Journals / Türk Üroloji Dergisi/Turkish Journal of Urology / 2005 / Cilt: 31 - Sayı: 2
Laparoscopic sacrocolpopexy with double mesh: Our initial experiences
- Pages
- 253–258
- DOI
- —
Abstract
Introduction: Genital prolapse is a common problem in women, and repair of pelvic organ prolapse (POP) is a frequent pelvic reconstructive procedure performed in post hysterectomy patients. The aim of the treatment is to control the clinical manifestations and to prevent complications. There is wide variety of surgical techniques used to treat POP. Recently laparoscopic abdominal sacrocolpopexy (LASC) has been described for the treatment of symptomatic POP. LASC offers all the benefits of traditional open surgery with the minimal invasiveness of the transvaginal approach. In this study our aim is to assess the feasibility and results of LASC with two meshes along the anterior and posterior vaginal walls in correcting POP in our initial 5 cases. Materials and Methods: Between October 2003 and May 2004 we performed LASC in 5 women. All patients reported previous hysterectomy and symptoms of POP, that came out 4-7 years after hysterectomy. Four patients had local vaginal symptoms. The other patient declared bilateral flank pain and radiological examinations showed bilateral hydronephrosis. Preoperative evaluation included POP staging using a standard questionnaire, pad test, residual urine volume, urodynamics, including Valsalva's leak point pressure. LASC was carried out via transperitoneal route by using 4 trocars. We used 2x10 cm double mesh (anterior and posterior) for all cases. We performed laparoscopic left over cyst excision and right inguinal hernioraphy in the same patient as an additional procedure. The patients were post-operatively followed-up and evaluated at the first week, 1st, 3rd, and 6th months and later on with 6 months of intervals according to our protocol using a standard questionnaire. A nurse from the urodynamic unit helped the patients to fill a questionnaire to evaluate the results of the surgery at the 6th month of follow up. Results: The mean patient age was 53.5 (39-70) years. There was no conversion to open surgery. Mean operation time was 205 minutes (ranged from 180 to 240). Mean hospital stay was 2 days (ranged from 2 to 4 days). Mean urethral catheterization period was 2 (range: 1-3) days. There were no early and late complications. Mean follow up time for the patients was 9 (6-11) months. Bilateral hydronephrosis in 1 patient improved significantly. All patients were rendered symptom free after the procedure. Furthermore they were satisfied with the operation and declared that they could accept the operation again as well as recommend it to their relatives or friends. Conclusion: Laparoscopic abdominal sacrocolpopexy offers all the benefits of traditional open surgery with the minimal invasiveness of the transvaginal approach. LASC is a safe and effective procedure. Operative time and postoperative complications are related with surgeon's experience. However it could be eliminated with increasing experience.
Özet
Pelvik organ prolapsusun (POP) tedavisinde laparoskopik yaklaşım önemli avantajlara sahiptir. Bu çalışmada, ön ve arka vajinal duvar boyunca 2 ayrı yama kullanarak gerçekleştirdiğimiz laparoskopik sakrokolpopeksi ile ilgili başlangıç deneyimleri sunulmaktadır. Kliniğimizde Ekim 2003-Mayıs 2004 tarihleri arasında ortalama yaşı 53.5 (39-70) olan toplam 5 hastaya laparoskopik sakrokolpopeksi operasyonu uygulandı. Hastaların 4'ü ıkınma ile ele gelen vajinal kitle, l'i ise iki taraflı lomber ağrı yakınması ile başvurdu. Yakınmaların histerektomi sonrası ortalama 5.2 yıl (4-7) sonra başladığı belirlendi. Tüm hastalarda 3 veya 4. evre POP belirlendi. Lomber ağrı ile başvuran hastada iki taraflı grade 3 hidronefroz saptandı. Operasyonda 4 adet trokar ve 2x10 cm boyutlarında hazırlanan 2 adet prolen yama kullanıldı. Hastalar operasyon sonrası 1. hafta, 3., 6. ay ve daha sonra her 6 ayda bir kontrole çağrıldı.Hiçbir hastamızda erken veya geç dönemde istenmeyen yan etki görülmedi. Operasyon süreleri ortalaması 205 dakika (180-240) olarak hesaplandı. Ameliyat sonrası izlem süresi ortalama 9 ay (6-11) olan hastalardan sadece 1 'inde takiplerde 2. derece POP saptandı. Ameliyat öncesinde iki taraflı hidronefroz belirlenen hastada ise ameliyat sonrası belirgin düzelme saptandı. Tüm hastaların operasyon öncesi duruma göre tamamen düzeldiği veya daha iyi oldukları ve gerektiğinde operasyonu yakınlarına ve akrabalarına önerebilecekleri bilgisine ulaşıldı. Başlangıç deneyimleri POP tedavisinde laparoskopik sakrokolpopeksinin etkin ve güvenilir bir yöntem olduğunu göstermektedir.