Gökmen SUKGEN, Ünal TURKAY, Mehmet OZSURMELİ

Pelvik organ prolapsusu olan üreme çağındaki kadınların uterus koruyucu cerrahisinde laparoskopik ve transvajinal meş operasyonlarının etkinliğinin karşılaştırılması (evre ≥2)

Amaç: Bu çalışmanın amacı, pelvik prolapsusu (POP) olan (evre≥2) üreme çağındaki kadınlarda laparoskopik ve transvajinal meş ameliyatlarının etkinliğini ile karşılaştırmaktır. Gereç ve Yöntem: Bu çalışmada, semptomatik POP-Q evre 2 ve üzeri pelvik prolapsus tanısı alan laparoskopik cerrahi geçiren 22 hasta ile (Grup-1), transvajinal meş (TVM) uygulanan 83 olguyu (grup 2) retrospektif olarak değerlendirdik. Prolapsus Pelvik Organ POP-Q kullanılarak derecelendirildi. Mevcut TVM cerrahi kitleri olarak dört kollu mesh kullanıldı. Bulgular: Her iki gruptaki hastaların ortalama yaşı sırasıyla 42,2 ± 11,4 ve 38,3 ± 12,8 yıldı. Laparoskopi yapılan hastaların ortalama hastanede kalış süresi 2,3 gün (1-4 gün), bu süre Grup-2'de 3 gün (2-4 gün) olarak gözlendi. Hastalarımızın hiçbirinde erken veya geç dönemde herhangi bir yan etki görülmedi. Başarı oranı laparoskopik cerrahi uygulanan hastalarda% 95.45 iken TVM cerrahisi grubunda% 98.10 idi. Sonuç: Transvajinal meş cerrahisinin, yüksek başarı oranı ve minimal komplikasyon oranları nedeniyle pelvik organ prolaps cerrahisinde başarılı bir teknik olduğu gösterilmiştir.

Anahtar Kelimeler:

Pelvic Prolapse, Laparoscopic Surgery, Transvaginal Mesh Surgery

Comparison of effectiveness of laparoscopic and transvaginal mesh operations in uterus protective surgery of women in reproductive-age with pelvic organ prolapse (stage ≥2).

Purpose: The aim of this study was to compare the efficiency of laparoscopic and transvaginal mesh operations with conservative surgery of reproductive-age women with pelvic organ prolapse (stage≥2) (POP). Materials and Methods: In this study, we retrospectively evaluated 22 cases of 105 patients who diagnosed with symptomatic POP-Q stage 2 and above pelvic prolapse, part of whom underwent laparoscopic surgery (Group-1) while the other part composed of those who underwent transvaginal mesh (TVM) surgery (Group-2). Urogenital prolapse Pelvic Organ was graded using POP-Q.As the current TVM surgical kits four-arms mesh was used. Results: The mean age of the patients of both groups was 42.2±11.4 and 38.3±12.8 years, respectively. The mean duration of hospitalization for the patients underwent laparoscopy was 2.3 days (range:1-4 days), that period was observed as 3 days in Group-2 (range:2-4 days). None of our patients had any adverse reactions in the early or late stages. The rate of success was 95.45% for patients who underwent laparoscopic surgery, while it was 98.10% for the group of TVM surgery. Conclusion: Transvaginal mesh surgery was found to be a relatively successful technique in pelvic organ prolapse surgery owing to the high rate of success and minimal rates of complications.

PDF

___

1. Constantini E, Porena M, Lazzeri M, Mearini L, Bini V, Zucchi A. Changes in female sexual function after pelvic organ prolapse repair. Int Urogynecol. J. 2013;24:1481-7
2. El Haddad R, Svabik K, Masata J, Koleska T, Hubka P, Martan A. Women's quality of life and sexual function after transvaginal anterior repair with mesh insertion. Eur J Obstet Gynecol Reprod Biol. 2013;167:110-13.
3. Jarząbek-Bielecka G, Buks J, Witkowska J, Wilczak M, Pisarska-Krawczyk M, Kędzia W et al. Aging: Women sexual activity, pelvic organ prolapse and urinary incontinence. Polski Przegląd Nauk o Zdrowiu. 2014;1:25-8.
4. Pattel MS, Mellen C, O’ Sullivan DM, Lassala CA. Pessary use and impact on quality of life and body image. Female Pelvic Med Reconstr Surg. 2011;17:298-301.
5. National Institute for Health and Care Excellence. Managing pelvic organ prolapse. In: Urinary incontinence and pelvic organ prolapse in women NICE guideline Draft. October 2018;24.
6. Zucchi A, Lazzeri M Porena M, Del Zingaro M, Costantini E. Uterus preservation in prolapse surgery. Nat Med. 2010;7:626–33.
7. Tola EN, Erdemoğlu E, Erdemoğlu E. Uterine sparing surgical methods in pelvic organ prolapse. Turk J Obstet Gynecol. 2015;12:168–72.
8. Walter JE. Transvaginal mesh procedures for pelvic organ prolapse. J Obstet Gynaecol Can. 2011;33:168– 74.
9. Rogo-Gupta L. Current trends in surgical repair of pelvic organ prolapse. Curr Opin Obstet Gynecol. 2013;25:395-8.
10. Acsinte OM, Rabischong B, Bourdel N, Canis M, Botchorishvili R. Laparoscopic promontofixation in 10 steps. J Minim Invasive Gynecol. 2018;25:767.
11. Bump RC, Mattiasson A, Brubaker LP, DeLancey JO, Klarskov P, Shull BL et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. Am J Obstet Gynecol. 1996;175:10-7.
12. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205-13.
13. Florin M and Florin Z. Laparoscopic Treatment of Inguinal Hernias. In Mihaileanu Florin and Florin Zaharie (Eds). Laparoscopic Treatment of Inguinal Hernias, Romania. 2018;1-35.
14. Dietz V, van der Vaart CH, van der Graaf Y, Heintz P, Schraffordt Koops SE. One-year follow-up after sacrospinous hysteropexy and vaginal hysterectomy for uterine descent: a randomized study. Int Urogynecol J Pelvic Floor Dysfunct. 2010;2:209-16.
15. Gutman R, Maher C. Uterine-preserving POP surgery. Int Urogynecol J. 2013;24:1803-13.
16. Maher CF, Cary MP, Slack MC, Murray CJ, Milligan M, Schluter P. Uterine preservation or hysterectomy at sacrospinou s colpopexy for uterovaginal prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2001;12:381- 84.
17. Gamble TL, Aschkenazi S, Nguyen A. Bilateral graftaugmented sacrospinous hysteropexy: 1-year anatomic and functional outcomes following surgery for uterine preservation. J Pelvic Med Surg. 2008;14, 275–79.
18. Detollenaere RJ, Boon Jd, Stekelenburg J, IntHout J, Vierhout ME, Kluivers KB et al. Sacrospinous hysteropexy versus vaginal hysterectomy with suspension of the uterosacral ligaments in women with uterine prolapse stage 2 or higher: multicentre randomised non-inferiority trial. BMJ. 2015;351:h3717.
19. Achtari C, Dwyer PL. Sexual function and pelvic floor disorders. Best Pract Res Clin Obstet Gynecol. 2005;19:993–1008.
20. Gyhagen M, Bullarbo M, Nielsen T, Milsom I. Prevalence and risk factors for pelvic organ prolapse 20 years after child birth: a national cohort study in singleton primiparae after vaginal or caesarean delivery. BJOG. 2013;120:152-60.
21. Miedel A, Tegerstedt G, Maehle-Schmidt M, Nyren O, Hammarstrom M. Nonobstetric risk factors for symptomatic pelvic organ prolapse. Obstet Gynecol. 2009;113:1089-97.
22. Silva WA, Pauls RN, Segal JL, Uterosacral vault suspension: five-year outcomes. Obstet Gynecol. 2006;108:255-63.
23. Thakar R, Sultan AH Hysterectomy and pelvic organ dysfunction. Best Pract Res Clin Obstet Gynaecol. 2005;19: 403–18.
24. Neuman M, Lavy Y. Conservation of the prolapsed uterus is a valid option: medium term results of a prospective comparative study with the posterior intravaginal slingoplasty operation. Int Urogynecol J Pelvic Floor Dysfunct. 2007;18: 889-93.
25. Lopes ED, Lemos NL, Carramao SS, Lunardelli JL, Ruano JM, Aoki T et al. Transvaginal polypropylene mesh versus sacrospinous ligament fixation for the treatment of uterine prolapse: 1-year follow-up of a randomized controlled trial. Int Urogynecol J. 2010;21:389–94.
26. Ağaçayak E, Tunç SY, İçen MS, Başaranoğlu S, Fındık MF, Sak S et al. Should we add unilateral sacrospinous ligament fixation to vaginal hysterectomy in management of stage 3 and stage 4 pelvic organ prolapse? Turk J Obstet Gynecol. 2015;12:144–50.