Obstetrics and Gynecology University Department, Mauriziano Umberto I Hospital, Turin, Italy; University of Turin, Department of Surgical Sciences, Turin, Italy.
Obstetrics and Gynecology University Department, Mauriziano Umberto I Hospital, Turin, Italy; University of Turin, Department of Surgical Sciences, Turin, Italy.
Eur J Obstet Gynecol Reprod Biol. 2022 Mar;270:221-226. doi: 10.1016/j.ejogrb.2022.01.012. Epub 2022 Jan 15.
McCall culdoplasty is a commonly performed procedure for pelvic organ prolapse surgical repair; despite its good efficacy, however, anterior prolapse recurrence frequently occurs. The aim of our study was to verify whether fixation of utero-sacral ligaments (USLs) to anterior vaginal wall during a modified McCall culdoplasty (MMC) could reduce the rate of anterior recurrence of prolapse.
This was a retrospective study on women submitted to MMC after vaginal hysterectomy and anterior colporraphy for prolapse repair. Patients undergoing concurrent anterior fixation of USLs (AF) were compared to cases treated with MMC alone, evaluating potential differences in anatomic result of prolapse repair at 12 months, rate of anterior recurrence over time, operative data and post-operative morbidity.
Women undergoing MMC with AF (n = 45), compared with patients treated with MMC alone (n = 77), showed better results in terms of anatomic support in the anterior compartment at 12 months, assessed by means of POP-Q system parameters Aa (-1.8 cm vs -1.2 cm, p 0.0025) and Ba (-2.0 cm vs -1.3 cm, p 0.00015), and a lower rate of anterior recurrence (11.1% vs 29.9%, p 0.025); the other parameters of prolapse anatomic staging did not differ significantly, nor did operative data or post-operative morbidity. Follow up confirmed a longer disease-free survival over time for women treated with MMC with AF (p 0.028) CONCLUSIONS: Fixation of USLs to anterior vaginal wall at time of post-hysterectomy MMC appears to improve anatomic outcomes of the procedure reducing the risk of anterior prolapse, without implying a reduced safety, nor a greater surgical complexity.
麦卡 culdoplasty 是一种常用于盆腔器官脱垂手术修复的方法；尽管疗效良好，但前突复发率仍然很高。我们的研究目的是验证在改良麦卡 culdoplasty（MMC）中固定子宫骶骨韧带（USLs）至前阴道壁是否可以降低脱垂复发的前突率。
这是一项对因脱垂接受阴道子宫切除术和前阴道修补术修复的妇女进行的 MMC 回顾性研究。将接受 USLs 同期前固定（AF）的患者与仅接受 MMC 治疗的患者进行比较，评估 12 个月时脱垂修复的解剖结果、随时间推移的前突复发率、手术数据和术后发病率的潜在差异。
与仅接受 MMC 治疗的患者（n=77）相比，接受 MMC 加 AF 的患者（n=45）在 12 个月时前间隙解剖支持方面的结果更好，POP-Q 系统参数 Aa（-1.8cm 与-1.2cm，p=0.0025）和 Ba（-2.0cm 与-1.3cm，p=0.00015）更好，且前突复发率较低（11.1%与 29.9%，p=0.025）；脱垂解剖分期的其他参数差异无统计学意义，手术数据或术后发病率也无差异。随访证实，接受 MMC 加 AF 治疗的患者随时间推移的无病生存率更长（p=0.028）。
在 post-hysterectomy MMC 时固定 USLs 至前阴道壁似乎可以改善手术的解剖结果，降低前突脱垂的风险，而不会降低安全性或增加手术复杂性。
