Department of Obstetrics & Gynecology, University Hospitals KU Leuven, Herestraat 49, 3000, Leuven, Belgium.
Department of Development and Regeneration, Unit Urogenital, Abdominal and Plastic Surgery, KU Leuven, Leuven, Belgium.
Int Urogynecol J. 2023 Nov;34(11):2799-2807. doi: 10.1007/s00192-023-05631-0. Epub 2023 Aug 26.
In the case of recurrent apical prolapse following laparoscopic sacrocolpopexy (LSCP), one may consider a "redo" procedure. We hypothesized that redo LSCP may carry an increased complication risk and less favorable outcomes when compared with primary procedures.
This is a single-center, matched case-control (1:4) study, comparing all 39 women who had a redo LSCP and 156 women who had a primary LSCP for symptomatic apical prolapse between 2002 and 2020 with a minimum follow-up of 12 months. Matching was based on proximity to the operation date. The primary outcome was the occurrence of intraoperative and early postoperative complications within 3 months. Secondary outcomes included subjective (Patient Global Impression of Change [PGIC] ≥4) and objective (Pelvic Organ Prolapse Quantification [POP-Q] stage <2) success rates, surgical variables, graft-related complications and reinterventions.
There was no difference in the rate of intraoperative and early postoperative complications (redo: 21.1% vs control: 29.8%, OR: 0.63, 95% CI 0.27-1.48). The conversion rate was higher in redo patients (redo: 10.3% vs control: 0.6, OR: 17.71, 95% CI 1.92-163.39). Early postoperative complications were comparable: they were mainly infectious and managed by antibiotics. At a comparable follow-up (redo: 81 months (IQR: 54) vs control: 71.5 months (IQR: 42); p=0.37), there were no differences in graft-related complications (redo: 17.9% vs control: 9.6%, p=0.14) and reinterventions for complications (redo: 12.8% vs control: 5.1%, p=0.14) or prolapse (redo: 15.4% vs control: 8.3%, p=0.18). Subjective (redo: 88.5% vs control: 80.2%, p=0.41) and objective (redo: 31.8% vs control: 24.7%, p=0.50) success rates were also comparable.
In our experience, redo LSCP is as safe and effective as a primary LSCP, but there is a higher risk of conversion.
在腹腔镜骶骨阴道固定术（LSCP）后出现复发性顶端脱垂的情况下，可能需要考虑“再次手术”。我们假设与初次手术相比，再次 LSCP 可能会增加并发症风险和降低结局满意度。
这是一项单中心、配对病例对照（1:4）研究，比较了 2002 年至 2020 年期间因有症状的顶端脱垂而接受再次 LSCP 的 39 名女性和接受初次 LSCP 的 156 名女性，所有患者的随访时间均至少为 12 个月。配对是基于手术日期的接近程度。主要结局是 3 个月内的术中及早期术后并发症。次要结局包括主观（患者整体印象变化[PGIC]≥4）和客观（盆腔器官脱垂量化[POP-Q]分期<2）成功率、手术变量、移植物相关并发症和再次干预。
术中及早期术后并发症的发生率无差异（再次手术：21.1%；对照组：29.8%；OR：0.63；95%CI：0.27-1.48）。再次手术组的转化率更高（再次手术：10.3%；对照组：0.6%；OR：17.71；95%CI：1.92-163.39）。早期术后并发症相似，主要为感染性并发症，采用抗生素治疗。在相似的随访时间（再次手术：81 个月（IQR：54）；对照组：71.5 个月（IQR：42）；p=0.37），移植物相关并发症（再次手术：17.9%；对照组：9.6%；p=0.14）和并发症再次干预（再次手术：12.8%；对照组：5.1%；p=0.14）或脱垂（再次手术：15.4%；对照组：8.3%；p=0.18）无差异。主观（再次手术：88.5%；对照组：80.2%；p=0.41）和客观（再次手术：31.8%；对照组：24.7%；p=0.50）成功率也相似。
根据我们的经验，再次 LSCP 与初次 LSCP 一样安全有效，但转化率更高。
