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30.06.2018 | Original Article Open Access

Uterus preservation is superior to hysterectomy when performing laparoscopic lateral suspension with mesh

Zeitschrift:
International Urogynecology Journal
Autoren:
Nikolaus Veit-Rubin, Jean Dubuisson, Florin Constantin, Sören Lange, Isabelle Eperon, Victor Gomel, Jean-Bernard Dubuisson
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s00192-018-3678-3) contains supplementary material, which is available to authorized users.

Prior presentations

• The results of this study were presented as an oral poster communication at the 10th Annual Meeting of the European Urogynaecological Association (EUGA) held in Barcelona, Spain, from 19 to 21 October 2017.
• A previous publication presented the factors associated with patient satisfaction after laparoscopic lateral suspension with mesh: “Patient satisfaction after laparoscopic lateral suspension with mesh for pelvic organ prolapse: outcome report of a continuous series of 417 patients.” Veit-Rubin N, Dubuisson JB, Gayet-Ageron A, Lange S, Eperon I, Dubuisson J. Int Urogynecol J. 2017 Nov;28(11):1685-1693. https://​doi.​org/​10.​1007/​s00192-017-3327-2. Epub 2017 Apr 17. PMID: 28417156.
• A previously published video article demonstrated the technique of uterine-preserving lateral suspension with mesh: “Uterus-preserving laparoscopic lateral suspension with mesh for pelvic organ prolapse: a patient-centred outcome report and video of a continuous series of 245 patients.” Veit-Rubin N, Dubuisson JB, Lange S, Eperon I, Dubuisson J. Int Urogynecol J. 2016 Mar;27(3):491-3. https://​doi.​org/​10.​1007/​s00192-015-2859-6. Epub 2015 Oct 17. PMID: 26476819.

Abstract

Introduction and hypothesis

We aimed to compare differences between laparoscopic lateral suspension with mesh (LLS) performed with supracervical hysterectomy (LLSHE) and without hysterectomy (LLSUP).

Methods

We retrospectively collected data from women operated by a single surgeon between 2003 and 2011. From a total of 339 women with symptomatic anterior and/or apical pelvic organ prolapse (POP) and an intact uterus, 224 had LLSUP (70.4%) and 94 had LLSHE (29.6%). Three hundred and sixteen patients were examined at 1 year. Primary outcomes were objective and subjective success at 1 year during clinical evaluation. Secondary outcomes were complications (Clavien-Dindo scale) and mesh exposure. Patient satisfaction was evaluated by telephone interview using a 10-point scale and the Patient Global Impression of Improvement Scale (PGI-I).

Results

LLSUP and LLSHE did not differ for age (mean 57 and 55 years, respectively), preoperative status, complications, and participation at the interview (52 vs 53%). LLSHE is associated with higher mesh exposure (6.5 vs 1.3%, p = 0.014) and more frequent use of Mersilene. Titanium-coated and noncoated polypropylene was more frequently used in LLSUP. At 1 year, both anatomic success rate for the anterior compartment (98.7 vs 94.6%, p = 0.021) and subjective success rate (83.5 vs 72.8%, p = 0.035) were higher for LLSUP. Without hysterectomy, patients more often improved (90.5 vs 76.5%, p = 0.013) and would more frequently recommend the procedure (94.5 vs 80.4%, p = 0.004).

Conclusions

LLS with or without hysterectomy is a safe technique with high patient satisfaction. The uterus-preserving approach appears to result in better anatomic outcome for the anterior compartment, better subjective outcome, and higher patient satisfaction.

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