Asker Zeki ÖZSOY, Ali YANIK, Gonca İmir YENİCESU, Özlem AKKAR BOZOKLU, Abdullah BOZTOSUN, Muradiye YILDIRIM, İptisam İpek MÜDERRİS

Apikal genital prolapsuslarda sakropeksi ve sakrospinöz ligaman fiksasyonu sonuçları

Amaç. Apikal genital prolapsus olgularının cerrahi tedavisinde uygulanan sakropeksi vesakrosipinoz ligaman fiksasyonu operasyonlarının değerlendirilmesi. Yöntem. Uterin prolapsusveya vajen kaf prolapsusu nedeni ile opere edilen toplam 49 hastanın kayıtları retrospektifincelendi.Tüm hastaların sonuçları değerlendirildi, aynı zamanda sakropeksi (abdominalsakrokolpopeksi/sakroservikopeksi) ve sakrospinöz ligaman fiksasyon grupları oluşturularakdeğerlendirilme de yapıldı. Olgular postoperatif dönemdeki şikayetler, üriner inkontinans, hastamemnuniyeti ve postoperatif bulgular yönünden incelendi. Bulgular. Sakropeksi grubundaortalama takip süresi 41,2 ay (41,2±24,9), sakrospinöz fiksasyon grubunda ise 69,1 ay (69,1±8,2)bulundu. Sakropeksi grubunda prolapsus nüksü tespit edilmedi. Sakrospinöz ligaman fiksasyongrubunda ise 2 olguda (%11,1) nüks tespit edildi. Nüks açısından iki grup arasında anlamlı bir farkyoktu (p=0,058). Sakrospinöz fiksasyon grubunda sakropeksi grubuna göre anlamlı derecede dahayüksek oranda ön/arka onarım yapılmış olmasına rağmen (%83,3'e karşı, %38,7, p=0,013)postoperatif tespit edilen sistorektosel bakımından iki grup arasında fark yoktu. Sakropeksigrubundaki hastaların %93,5i memnun, %6,5i orta düzeyde memnun iken, memnun olmayanhasta yoktu. Sakrosipinoz ligaman fiksasyon grubunda ise 2 olguda (%11,1) memnuniyetsizlikmevcuttu. Hasta memnuyeti bakımından iki grup arasında anlamlı fark vardı (p=0,034). Sonuç.Apikal genital prolapsus olguları için sakropeksi operasyonları ve sakrospinöz ligaman fiksasyonuoperasyonunun yüzgüldürücü olduğu açıktır. Nüks ve hasta memnuniyeti yönünden, sakropeksioperasyonlarının daha yüz güldürücü olduğu söylenebilir. Sakropeksi opersyonları, sistorektoseloperasyonu gereksinimini de azaltmaktadır.

Results of sacropexy and sacrosp inous ligament f ixation in apical genital prolapses

Aim. Evaluation of sacropexy and sacrospinous ligament fixation operations that are applied in thesurgical treatment of the cases of apical genital prolapses. Methods. The records of 49 patientswho are operated for uterine prolapse or vaginal cuff prolapse were analysed retrospectively. Theresults of all patients were evaluated, and then the patients are allocated in two groups namely assacropexy (abdominal sacrocolpopexy/sacrocervicopexy) and sacrospinous ligament fixationgroups. Additionaly, the outcomes of groups were compared with each other. The cases wereinvestigated specifically in terms of postoperative complaints, urinary incontinence, operationsatisfaction, and postoperative signs. Results. Mean follow-up periods were 41.2 months(41.2±24.9) in the sacropexy group, and 69.1 months (69.1±8.2) in the sacrospinous fixationgroup. There weren t any cases of recurrent prolapse in the sacropexy group. Recurrence occuredin two cases (11.1%) in the sacrospinous ligament fixation group. There were no significantdifferences in recurrence rates between the two groups (p=0.058). Although anterior and posteriorrepair was more frequently applied in sacrospinous fixation group than sacropexy group (83.3%vs. 38.7%; p=0.013), the rates of postoperatively detected cysto-rectocele were similar in bothgroups. While 93.5% of the patients in the sacropexy group were fully satisfied, and 6.5% of themwere moderately satisfied and there were no unsatisfied patients. In the sacrospinous ligamentfixation group there were 2 unsatisfied patients (11.1%). In terms of patient satisfaction there wassignificant difference between two groups (p=0.034). Conclusion. For cases of apical genitalprolapse, sacropexy and sacrospinous ligament fixation operations are obviously promising. Onthe other hand, in terms of recurrence and patient satisfaction, sacropexy operations can beconsidered to be more promising. In addition, it can be said that sacropexy procedure can alsoreduce the need for the cystorectocele operation.

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