Satisfactory medium-long term patient reported outcomes after laparoscopic single-mesh sacrohysteropexy

Abstract

Background: There is scarce information on the effectiveness of the laparoscopic single mesh sacrohysteropexy (smSHP). Attachment of a single sheet of flat mesh posteriorly to the cervix provides less mesh use and a less invasive distal mesh fixation.

Objectives: To assess medium to long-term follow-up results of patients who underwent laparoscopic smSHP utilising a less invasive technique with single sheet flat mesh.

Materials and methods: In the present retrospective cohort study, the data of 71 women who underwent laparoscopic smSHP for apical uterine prolapse with or without colporrhaphy (anterior and/or posterior) at the urogynaecology unit of a university hospital between January 2008 and January 2020 was reviewed. Data was collected on demographics, presenting symptoms, preoperative findings, surgery, and postoperative outcomes.

Main outcome measures: Medium to long-term patient-reported outcomes.

Results: The median age of the study population was 44 years. Median follow-up duration was 5 years (1-12). Symptomatic recurrence over time and repeat surgery rates were 13.1% and 3.1% respectively. Comparison of the pre-operative and medium to long-term evaluation scores of the pelvic floor distress inventory-20 (PFDI-20) and assessment of the patient global impression of improvement (PGI-I) revealed long-standing improvement in pelvic floor dysfunction.

Conclusions: Laparoscopic smSHP appears to be successful and safe with low recurrence and complication rates and provides satisfactory patient reported outcomes.

What's new?: Medium to long-term patient-reported outcomes based on PFDI-20 and PGI-I surveys are satisfactory following smSHP.

Figure 1

Description of the surgical technique. (A) Mesh attachment site at the uterus. (B) Mesh attachment site at the sacrum. (C) Mesh fixated to the uterus and the sacrum. (D) Final view of the surgical site after closure of peritoneum. C: Cervix, SM: Mesh attachment site at the sacrum, SP: Sacral promontory, SU: Non-absorbable sutures, UM: Mesh attachment site at the uterus, V: Presacral veins.

Figure 2

Flow-chart of the laparoscopic single mesh sacrohysteropexy cases with or without concomitant anterior and/or posterior repair.