Hafedh Bandr, Idris Sarah Mohammed, Nadreen Farah, Banasser Abdulrhman M, Iskandarani Radiah, Baradwan Saeed
Department of Obstetrics and Gynecology, King Faisal Specialist Hospital and Research Center, Jeddah, Saudi Arabia.
Int J Womens Health. 2024 Sep 10;16:1483-1491. doi: 10.2147/IJWH.S474835. eCollection 2024.
Laparoscopic sacrohysteropexy is an emerging uterine-preserving strategy for management of uterovaginal prolapse (UVP). The literature on laparoscopic sacrohysteropexy for management of UVP is very scarce from Saudi Arabia. This research examined the feasibility, clinical utility, and safety of laparoscopic sacrohysteropexy in a Saudi setting.
A retrospective study was conducted, including all patients who met the inclusion criteria. The laparoscopic sacrohysteropexy technique was adapted with modifications from the "Oxford hysteropexy". The primary endpoint was overall success, defined as anatomical success in all vaginal compartments (UVP grade 0 or 1 postoperatively). The secondary endpoint was the mean change in point C. Descriptive data were summarized with numbers and percentages, while numerical data used means ± standard deviations. Fisher's exact and Student's tests were used for univariate analyses. Significant surgical outcome predictors were identified via logistic regression, with p <0.05 considered statistically significant.
Overall, 21 patients met the inclusion criteria. The most frequent indication for laparoscopic sacrohysteropexy was UVP without anterior or posterior wall prolapse (n = 15, 71.4%), whereas the most frequent grade of UVP was grade III (n = 13, 61.9%). One patient (4.8%) required switch to laparotomy due to severe adhesions. No perioperative complications were recorded. The mean change in point C and hospital stay were 5.8 ± 2.1 (range: 0-8) and 1.4 ± 0.6 days (range: 1-3), respectively. Surgical success was achieved in 18 patients (85.7%). Only three patients experienced recurrences (one, two, and six months postoperatively). The mean change in point C was significantly higher in successful cases contrasted with the failed cases (6.5 versus 1.3).
Laparoscopic sacrohysteropexy for management of uterovaginal prolapse revealed technical feasibility, safety, and beneficial utility of the procedure. Further large-sized and multicentric investigations are important to gather additional pertinent information on laparoscopic sacrohysteropexy.
腹腔镜骶骨子宫固定术是一种新兴的保留子宫治疗子宫阴道脱垂（UVP）的策略。沙特阿拉伯关于腹腔镜骶骨子宫固定术治疗UVP的文献非常稀少。本研究探讨了在沙特背景下腹腔镜骶骨子宫固定术的可行性、临床实用性和安全性。
进行了一项回顾性研究，纳入所有符合纳入标准的患者。腹腔镜骶骨子宫固定术技术在“牛津子宫固定术”基础上进行了改良。主要终点是总体成功率，定义为所有阴道隔解剖学成功（术后UVP为0级或1级）。次要终点是C点的平均变化。描述性数据用数字和百分比汇总，数值数据用均值±标准差表示。采用Fisher精确检验和Student检验进行单因素分析。通过逻辑回归确定显著的手术结果预测因素，p<0.05被认为具有统计学意义。
总体而言，21例患者符合纳入标准。腹腔镜骶骨子宫固定术最常见的适应证是无前后壁脱垂的UVP（n = 15，71.4%），而最常见的UVP分级是III级（n = 13，61.9%）。1例患者（4.8%）因严重粘连需要转为开腹手术。未记录围手术期并发症。C点的平均变化和住院时间分别为5.8±2.1（范围：0 - 8）和1.4±0.6天（范围：1 - 3）。18例患者（85.7%）手术成功。仅3例患者复发（术后1个月、2个月和6个月各1例）。成功病例的C点平均变化显著高于失败病例（6.5对1.3）。
腹腔镜骶骨子宫固定术治疗子宫阴道脱垂显示出该手术的技术可行性、安全性和有益实用性。进一步开展大规模多中心研究对于收集关于腹腔镜骶骨子宫固定术的更多相关信息很重要。
