Neuman Jonatan, Groutz Asnat, Neuman Menahem, Gold Ronen S
Medical School, Semmelweis University, 1085 Budapest, Hungary.
Urogynecology Unit, Lis Women Hospital, Tel Aviv Medical Center, Gray Faculty of Medical and Health Sciences, Tel Aviv University, Tel Aviv 6423906, Israel.
J Clin Med. 2025 Jul 24;14(15):5235. doi: 10.3390/jcm14155235.
Recurrent apical pelvic organ prolapse (POP) presents significant management challenges, with limited evidence on optimal surgical approaches. This study evaluated the safety and long-term effectiveness of minimally invasive sacrospinous ligament (SSL) fixation using the EnPlace device for treating recurrent apical POP. A cohort analysis was performed on 82 consecutive patients (mean age 65.9 ± 8.6 years) with stage III or IV recurrent symptomatic apical POP. All patients underwent transvaginal SSL fixation using the EnPlace device between January 2021 and July 2023. Primary outcomes included anatomical cure rates, patient satisfaction, and complications. Long-term follow-up was conducted via a structured telephone survey in December 2024. The mean interval between primary and recurrent repair was 3.2 ± 2.6 years. Most patients (64.6%) underwent surgery under regional anesthesia with a mean operative time of 24.1 ± 7.1 min and minimal blood loss (23.8 ± 6.5 mL). No intraoperative complications occurred, and 98.8% of patients were discharged the same day. Two early postoperative complications occurred, neither requiring surgical intervention. At six-month follow-up, significant improvements were observed in POP-Q measurements for apical prolapse, cystocele, and rectocele. Long-term follow-up (mean 31.6 ± 8.3 months) revealed that only 11 patients (13.4%) reported mild POP symptoms. Patient satisfaction scores averaged 90.8 ± 17.1, with only 8.5% reporting low satisfaction. Only two patients (2.4%) required additional intervention for recurrent apical POP. Minimally invasive SSL fixation using the EnPlace device demonstrates favorable safety and efficacy for recurrent apical POP, offering a viable alternative to more invasive procedures with high patient satisfaction and low recurrence rates.
复发性盆腔脏器顶端脱垂（POP）带来了重大的治疗挑战，关于最佳手术方法的证据有限。本研究评估了使用EnPlace装置进行微创骶棘韧带（SSL）固定治疗复发性盆腔脏器顶端脱垂的安全性和长期有效性。对82例连续的III期或IV期复发性有症状盆腔脏器顶端脱垂患者（平均年龄65.9±8.6岁）进行了队列分析。所有患者在2021年1月至2023年7月期间使用EnPlace装置进行了经阴道SSL固定。主要结局包括解剖治愈率、患者满意度和并发症。2024年12月通过结构化电话调查进行了长期随访。初次修复与复发修复之间的平均间隔时间为3.2±2.6年。大多数患者（64.6%）在区域麻醉下接受手术，平均手术时间为24.1±7.1分钟，失血极少（23.8±6.5毫升）。未发生术中并发症，98.8%的患者在当天出院。发生了2例早期术后并发症，均无需手术干预。在6个月的随访中，盆腔脏器脱垂定量分期系统（POP-Q）测量显示顶端脱垂、膀胱膨出和直肠膨出有显著改善。长期随访（平均31.6±8.3个月）显示，只有11例患者（13.4%）报告有轻度POP症状。患者满意度评分平均为90.8±17.1，只有8.5%的患者报告满意度低。只有2例患者（2.4%）因复发性盆腔脏器顶端脱垂需要额外干预。使用EnPlace装置进行微创SSL固定对复发性盆腔脏器顶端脱垂显示出良好的安全性和有效性，为更具侵入性的手术提供了可行的替代方案，患者满意度高且复发率低。
