Komplikationen, Reprolapsraten und funktionelle Ergebnisse nach laparoskopischer Sakropexie: eine Kohortenstudie

 

 Buy Article Permissions and Reprints

Zusammenfassung

Fragestellung: Die tiefe, laparoskopische Sakropexie gewinnt als moderne Methode der Deszensuschirurgie zunehmend an Bedeutung. Ziel der vorliegenden Studie ist es, Komplikationen, Rezidivraten sowie das funktionelle Ergebnis nach laparoskopischer Sakropexie zu beurteilen. Material und Methode: In die Studie wurden 287 Patientinnen mit einem Decensus genitalis > I° und konsekutiver laparoskopischer Sakropexie einbezogen. Bei noch vorhandenem Uterus wurde zusätzlich eine LASH durchgeführt (n = 171). Vordere und hintere Scheidenplastiken, Lateral Repair und Anti-Inkontinenz-Eingriffe wurden bei Bedarf simultan zur Sakropexie durchgeführt. Alle Patientinnen wurden retrospektiv in einem Fragebogen zu Folgeoperationen, De-novo-Harninkontinenz und Prolapsrezidiven befragt. Die Operationszufriedenheit wurde anhand einer 10-Punkte-Skala ermittelt (0 = unzufrieden, 10 = höchst zufrieden). Zusätzlich wurden postoperative Komplikationen anhand der Patientenakten ermittelt. Ergebnisse: Das mittlere Alter betrug 62,4 Jahre (31–91 Jahre). Der mittlere Beobachtungszeitraum umfasste 28 Monate. 84 % (n = 242) beantworteten den Fragebogen. Wir hatten keine schwerwiegenden intraoperativen Verletzungen. Als wichtigste frühe postoperative Komplikation fanden sich Harnwegsinfekte (11,4 %) sowie Wund- bzw. Stumpfinfekte nach LASH (6,6 %). 18,6 % (n = 45) der Patientinnen gaben an, sich Folgeoperationen unterzogen zu haben. In 4 Fällen wurde als Spätkomplikation ein mechanischer Ileus beobachtet. De-novo-Stressinkontinenz gaben 16 Patientinnen an, De-novo-Urgency 8. Mesh-Erosionen fanden sich bei 2 Patientinnen. Die mittlere OP-Zufriedenheit betrug 8,3 Punkte. Schlussfolgerung: Die laparoskopische Sakropexie zeigt insgesamt geringe Rezidiv- und Komplikationsraten sowie ein hohes Maß an Patientenzufriedenheit. Harnwegsinfekte bleiben ein Problem nach gynäkologischen Interventionen. Informationen über mögliche larvierte Inkontinenzen und Rezidive sollten Bestandteil des präoperativen Aufklärungsgesprächs sein.

Abstract

Purpose: Deep laparoscopic sacropexy is a modern method to treat genital prolapse. The aim of this study was to evaluate the intermediate-term outcome after laparoscopic sacropexy with regard to the rate of complications, re-prolapse rate and patient satisfaction. Material and Methods: 287 patients suffering from genital prolapse > I° treated by laparoscopic sacropexy were included in the study. LASH (laparoscopic supracervical hysterectomy) was performed in cases where the uterus was still present (n = 171). Anterior and posterior colporrhaphy, lateral repair and anti-incontinence operations were performed simultaneously if necessary. All patients were asked in a questionnaire about de novo symptoms, recurrence and subsequent operations. Patients were asked to evaluate their satisfaction with the operation using a scale (0 = worst result, dissatisfied, 10 = best result, maximum satisfaction). In addition, the medical records of the patients were analyzed. Results: Mean age at operation was 62.4 years (31–91 years). Mean follow-up was 28 months. 84 % (n = 242) of patients completed the questionnaire. No severe intraoperative complications occurred. Infections of the lower urinary tract occurred in 11.4 %, wound infections and stump infection after LASH in 6.6 %. 18.6 % (45/242) patients underwent subsequent operations. Four patients developed a mechanical ileus. 16 patients reported de novo stress incontinence and eight patients de novo urgency. Re-prolapse was reported in 7.8 %. Mesh erosion was seen in two cases. Mean operative satisfaction score was 8.3. Conclusion: Laparoscopic sacropexy shows good intermediate-term results with low re-prolapse and complication rates and high patient satisfaction. Infections of the lower urinary tract constitute a problem after gynecological surgery. Information on preoperative risks and benefits should include accurate advice on de novo incontinence and re-prolapse rates.

Literatur

• 1 Kluivers K, HendricksJ, Shek C et al. Pelvic organ prolapse symptoms in relation to POPQ, ordinal stages and ultrasound prolapse assessment.  Int Urogynecol J Pelvic Floor Dysfunct. 2008;  19 1299-1302
  PubMedGoogle Scholar
• 2 Bump R, Mattiasson A, Bo K et al. The standardisation of terminology of female pelvic organ prolapse and pelvic floor dysfunction.  Am J Obstet Gynecol. 1996;  175 10-17
  CrossrefPubMedGoogle Scholar
• 3 Beer M, Kuhn A. Surgical techniques for vault prolapse: A review of the literature.  Europ J Obst Gynecol. 2005;  119 144-155
  CrossrefPubMedGoogle Scholar
• 4 Benhaim Y, de Tayrac R, Deffieux X et al. [Treatment of genital prolapse with a polypropylene mesh inserted via the vaginal route. Anatomic and functional outcome in women aged less than 50 years].  J Gynecol Obstet Biol Reprod (Paris). 2006;  35 219-226
  PubMedGoogle Scholar
• 5 Nauth M A, Funfgeld C. Correction of cystocele and stress incontinence with anterior transobturator mesh.  Eur J Obstet Gynecol Reprod Biol. 2007;  119 144-155
  CrossrefPubMedGoogle Scholar
• 6 Fatton B, Amblard J, Debodinance P et al. Transvaginal repair of genital prolapse: preliminary results of a new tension-free vaginal mesh (Prolift technique) – a case series multicentric study.  Int Urogynecol J Pelvic Floor Dysfunct. 2007;  18 743-752
  PubMedGoogle Scholar
• 7 Diana M, Zoppe C, Mastrangeli B. Treatment of vaginal vault prolapse with abdominal sacral colpopexy using prolene mesh.  Am J Surg. 2000;  179 126-128
  CrossrefPubMedGoogle Scholar
• 8 Hsiao K C, Latchamsetty K, Govier F E et al. Comparison of laparoscopic and abdominal sacrocolpopexy for the treatment of vaginal vault prolapse.  J Endourol. 2007;  21 926-930
  CrossrefPubMedGoogle Scholar
• 9 Banerjee C, Noé G. Laparoscopic sacropexy – an underestimated method of vaginal vault surgery.  Geburtsh Frauenheilk. 2008;  68 492-496
  Article in Thieme ConnectPubMedGoogle Scholar
• 10 de Tayrac R, Devoldere G, Renaudie J et al. Prolapse repair by vaginal route using a new protected low-weight polypropylene mesh: 1-year functional and anatomical outcome in a prospective multicentre study.  Int Urogynecol J Pelvic Floor Dysfunct. 2007;  18 251-256
  CrossrefPubMedGoogle Scholar
• 11 de Tayrac R, Deffieux X, Gervaise A et al. Long-term anatomical and functional assessment of trans-vaginal cystocele repair using a tension-free polypropylene mesh.  Int Urogynecol J Pelvic Floor Dysfunct. 2006;  17 483-488
  CrossrefPubMedGoogle Scholar
• 12 Deffieux X, de Tayrac R, Huel C et al. Vaginal mesh erosion after transvaginal repair of cystocele using Gynemesh or Gynemesh-Soft in 138 women: a comparative study.  Int Urogynecol J Pelvic Floor Dysfunct. 2007;  18 73-79
  CrossrefPubMedGoogle Scholar
• 13 Achtari C, Hiscock R, O'Reilly B A et al. Risk factors for mesh erosion after transvaginal surgery using polypropylene (Atrium) or composite polypropylene/polyglactin 910 (Vypro II) mesh.  Int Urogynecol J Pelvic Floor Dysfunct. 2005;  16 389-394
  CrossrefPubMedGoogle Scholar
• 14 Foulques H. [Tolerance of mesh reinforcement inserted through vaginal approach for the cure of genital prolapses. A 317 continuous case study].  J Gynecol Obstet Biol Reprod (Paris). 2007;  36 653-659
  PubMedGoogle Scholar
• 15 Lim Y N, Muller R, Corstiaans A et al. A long-term review of posterior colporrhaphy with Vypro 2 mesh.  Int Urogynecol J Pelvic Floor Dysfunct. 2007;  18 1053-1057
  PubMedGoogle Scholar
• 16 de Tayrac R, Picone O, Chauveaud-Lambling A et al. A 2-year anatomical and functional assessment of transvaginal rectocele repair using a polypropylene mesh.  Int Urogynecol J Pelvic Floor Dysfunct. 2006;  17 100-105
  PubMedGoogle Scholar
• 17 Yan A, Anne M, Karine A et al. Cystocele repair by a synthetic vaginal mesh secured anteriorly through the obturator foramen.  Eur J Obstet Gynecol Reprod Biol. 2004;  115 90-94
  CrossrefPubMedGoogle Scholar
• 18 Maher C, Baessler K, Glazener C et al. Surgical management of pelvic organ prolapse in women.  Cochrane Database Syst Rev. 2007;  CD004014
  PubMedGoogle Scholar
• 19 Maher C F, Qatawneh A M, Dwyer P L et al. Abdominal sacral colpopexy or vaginal sacrospinous colpopexy for vaginal vault prolapse: a prospective randomized study.  Am J Obstet Gynecol. 2004;  190 20-26
  CrossrefPubMedGoogle Scholar
• 20 Wu J M, Wells E C, Hundley A F et al. Mesh erosion in abdominal sacral colpopexy with and without concomitant hysterectomy.  Am J Obstet Gynecol. 2006;  194 1418-1422
  CrossrefPubMedGoogle Scholar
• 21 Bensinger G, Lind L, Lesser M et al. Abdominal sacral suspensions: analysis of complications using permanent mesh.  Am J Obstet Gynecol. 2005;  193 2094-2098
  CrossrefPubMedGoogle Scholar
• 22 Visco A G, Weidner A C, Barber M D et al. Vaginal mesh erosion after abdominal sacral colpopexy.  Am J Obstet Gynecol. 2001;  184 297-302
  CrossrefPubMedGoogle Scholar
• 23 Banerjee C, Banerjee M, Fanselau C et al. Sexual impairment in patients with pelvic organ prolapse and the influence on sexuality after laparoscopic sacropexy: A hospital based cohort study.  Gynecological Surgery. 2009;  6 128-129
  PubMedGoogle Scholar
• 24 Hakvoort R A, Elberink R, Vollebregt A et al. How long should urinary bladder catheterisation be continued after vaginal prolapse surgery? A randomised controlled trial comparing short term versus long term catheterisation after vaginal prolapse surgery.  BJOG. 2004;  111 828-830
  PubMedGoogle Scholar
• 25 Ross J W, Preston M. Laparoscopic sacrocolpopexy for severe vaginal vault prolapse: five-year outcome.  J Minim Invasive Gynecol. 2005;  12 221-226
  CrossrefPubMedGoogle Scholar
• 26 Higgs P J, Chua H L, Smith A R. Long term review of laparoscopic sacrocolpopexy.  BJOG. 2005;  112 1134-1138
  PubMedGoogle Scholar
• 27 Volz J, Strittmatter H, Volz E et al. Die pelviskopische Sakropexie zur Therapie des Vaginalprolapses.  Geburtsh Frauenheilk. 1993;  53 705-708
  Article in Thieme ConnectPubMedGoogle Scholar
• 28 Brubaker L, Cundiff G W, Fine P et al. Abdominal sacrocolpopexy with Burch colposuspension to reduce urinary stress incontinence.  N Engl J Med. 2006;  354 1557-1566
  CrossrefPubMedGoogle Scholar
• 29 Jünermann K. Prolapschirurgie.  Urologe. 2005;  44 260-269
  CrossrefPubMedGoogle Scholar
• 30 Nygaard I E et al. Abdominal sacrocolpopexy: a comprehensive review.  Am Coll Obstet Gynecol. 2004;  104 805-823
  CrossrefPubMedGoogle Scholar

Dr. med. Karl-Guenter Noé

KKH Dormagen
Akademisches Lehrkrankenhaus der Universität Köln

Dr. Geldmacherstraße 20

41539 Dormagen

Email: karl-guenter.noe@kkh-ne.de