| Abstrakt: |
Pelvic organ prolapse is a condition where pelvic organs descend into the vaginal canal due to weakened muscles. Uterosacral ligament suspension is a surgical procedure addressing POP by strengthening the support to the uterus. The two main approaches of USLS are vaginal and laparoscopic, with no consensus of which method is superior. We set out to systematically evaluate and compare the safety and efficacy outcomes of vaginal and laparoscopic approaches in POP. We searched all major databases to find all studies comparing vaginal to laparoscopic (or robotic assisted laparoscopic) techniques for the repair of POP. We included randomized controlled trials and observational studies. Our initial search yielded 2459 papers. 17 papers ultimately qualified for our analysis. Women undergoing vaginal or laparoscopic (including laparoscopic assisted robotic) repair of POP with or without hysterectomy. Vaginal or laparoscopic surgery. The vaginal approach demonstrated significantly shorter operation times (MD= 15.07 [7.06, 23.08],(P = 0.002); however, patients in this group experienced prolonged hospital stays (MD=-0.41 [-0.82,-0.01], (P=0.05), higher blood loss (MD=-41.17 [-70.71,-11.64],(P=0.006), and a significantly higher rate of recurrence (OR=0.59 [0.46,0.76], (P=0.001). Both groups exhibited similar incidences of UTIs (OR=0.73[0.52,1.01], (P=0.06) and blood transfusions (OR=0.79 [0.38, 1.65], (P = 0.53), along with comparable rates of reoperation (OR= 0.84[0.58,1.22],(P=0.37) and readmission (OR=0.70 [0.39, 1.23], (P=0.21). The laparoscopic group showed significantly higher clinical and anatomical success rates (OR=4.94 [1.62, 15.07], (P=0.005), (OR= 3.56 [1.98, 6.40], (P=0.001) and a lower incidence of urinary retention (OR= 0.41 [0.22,0.74],(P=0.003). No discernible differences were observed in the incidence of ileus and dyspareunia between the two groups. While the vaginal approach offers shorter operation times, our analysis shows it is associated with longer hospital stays, higher estimated blood loss, a higher rate of urinary retention and an increased rate of POP recurrence. [ABSTRACT FROM AUTHOR] |
