Long-Term Assessment of a Prospective Cohort of Patients Undergoing Laparoscopic Sacrocolpopexy

• Published in: Obstetrics and gynecology (New York. 1953) Vol. 134; no. 2; pp. 323 - 332
• Main Authors: Pacquée, Stefaan, Nawapun, Katika, Claerhout, Filip, Werbrouck, Erika, Veldman, Joan, Dʼhoore, André, Wyndaele, Jan, Verguts, Jasper, De Ridder, Dirk, Deprest, Jan
• Format: Journal Article
• Language: English
• Published: United States by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved 01.08.2019
• Subjects: Aged; Aged, 80 and over; Cervix Uteri - surgery; Cohort Studies; Female; Follow-Up Studies; Gynecologic Surgical Procedures - methods; Gynecologic Surgical Procedures - statistics & numerical data; Humans; Laparoscopy - statistics & numerical data; Middle Aged; Patient Satisfaction; Pelvic Organ Prolapse - surgery; Prospective Studies; Recurrence; Reoperation - statistics & numerical data; Sacrococcygeal Region; Surgical Mesh; Treatment Outcome; Urologic Surgical Procedures - methods; Urologic Surgical Procedures - statistics & numerical data; Vagina - surgery
• ISSN: 0029-7844; 1873-233X
• DOI: 10.1097/AOG.0000000000003380

OBJECTIVE:To report long-term outcomes after laparoscopic sacrocolpopexy. METHODS:We conducted a prospective descriptive cohort study on 331 consecutive patients who underwent laparoscopic sacrocolpopexy for symptomatic prolapse (Pelvic Organ Prolapse Quantification [POP-Q] system stage 2 or greater) at one center, with minimum 1.5 years of follow-up by April 30, 2014. Primary outcome measures were Patient Global Impression of Change score and failure at the apex (C≥−1 cm; POP-Q stage 2 or greater). Secondary outcomes were anatomical failure in other compartments, duration of follow-up, occurrence and time point of complications, reinterventions, and functional outcomes by response to a standardized 24-question interview on prolapse and bladder, bowel, and sexual function. Assessment was by an experienced clinician not involved in patient management. RESULTS:The follow-up rate was 84.6% (280/331); 185 of 331 (55.9%) patients were both physically examined and interviewed, and 95 of 331 (25.7%) were interviewed only. The median age at interview was 72 years (interquartile range 13 years), with a follow-up period of 85.5 months (interquartile range 46 months). Approximately 83% (231/280) reported improvement; 5.7% (16/280) were unchanged, 5.7% (16/280) felt slightly worse, and 6.8% (17/280) reported clear deterioration. Anatomical failure at point-C was 8.6% (16/185); anterior (22.2%, 41/185) and posterior (28.6%, 53/185) prolapse were more common than apical prolapse. Of those with level-I anatomical cure, 10.1% (17/185) felt worse; half of them (9/17) because of prolapse in another compartment. The others had urinary problems (41.2%, 7/17), obstructive defecation (11.8%, 2/17), or dyspareunia (11.8%, 2/17). Conversely, the majority of patients with recurrence at the vault (62.5%, 10/16) self-reported to be improved. The reoperation rate was 17.8% (48/270), including 19 (7.0%) for graft-related complications and nine (3.3%) for prolapse. CONCLUSION:More than four out of five patients (82.5%) felt improved 86 months after laparoscopic sacrocolpopexy. Of those not improved, two thirds had recurrent prolapse; however, typically mid-vaginal. The other third reported urinary or bowel problems or dyspareunia. Reintervention for prolapse was 3.3%. The most common reasons for reoperation were graft-related complications (7.0%) and urinary incontinence (6.7%).