腹腔鏡下仙骨腟固定術における組織間腔を意識した後腟壁剥離法

抄録

Objectives: To propose two different methods to dissect the posterior vaginal wall in laparoscopic sacrocolpopexies and confirm the efficacy and safety of these methods.

Design: Retrospective observational study.

Setting: Single urogynecology center in Chiba prefecture.

Patients: Fifty-five patients who underwent laparoscopic sacrocolpopexies with posterior dissections, which were performed by a single surgeon, between January 2017 and December 2017 were enrolled in this study.

Intervention: Either of the two different posterior dissection methods, that is, the rectovaginal or pararectal approach, was used according to dissection difficulty.

Primary Outcomes: Perioperative complications, operating time required for dissection, and postoperative defecation symptoms two months after surgery.

Results: The rectovaginal and pararectal dissection methods were used in 26 and 29 patients, respectively. Severe pelvic organ prolapse and adhesion between the posterior vaginal wall and rectum were frequently observed in the patients treated using the pararectal approach. The rectovaginal approach required significantly less operating time than did the pararectal approach. No perioperative complications, including rectal injury, vaginal injury, and mesh exposure, were observed. There were no significant differences in postoperative defecation symptoms, except for pain, between the two groups.

Conclusion: The two different posterior dissection methods, used on the basis of dissection difficulty, are effective and safe for efficient dissections.