Comparison of patient reported outcomes, pelvic floor function and recurrence after laparoscopic sacrohysteropexy versus vaginal hysterectomy with McCall suspension for advanced uterine prolapse
| Autor: | Yavuz Emre Şükür, Fulya Dökmeci, Şerife Esra Çetinkaya, Mehmet Murat Seval |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
medicine.medical_specialty Turkey 03 medical and health sciences Gynecologic Surgical Procedures 0302 clinical medicine Recurrence Uterine Prolapse Culdoplasty medicine Humans Patient Reported Outcome Measures 030212 general & internal medicine Laparoscopy Prospective cohort study Aged Retrospective Studies Aged 80 and over 030219 obstetrics & reproductive medicine Pelvic floor medicine.diagnostic_test business.industry Prolapse surgery Obstetrics and Gynecology Uterine prolapse Pelvic Floor Recovery of Function Middle Aged Sacrohysteropexy medicine.disease Surgery medicine.anatomical_structure Reproductive Medicine Hysterectomy vaginal Female business |
| Zdroj: | European Journal of Obstetrics & Gynecology and Reproductive Biology. 247:127-131 |
| ISSN: | 0301-2115 |
| Popis: | To compare medium/long-term outcomes in terms of pelvic floor function, patient reported prolapse recurrence and repeat prolapse surgery after laparoscopic sacrohysteropexy (LSHP) and vaginal hysterectomy with McCall suspension (VHMcCall) which is the most commonly performed surgical option for severe uterine prolapse from past to present.Files of patients who underwent LSHP and VHMcCall for advanced utero-vaginal prolapse (stage 34) at the Department of Gynecology in Ankara University School of Medicine between 2008 and 2018 were reviewed (n = 517). Data of women who were followed up for at least 1-year and containing both the full-filled Patient Global Impression of Improvement (PGI-I) survey and Turkish validated Pelvic Floor Distress Inventory-20 (PFDI-20), were included.A total of 132 women were included in the study; 46 women who underwent LSHP and 86 women who underwent VHMcCall. Even though the median age of the LSHP group was significantly lower than the median age of VHMcCall group (42 vs. 67 years; P;0.001), recurrence and repeat surgery rates were found to be similar after both surgical approaches as well as the scores of PGI-I and PFDI-20. However, in women who were operated before their sixties, symptomatic recurrence was found to be significantly lower after LSHP than VHMcCall (16.2 % vs. 47.4 %, respectively; P = 0.024) as well as repeat prolapse surgery (2.7 % vs. 26.3 %, respectively; P = 0.014). PGI-I and PFDI-20 scores also suggested better pelvic floor function after LSHP significantly (p = 0.004p = 0.003 respectively). When adjusted for age, VHMcCall significantly increased the risk of symptomatic prolapse recurrence compared to LSHP (OR: 4.65; 95 % CI: 1.326-16.312; P = 0.016).LSHP and VHMcCall might seem to be surgical options for individualized management with similar pelvic floor functionrecurrence in the medium/long-term follow-up, but the age adjusted risk analysis showed higher rates of symptomatic recurrence after VHMcCall. Moreover, the better outcomes after LSHP in the younger subset, revealed the need of further clarification with well-designed prospective studies. |
| Databáze: | OpenAIRE |
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