骨盤臓器脱に対する腹腔鏡下仙骨子宮靭帯固定術と腹腔鏡下仙骨腟固定術における中期的成績の後方視的比較検討

抄録

Study objectives: To compare the intermediate term follow-up outcomes of laparoscopic uterosacral ligament suspension (L-USLS) and laparoscopic sacral colpopexy (LSC) in patients with pelvic organ prolapse.

Methods: We retrospectively analyzed the data of 16 and 36 women who underwent L-USLS and LSC, respectively, between April 2017 and December 2019 and compared their age, body mass index, surgical time, blood loss, recurrent prolapse, and postoperative complication. Subjective recurrent prolapse was defined by the patient's bulge symptoms, and objective recurrent prolapse was defined as POP-Q (Pelvic Organ Prolapse Quantification) ≥2 in the dorsal lithotomy position with abdominal pressure.

Results: There was no difference in the surgical time (147.4±30.9 vs 150.9±31.4 min, P=0.82) and blood loss (28.1±53.3 vs 27.5±43.5mL, P=0.68) between the groups, and neither group developed postoperative complication, including mesh erosion and infection. During the median follow-up period of 22(3-33) and 13(6-28) months the L-USLS and LSC groups, respectively, subjective and objective recurrence rates were significantly higher in the L-USLS group than in the LSC group (56% vs 8%, P=0.016 and 56% vs 38%, P<0.001, respectively). Furthermore, the retreatment rate including reoperation and pessary was significantly higher in the L-USLS group than in the LSC group (19% vs 0%, P=0.039). Although cystocele was the most common recurrence, apical prolapse was also observed in 19% patients in the L-USLS group.

Conclusion: Although L-USLS was relatively easy and safe to perform, the L-USLS group had a high recurrence rate and similar complication rate and surgical time compare to the LSC group.