Long-term safety, objective and subjective outcomes of laparoscopic sacrocolpopexy without peritoneal closure

• Published in: International Urogynecology Journal 2020-08, Vol.31 (8), p.1593-1600
• Main Authors: van den Akker, Crissie M., Klerkx, Wenche M., Kluivers, Kirsten B., van Eijndhoven, Hugo W. F., Withagen, Mariëlla I. J., Scholten, Piet C.
• Format: Article
• Language: English
• Subjects: Gynecology; Laparoscopy; Medicine; Medicine & Public Health; Original Article; Patients; Pelvic organ prolapse; Questionnaires; Studies; Surgery; Systematic review; Urology
• ISSN: 0937-3462; 1433-3023
• DOI: 10.1007/s00192-019-04020-w

Introduction and hypothesis The laparoscopic sacrocolpopexy (LSC) is performed to support DeLancey’s level I in patients with pelvic organ prolapse (POP). Although several studies have been conducted on the safety, objective and subjective outcomes of LSC, the specific effect of retroperitonealisation of mesh is unknown. This study is aimed at analysing the safety, objective and subjective outcomes of the LSC without peritoneal closure of mesh. Methods The patients included have undergone an LSC for POP between 2004 and 2014. Retrospectively, a cohort of n  = 178 was identified and asked to participate in a follow-up study. Chart research was performed. When informed consent was obtained, questionnaires were sent and the patients underwent a physical examination, including a POP-Q assessment. Each complication was scored by four reviewers for possibly being related to the non-peritonealisation of mesh. Results The data on the outcome cohorts were complete for safety n  = 178, objective n  = 124, and subjective n  = 61. The Patient Global Impression of Improvement (PGI-I) score is provided in 106 questionnaires. In this study, 77 complications were observed in 49 different patients. The total success rate (no reoperation, no descent beyond the hymen and no bulging symptoms) is 59.0% with a median follow-up (IQR) of 35 months (18–51). Seventy-six patients (71.7%) described their condition as being (much) improved after LSC. Conclusions Three serious complications observed during the 178 LSCs were, by full consensus, thought to be possibly related to the non-peritonealisation of mesh. More than 70% of the patients found their condition to be (much) improved after the procedure.