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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

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Abstract

Introduction and hypothesis

Changes in the psychological value of reproductive organs have led to a growing interest in uterine-preserving surgery for pelvic organ prolapse (POP). Sacral hysteropexy is considered as gold standard, although dissection of the promontory may be challenging. We show a video and present a report on a series of patients operated by laparoscopic lateral suspension with mesh as an alternative.

Methods

Clinical evaluation was performed using the simplified Pelvic Organ Prolapse Quantification System (POP-Q). Primary outcomes were subjective and objective cure; secondary outcomes were rates for reoperation and complications. We assessed patient’s satisfaction in a telephone interview using a visual analogue scale and the Patient Global Impression of Improvement Scale (PGI-I) scale.

Results

Two hundred and fifty-four patients were treated between 2004 and 2011 with a median follow-up of 7.5 years. At 1 year 82.7 % of patients were asymptomatic, and anatomic success rates were 88.2 % for the anterior, 86.1 % for the apical and 80.8 % for the posterior compartment; 1.2 % had mesh exposure, and the reoperation rate was 7.4 %. More than 80 % of patients were highly satisfied with the outcome.

Conclusions

Uterine-preserving laparoscopic lateral suspension with mesh is a safe technique with promising results and low complication rates. It may be an alternative to sacral hysteropexy for high-morbidity patients.

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References

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    Milsom I, Altman D, Herbison P, Lapitan MC, Nelson R, Sillén U et al (2009) Epidemiology of urinary (UI) and faecal (FI) Incontinence and pelvic organ prolapse (POP). In: Cardozo L, Abrams P, Khoury S, Wein A (eds) Incontinence. Health Publications Ltd, Paris, pp 35–111

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    Maher C et al (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 4:CD004014

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    Haylen BT et al (2011) An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint terminology and classification of the complications related directly to the insertion of prostheses (meshes, implants, tapes) & grafts in female pelvic floor surgery. Int Urogynecol J 22(1):3–15

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    Toozs-Hobson P et al (2012) An International Urogynecological Association (IUGA)/International Continence Society (ICS) joint report on the terminology for reporting outcomes of surgical procedures for pelvic organ prolapse. Int Urogynecol J 23(5):527–535

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Acknowledgments

We would like to thank Michel Boulvain for his methodological advice.

Consent

Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

Author information

Correspondence to Nikolaus Veit-Rubin.

Ethics declarations

Conflict of interest

Jean-Bernard Dubuisson is a medical advisor for pfm medical.

All other authors declare that they have no conflict of interest.

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Veit-Rubin, N., Dubuisson, J., Lange, S. et al. 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. Int Urogynecol J 27, 491–493 (2016). https://doi.org/10.1007/s00192-015-2859-6

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Keywords

  • Pelvic organ prolapse
  • Laparoscopic lateral suspension
  • Patient satisfaction