Warrell Unit, St Mary's Hospital, Manchester Foundation Trust, Oxford Road, Manchester, M13 9WL, UK.
Maternal & Fetal Health Research Centre, Manchester Academic Health Centre, University of Manchester, Manchester, M13 9WL, UK.
Int Urogynecol J. 2024 Jan;35(1):51-58. doi: 10.1007/s00192-023-05584-4. Epub 2023 Jul 21.
The Variation in Surgical Technique study (VaST), demonstrated the large variation in surgical techniques used in native tissue (NT) anterior pelvic organ prolapse (POP) repairs. However, there are few comparative studies of different surgical techniques. This study was aimed at exploring whether surgical technique influenced the outcomes of NT anterior POP repairs.
The surgical techniques of 22 consultant surgeons performing NT anterior POP repairs were filmed and categorised. These surgeons performed 809 anterior repairs within the PROlapse Surgery: Pragmatic Evaluation and randomised Controlled Trial (PROSPECT). Logistical regression models were used to determine the influence of the different surgical techniques on subjective and objective outcomes, using data collected during PROSPECT.
In adjusted multivariate linear regression models, fascial-flap repair was associated with an improved subjective outcome (POP-SS) compared with midline plication (β = -2.50 [-4.42 to -0.57]; p = 0.01). At 12 months, separate fascial defect repair was associated with a poorer objective outcome than midline plication (OR 6.06 [1.82-3.52], p = 0.006). At 24 months, deep dissection was associated with a poorer POP-SS than superficial dissection (0.32-2.60, p = 0.0). Continuous-locking closure of the skin was also associated with improved POP-SS compared with continuous non-locking closure (12 months: β = -1.94 [-3.42 to -0.45], p = 0.01).
Surgical technique may influence the outcome of native tissue anterior POP repairs. Our results should not change practice but inform future research; to develop methods of explicitly recording surgical techniques and allow confirmation of the effect of these aspects of technique on outcome.
手术技术变异研究（VaST）表明，在固有组织（NT）前盆腔器官脱垂（POP）修复中，手术技术的差异很大。然而，比较不同手术技术的研究很少。本研究旨在探讨手术技术是否影响 NT 前 POP 修复的结果。
对 22 位进行 NT 前 POP 修复的顾问外科医生的手术技术进行拍摄和分类。这些外科医生在 PROlapse Surgery: Pragmatic Evaluation and randomised Controlled Trial (PROSPECT) 中进行了 809 例前 POP 修复。使用 PROSPECT 期间收集的数据，使用逻辑回归模型确定不同手术技术对主观和客观结果的影响。
在调整后的多元线性回归模型中，与中线缝合相比，筋膜瓣修复与主观结局（POP-SS）改善相关（β=-2.50 [-4.42 至-0.57]；p=0.01）。12 个月时，与中线缝合相比，单独修复筋膜缺损与客观结局较差相关（OR 6.06 [1.82-3.52]，p=0.006）。24 个月时，深层解剖与浅层解剖相比，POP-SS 较差（0.32-2.60，p=0.0）。皮肤连续锁定闭合与连续非锁定闭合相比，也与 POP-SS 改善相关（12 个月：β=-1.94 [-3.42 至-0.45]，p=0.01）。
手术技术可能影响固有组织前 POP 修复的结果。我们的结果不应改变实践，但应告知未来的研究；开发明确记录手术技术的方法，并允许确认这些技术方面对结果的影响。
