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Surgical Endoscopy
Published in: Surgical Endoscopy 4/2019

01-04-2019

Outcomes of laparoscopic management of multicompartmental pelvic organ prolapse

Authors: J. C. Martín del Olmo, M. Toledano, M. L. Martín Esteban, M. A. Montenegro, J. R. Gómez, P. Concejo, M. Rodríguez de Castro, F. del Rio

Published in: Surgical Endoscopy | Issue 4/2019

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Abstract

Background

Pelvic organ prolapse (POP) is an increasing medical problem with complex diagnostics and controversial surgical management. It causes a series of dysfunctions in the gynecological, urinary, and anorectal organs. Numerous procedures have been proposed to treat these conditions, but in recent years, ventral mesh rectocolposacropexy (VMRCS) has emerged as the procedure of choice for the surgical treatment of POP, especially by a laparoscopic approach. This surgical technique limits the risk of autonomic nerve damage, and the colpopexy allows the correction of concomitant prolapse of the middle compartment. However, symptoms derived from anterior compartment prolapse remain a major morbidity and sometimes require an additional procedure. The aim of this study is to evaluate the results of laparoscopic prosthetic rectocolposacropexy (LRCS) and colposacropexy (LCS) procedures performed to manage combined multicompartmental POP.

Methods

Between November 2008 and December 2017, 38 patients with symptomatic POP underwent rectocolposacropexy (RCS) or colposacropexy (CS) by a laparoscopic approach. Demographics, mortality, morbidity, hospital stay, and functional outcomes were retrospectively analyzed.

Results

The median operating time was 200 min (IQR 160–220). Additional simultaneous surgery for POP was performed in nine cases: five suburethral slings and four hysterectomies were performed. No mortality was recorded. The conversion rate was 7.89%. There were two intraoperative complications (5.26%): one enterotomy and one urinary bladder tear. Late complications occurred in 5.26% of cases. After a mean follow-up of 20 months, constipation was completely resolved or improved in 83.33% of patients, urinary stress incontinence was resolved or improved in 52.94%, and gynecological symptomatology was resolved or improved in 93.75%. The recurrence rate was 5.26%.

Conclusions

Laparoscopic mesh rectocolposacropexy and colposacropexy are safe and effective techniques associated with very low morbidity. In the medium term, they provide good results for POP and associated symptoms, but urinary symptomology has a worse outcome.
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Metadata
Title
Outcomes of laparoscopic management of multicompartmental pelvic organ prolapse
Authors
J. C. Martín del Olmo
M. Toledano
M. L. Martín Esteban
M. A. Montenegro
J. R. Gómez
P. Concejo
M. Rodríguez de Castro
F. del Rio
Publication date
01-04-2019
Publisher
Springer US
Published in
Surgical Endoscopy / Issue 4/2019
Print ISSN: 0930-2794
Electronic ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-018-6357-z

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