Khoiwal Kavita, Dash Kanhu Charan, Gaurav Amrita, Chaturvedi Jaya
Department of Obstetrics and Gynecology, All India Institute of Medical Sciences (AIIMS), Rishikesh, India
J Turk Ger Gynecol Assoc. 2023 Sep 7;24(3):144-151. doi: 10.4274/jtgga.galenos.2023.2022-12-15. Epub 2023 Aug 7.
To compare laparoscopic pectopexy with the standard laparoscopic sacropexy in women with symptomatic apical prolapse.
An interim analysis of an exploratory randomized controlled trial with the primary objective of comparing mesh fixation time and secondary objectives were to compare total operating time, blood loss, and intra-operative and post-operative complications. Additionally, patients completed the Prolapse Quality of Life (P-QOL) and Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) questionnaires before surgery and during six months follow-up visit to evaluate the overall improvement in quality of life and sexual function. Patient Global Impression of Improvement (PGI-I) score was calculated on the 7-10 day post-operatively and then at six months to assess the level of improvement.
The study included 30 patients; 15 underwent laparoscopic sacropexy, and 15 underwent laparoscopic pectopexy. Baseline characteristics were comparable in both groups. The mean duration of mesh fixation was significantly less with laparoscopic pectopexy (45.00±11.34 minutes) than laparoscopic sacropexy (54.67±9.35 minutes) (p=0.019). The total operating time and blood loss tended to be less in the pectopexy group, but not significantly so. Only one patient in the pectopexy group had a bladder injury. No patient in either group had any post-operative complications. One case in each group had a relapse of apical prolapse. All the domains of PISQ-12, P-QOL, and PGI-I scores improved significantly after both procedures.
Laparoscopic pectopexy is a safe, feasible, and comfortable alternative procedure to the standard sacropexy for apical prolapse. We noted significantly less mesh fixation time and less operating time, while blood loss tended to be less with laparoscopic pectopexy than with laparoscopic sacropexy. Post-operative parameters were comparable between techniques. Both corrective techniques for prolapse improved the PGI-I, P-QOL, and PISQ-12 scores.
比较腹腔镜耻骨后固定术与标准腹腔镜骶骨固定术治疗有症状的顶端脱垂女性的效果。
一项探索性随机对照试验的中期分析，主要目的是比较网片固定时间，次要目的是比较总手术时间、失血量以及术中及术后并发症。此外，患者在手术前及术后6个月随访时完成脱垂生活质量（P-QOL）和盆腔器官脱垂/尿失禁性功能问卷（PISQ-12），以评估生活质量和性功能的总体改善情况。术后7-10天及6个月时计算患者总体改善印象（PGI-I）评分，以评估改善程度。
该研究纳入30例患者；15例行腹腔镜骶骨固定术，15例行腹腔镜耻骨后固定术。两组基线特征具有可比性。腹腔镜耻骨后固定术的平均网片固定时间（45.00±11.34分钟）明显短于腹腔镜骶骨固定术（54.67±9.35分钟）（p=0.019）。耻骨后固定术组的总手术时间和失血量倾向于较少，但差异无统计学意义。耻骨后固定术组仅1例患者发生膀胱损伤。两组均无患者出现术后并发症。每组各有1例顶端脱垂复发。两种手术术后PISQ-12、P-QOL和PGI-I评分的所有领域均显著改善。
对于顶端脱垂，腹腔镜耻骨后固定术是一种安全、可行且舒适的替代标准骶骨固定术的手术方法。我们注意到腹腔镜耻骨后固定术的网片固定时间明显更短，手术时间也更短，且失血量倾向于比腹腔镜骶骨固定术更少。两种技术的术后参数具有可比性。两种脱垂矫正技术均改善了PGI-I、P-QOL和PISQ-12评分。
