤出、新发尿失禁、急迫性尿失禁、性交困难。12 个月随访时，POP-Q 检查显示所有参数均有统计学显著改善，所有患者的膨出、排尿和储存症状均完全缓解。
LSCP 治疗经阴道聚丙烯网片修补术后 POP 复发安全、可行且有效。我们建议进行前瞻性研究，以获得更大的样本量，进一步深入了解。
