De Gracia Susie, Fatton Brigitte, Cosson Michel, Campagne-Loiseau Sandrine, Ferry Philippe, Lucot Jean-Philippe, Debodinance Philippe, Panel Laure, Deffieux Xavier, Garbin Olivier, Lamblin Géry, Carlier-Guérin Caroline, Ramanah Rajeev, Fauconnier Arnaud, Serrand Chris, Fritel Xavier, de Tayrac Renaud
Service de Gynécologie, Centre Hospitalier Universitaire de Nîmes, Université de Montpellier, 30900 Nîmes, France.
Service de Gynécologie, CHU Jeanne de Flandre, 59000 Lille, France.
J Clin Med. 2023 Jan 6;12(2):468. doi: 10.3390/jcm12020468.
To evaluate the rates of serious complications and reoperation for recurrence following sacrospinous ligament fixation (SSLF) for apical pelvic organ prolapse. This was a national registry ancillary cohort comparative study. The VIGI-MESH registry includes data from 24 French health centers prospectively collected between May 2017 and September 2021. Time to occurrence of a serious complication or reoperation for genital prolapse recurrence was explored using the Kaplan-Meier curve and Log-rank test. The inverse probability of treatment weighting, based on propensity scores, was used to adjust for between-group differences. A total of 1359 women were included and four surgical groups were analyzed: Anterior SSLF with mesh (n = 566), Anterior SSLF with native tissue (n = 331), Posterior SSLF with mesh (n = 57), and Posterior SSLF with native tissue (n = 405). Clavien-Dindo Grade III complications or higher were reported in 34 (2.5%) cases, with no statistically significant differences between the groups. Pelvic organ prolapse recurrence requiring re-operation was reported in 44 (3.2%) women, this was higher following posterior compared with anterior SSLF ( = 0.0034). According to this large database ancillary study, sacrospinous ligament fixation is an effective and safe surgical treatment for apical prolapse. The different surgical approaches (anterior/posterior and with/without mesh) have comparable safety profiles. However, the anterior approach and the use of mesh were associated with a lower risk of reoperation for recurrence compared with the posterior approach and the use of native tissue, respectively.
评估骶棘韧带固定术（SSLF）治疗盆腔器官顶端脱垂后严重并发症及复发再手术的发生率。这是一项全国性注册辅助队列比较研究。VIGI-MESH注册库包含了2017年5月至2021年9月期间前瞻性收集的来自24个法国医疗中心的数据。使用Kaplan-Meier曲线和对数秩检验探讨生殖器脱垂复发的严重并发症或再手术的发生时间。基于倾向得分的治疗权重逆概率用于调整组间差异。共纳入1359名女性，分析了四个手术组：前路带网片的骶棘韧带固定术（n = 566）、前路带自体组织的骶棘韧带固定术（n = 331）、后路带网片的骶棘韧带固定术（n = 57）和后路带自体组织的骶棘韧带固定术（n = 405）。34例（2.5%）报告了Clavien-Dindo III级及以上并发症，组间无统计学显著差异。44例（3.2%）女性报告了需要再次手术的盆腔器官脱垂复发，后路骶棘韧带固定术后的复发率高于前路（P = 0.0034）。根据这项大型数据库辅助研究，骶棘韧带固定术是治疗顶端脱垂的一种有效且安全的手术方法。不同的手术方式（前路/后路以及带/不带网片）具有相当的安全性。然而，与后路和使用自体组织相比，前路和使用网片分别与较低的复发再手术风险相关。
