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Published in: Trials 1/2018

Open Access 01-12-2018 | Study protocol

Laparoscopic inguinal ligament suspension versus laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse: study protocol for a randomized controlled trial

Authors: Chunbo Li, Zhiyuan Dai, Huimin Shu

Published in: Trials | Issue 1/2018

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Abstract

Background

Pelvic organ prolapse (POP) is a common health problem. The lifetime risk of undergoing surgery for prolapse is 11%. POP significantly affects the effects on quality of life and activities of daily living. Laparoscopic sacrocolpopexy (LSC) has been viewed as the gold standard treatment for women with POP who desire reconstructive surgery. However, LSC is associated with technical difficulties, resulting in a long learning curve and operative time. Recently, our team introduced a new laparoscopic technique of inguinal ligament suspension (LILS) and had confirmed its safety and efficacy in treating vaginal vault prolapse. As a new surgical technique for POP, a prospective randomized controlled trial comparing the LILS with the standard technique of LSC is necessary. Therefore, we will conduct a trial.

Methods

The trial is a randomized controlled trial. It compares LILS with LSC in women with stage 2 or higher uterine prolapse. The primary outcomes of this study are perioperative parameters, including surgical time, blood loss, intraoperative complications, and hospital stay as well as surgical anatomical results using the pelvic organ prolapse questionnaire (POP-Q) classification at 6 weeks, 6 months, 12 months, and annually till 5 years after surgery. Secondary outcomes are subjective improvement in urogenital symptoms and quality of life, postoperative complications, postoperative recovery, sexual functioning, and cost-effectiveness at each follow-up point. Validated questionnaires will be used and the data will be analyzed according to the intention-to-treat principle. Based on an objective success rate of 90%, a noninferiority margin of 15%, and a dropout of 20%, 107 patients are needed in each arm to prove the hypothesis with a 95% confidence interval.

Discussion

The trial is a randomized controlled, multicenter, noninferiority trial that will provide evidence whether the efficacy and safety of LILS is noninferior to LSC in women with symptomatic stage 2 or higher uterine prolapse.

Trial registration

China Trial Register (CTR): ChiCTR-INR-15007408. Registered on 9 November 2015.
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Literature
1.
go back to reference Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6.CrossRefPubMed Olsen AL, Smith VJ, Bergstrom JO, Colling JC, Clark AL. Epidemiology of surgically managed pelvic organ prolapse and urinary incontinence. Obstet Gynecol. 1997;89:501–6.CrossRefPubMed
2.
3.
go back to reference Ganatra AM, Rozet F, Sanchez-Salas R, Barret E, Galiano M, Cathelineau X, et al. The current status of laparoscopic sacrocolpopexy: a review. Eur Urol. 2009;55:1089–103.CrossRefPubMed Ganatra AM, Rozet F, Sanchez-Salas R, Barret E, Galiano M, Cathelineau X, et al. The current status of laparoscopic sacrocolpopexy: a review. Eur Urol. 2009;55:1089–103.CrossRefPubMed
4.
go back to reference Gabriel B, Nassif J, Barata S, Wattiez A. Twenty years of laparoscopic sacrocolpopexy: where are we now? Int Urogynecol J. 2011;22:1165–9.CrossRefPubMed Gabriel B, Nassif J, Barata S, Wattiez A. Twenty years of laparoscopic sacrocolpopexy: where are we now? Int Urogynecol J. 2011;22:1165–9.CrossRefPubMed
5.
go back to reference Sarlos D, Kots L, Ryu G, Schaer G. Long-term follow-up of laparoscopic sacrocolpopexy. Int Urogynecol J. 2014;25:1207–12.CrossRefPubMed Sarlos D, Kots L, Ryu G, Schaer G. Long-term follow-up of laparoscopic sacrocolpopexy. Int Urogynecol J. 2014;25:1207–12.CrossRefPubMed
6.
go back to reference Good MM, Abele TA, Balgobin S, Montoya TI, McIntire D, Corton MM. Vascular and ureteral anatomy relative to the midsacral promontory. Am J Obstet Gynecol. 2013;208:486. e1–7CrossRefPubMed Good MM, Abele TA, Balgobin S, Montoya TI, McIntire D, Corton MM. Vascular and ureteral anatomy relative to the midsacral promontory. Am J Obstet Gynecol. 2013;208:486. e1–7CrossRefPubMed
7.
go back to reference Tubbs RS, McDaniel JG, Burns AM, Kumbla A, Cossey TD, Apaydin N, et al. Anatomy of the reflected ligament of the inguinal region. Romanian J Morphol Embryol. 2009;50:689–91. Tubbs RS, McDaniel JG, Burns AM, Kumbla A, Cossey TD, Apaydin N, et al. Anatomy of the reflected ligament of the inguinal region. Romanian J Morphol Embryol. 2009;50:689–91.
8.
go back to reference Holzheimer RG. Inguinal Hernia: classification, diagnosis and treatment--classic, traumatic and Sportsman's hernia. Eur J Med Res. 2005;10:121–34.PubMed Holzheimer RG. Inguinal Hernia: classification, diagnosis and treatment--classic, traumatic and Sportsman's hernia. Eur J Med Res. 2005;10:121–34.PubMed
9.
go back to reference Dai Z, Li C, Wang X, Shu H, Zhang K, Dai C. A new laparoscopic technique of inguinal ligament suspension for vaginal vault prolapse. Int J Surg. 2017;43:131–6.CrossRefPubMed Dai Z, Li C, Wang X, Shu H, Zhang K, Dai C. A new laparoscopic technique of inguinal ligament suspension for vaginal vault prolapse. Int J Surg. 2017;43:131–6.CrossRefPubMed
10.
go back to reference Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J. 2016;27:655–84.CrossRefPubMed Haylen BT, Maher CF, Barber MD, Camargo S, Dandolu V, Digesu A, et al. An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J. 2016;27:655–84.CrossRefPubMed
11.
go back to reference Srikrishna S, Robinson D, Cardozo L. Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Int Urogynecol J. 2010;21:523–8.CrossRefPubMed Srikrishna S, Robinson D, Cardozo L. Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Int Urogynecol J. 2010;21:523–8.CrossRefPubMed
12.
go back to reference Freeman RM, Pantazis K, Thomson A, Frappell J, Bombieri L, Moran P, et al. A randomised controlled trial of abdominal versus laparoscopic sacrocolpopexy for the treatment of post-hysterectomy vaginal vault prolapse: LAS study. Int Urogynecol J. 2013;24:377–84.CrossRefPubMed Freeman RM, Pantazis K, Thomson A, Frappell J, Bombieri L, Moran P, et al. A randomised controlled trial of abdominal versus laparoscopic sacrocolpopexy for the treatment of post-hysterectomy vaginal vault prolapse: LAS study. Int Urogynecol J. 2013;24:377–84.CrossRefPubMed
13.
go back to reference Lee RK, Mottrie A, Payne CK, Waltregny D. A review of the current status of laparoscopic and robot-assisted sacrocolpopexy for pelvic organ prolapse. Eur Urol. 2014;65:1128–37.CrossRefPubMed Lee RK, Mottrie A, Payne CK, Waltregny D. A review of the current status of laparoscopic and robot-assisted sacrocolpopexy for pelvic organ prolapse. Eur Urol. 2014;65:1128–37.CrossRefPubMed
14.
go back to reference Rozet F, Mandron E, Arroyo C, Andrews H, Cathelineau X, Mombet A, et al. Laparoscopic sacral colpopexy approach for genito-urinary prolapse: experience with 363 cases. Eur Urol. 2005;47:230–6.CrossRefPubMed Rozet F, Mandron E, Arroyo C, Andrews H, Cathelineau X, Mombet A, et al. Laparoscopic sacral colpopexy approach for genito-urinary prolapse: experience with 363 cases. Eur Urol. 2005;47:230–6.CrossRefPubMed
15.
go back to reference North CE, Ali-Ross NS, Smith AR, Reid FM. A prospective study of laparoscopic sacrocolpopexy for the management of pelvic organ prolapse. BJOG. 2009;116:1251–7.CrossRefPubMed North CE, Ali-Ross NS, Smith AR, Reid FM. A prospective study of laparoscopic sacrocolpopexy for the management of pelvic organ prolapse. BJOG. 2009;116:1251–7.CrossRefPubMed
16.
go back to reference Sarlos D, Brandner S, Kots L, Gygax N, Schaer G. Laparoscopic sacrocolpopexy for uterine and post-hysterectomy prolapse: anatomical results, quality of life and perioperative outcome-a prospective study with 101 cases. Int Urogynecol J. 2008;19:1415–22.CrossRef Sarlos D, Brandner S, Kots L, Gygax N, Schaer G. Laparoscopic sacrocolpopexy for uterine and post-hysterectomy prolapse: anatomical results, quality of life and perioperative outcome-a prospective study with 101 cases. Int Urogynecol J. 2008;19:1415–22.CrossRef
17.
go back to reference Sergent F, Resch B, Loisel C, Bisson V, Schaal JP, Marpeau L. Mid-term outcome of laparoscopic sacrocolpopexy with anterior and posterior polyester mesh for treatment of genito-urinary prolapse. Eur J Obstet Gynecol Reprod Biol. 2011;156:217–22.CrossRefPubMed Sergent F, Resch B, Loisel C, Bisson V, Schaal JP, Marpeau L. Mid-term outcome of laparoscopic sacrocolpopexy with anterior and posterior polyester mesh for treatment of genito-urinary prolapse. Eur J Obstet Gynecol Reprod Biol. 2011;156:217–22.CrossRefPubMed
18.
go back to reference Claerhout F, De Ridder D, Roovers JP, Rommens H, Spelzini F, Vandenbroucke V, et al. Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve. Eur Urol. 2009;55:1459–67.CrossRefPubMed Claerhout F, De Ridder D, Roovers JP, Rommens H, Spelzini F, Vandenbroucke V, et al. Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve. Eur Urol. 2009;55:1459–67.CrossRefPubMed
19.
go back to reference Perez T, Crochet P, Descargues G, Tribondeau P, Soffray F, Gadonneix P, et al. Laparoscopic sacrocolpopexy for management of pelvic organ prolapse enhances quality of life at one year: a prospective observational study. J Minim Invasive Gynecol. 2011;18:747–54.CrossRefPubMed Perez T, Crochet P, Descargues G, Tribondeau P, Soffray F, Gadonneix P, et al. Laparoscopic sacrocolpopexy for management of pelvic organ prolapse enhances quality of life at one year: a prospective observational study. J Minim Invasive Gynecol. 2011;18:747–54.CrossRefPubMed
20.
go back to reference Granese R, Candiani M, Perino A, Romano F, Cucinella G. Laparoscopic sacrocolpopexy in the treatment of vaginal vault prolapse: 8 years experience. Eur J Obstet Gynecol Reprod Biol. 2009;146:227–31.CrossRefPubMed Granese R, Candiani M, Perino A, Romano F, Cucinella G. Laparoscopic sacrocolpopexy in the treatment of vaginal vault prolapse: 8 years experience. Eur J Obstet Gynecol Reprod Biol. 2009;146:227–31.CrossRefPubMed
21.
go back to reference Price N, Slack A, Jackson SR. Laparoscopic sacrocolpopexy: an observational study of functional and anatomical outcomes. Int Urogynecol J. 2011;22:77–82.CrossRefPubMed Price N, Slack A, Jackson SR. Laparoscopic sacrocolpopexy: an observational study of functional and anatomical outcomes. Int Urogynecol J. 2011;22:77–82.CrossRefPubMed
22.
go back to reference Leruth J, Fillet M, Waltregny D. Incidence and risk factors of postoperative stress urinary incontinence following laparoscopic sacrocolpopexy in patients with negative preoperative prolapse reduction stress testing. Int Urogynecol J. 2013;24:485–91.CrossRefPubMed Leruth J, Fillet M, Waltregny D. Incidence and risk factors of postoperative stress urinary incontinence following laparoscopic sacrocolpopexy in patients with negative preoperative prolapse reduction stress testing. Int Urogynecol J. 2013;24:485–91.CrossRefPubMed
23.
go back to reference Ross JW, Preston M. Laparoscopic sacrocolpopexy for severe vaginal vault prolapse: five-year outcome. J Minim Invasive Gynecol. 2005;12:221–6.CrossRefPubMed Ross JW, Preston M. Laparoscopic sacrocolpopexy for severe vaginal vault prolapse: five-year outcome. J Minim Invasive Gynecol. 2005;12:221–6.CrossRefPubMed
24.
go back to reference Gadonneix P, Ercoli A, Salet-Lizée D, Cotelle O, Bolner B, Van Den Akker M, et al. Laparoscopic sacrocolpopexy with two separate meshes along the anterior and posterior vaginal walls for multicompartment pelvic organ prolapse. J Am Assoc Gynecol Laparosc. 2004;11:29–35.CrossRefPubMed Gadonneix P, Ercoli A, Salet-Lizée D, Cotelle O, Bolner B, Van Den Akker M, et al. Laparoscopic sacrocolpopexy with two separate meshes along the anterior and posterior vaginal walls for multicompartment pelvic organ prolapse. J Am Assoc Gynecol Laparosc. 2004;11:29–35.CrossRefPubMed
25.
go back to reference Christensen E. Methodology of superiority vs equivalence trials and non-inferiority trials. J Hepatol. 2007;46:947–54.CrossRefPubMed Christensen E. Methodology of superiority vs equivalence trials and non-inferiority trials. J Hepatol. 2007;46:947–54.CrossRefPubMed
Metadata
Title
Laparoscopic inguinal ligament suspension versus laparoscopic sacrocolpopexy in the treatment of pelvic organ prolapse: study protocol for a randomized controlled trial
Authors
Chunbo Li
Zhiyuan Dai
Huimin Shu
Publication date
01-12-2018
Publisher
BioMed Central
Published in
Trials / Issue 1/2018
Electronic ISSN: 1745-6215
DOI
https://doi.org/10.1186/s13063-018-2494-x

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