One-year outcomes of a suture-less laparoscopic sacral hysteropexy using polypropylene Y-mesh grafts and fibrin sealant spray: A prospective comparative study. Issue 5 (May 2020)

• Record Type: Journal Article
• Authors: Tsai, Ching-Pei; Kao, Hui-Fen; Liu, Chih-Ku; Shen, Pao-sheng; Chen, Ming-Jer; Hung, Man-Jung
• Is Part Of: Journal of the Chinese Medical Association. Volume 83:Issue 5(2020)
• Page Start: 484
• Page End: 490
• Publication Date: 2020-05
• Subjects: Fibrin sealant -- Lightweight polypropylene meshes -- Sacral hysteropexy -- Uterine preservation -- Uterovaginal prolapse; Medicine -- Periodicals; 610.5
• DOI: 10.1097/JCMA.0000000000000253
• Languages: English
• ISSNs: 1726-4901

Abstract

Abstract : Background: Laparoscopic sacral hysteropexy (SH) is a minimally invasive and effective treatment for uterovaginal prolapse in women who wish to retain the uterus. However, this procedure is limited by a steep learning curve and a long operating time. In this study, we aim to evaluate the surgical outcomes of a modified laparoscopic SH procedure using innovative methods of vaginal mesh attachment, which we hypothesized to be equally effective and time-saving. Methods: This was a prospective, parallel, comparative study conducted at a tertiary referral hospital. A total of 34 women with advanced (POPQ [Pelvic Organ Prolapse Quantification] stages ≧ 2) uterine prolapse, who underwent a laparoscopic SH procedure using lightweight polypropylene Y-mesh grafts (ALYTE), were studied. In half (n = 17) of the cases, fibrin sealant spray (TISSEEL) was applied to the meshes fixed at the anterior and posterior vaginal wall with fewer (six vs at least ten) sutures. A detailed comparison of one-year outcomes between groups was performed. Results: Patient characteristics and perioperative results were comparable between groups with the exception of a significantly shorter total operating time (247.0 vs 292.9 minutes, p = 0.04) noted in the fibrin group. At 1 year, anatomic success (POPQ stage ≦1) rates (76.5% vs 76.5%) were not different between groups. There were eight patients, with four in each group, who had surgical failure. Notably, most (7/8; 87.5%) surgical failures were at the anterior compartment (i.e, recurrent cystocele). No vaginal mesh extrusions were noted. After statistical analysis, we found "cystocele as the dominant prolapse before operation" was a significant predisposing factor for prolapse recurrence ( p = 0.019; odds ratio = 8.04). Conclusion: The modified laparoscopic SH procedure using Y-mesh grafts and fibrin sealant spray with fewer vaginal sutures was equally effective as conventional methods but saved time. Laparoscopic SH using Y-mesh grafts might not be as effective in repairing a concomitant dominant cystocele.