Introduction
Pelvic organ prolapse (POP) is an important health problem that may affect urinary, genital, and anorectal functions, and cause reduced life quality and social withdrawal in some of females. It has been reported that approximately 10 % of women have to undergo a surgical procedure because of POP during their lifetime [1,2]. POP surgery with a deficit-based strategy is performed via the vaginal route in patients with isolated anterior and posterior defects, and surgical treatment of apical prolapses may be performed with an abdominal or vaginal approach. Even though there is no any consensus on the standard surgical technique in these cases, abdominal approaches are more commonly preferred [3].
Sacrocolpopexy, the most commonly used surgical technique via the abdominal route, which was first identified in 1962, has been performed laparoscopically since 1992. Sacrocolpopexy has almost become the routine surgical standard thanks to its proven efficacy and safety, and is commonly used laparoscopically and robotically in parallel with the increased number of minimal invasive surgical techniques [[4], [5], [6]].
Due to dissection difficulty of the retroperitoneal area, iatrogenic denervation could occur in the pelvic plexus during sacropexy. Sparing parasympathetic and sympathetic nerves and plexuses, which have vital functions on urinary bladder, rectum, and sexual functions, has become a real issue in recent times and studies have reported that a lower frequency of complications was encountered when the nerves were spared during sacrocolpopexy procedures [[7], [8], [9]].
In this study, we aimed to evaluate laparoscopic nerve-sparing sacrocolpopexy as a commonly used surgical technique in patients with apical prolapse in terms of intraoperative and postoperative complications and mid-term anatomic and functional outcomes.
Section snippets
Materials and methods
The data for this study involved the notes obtained from the files of 115 patients with apical prolapse who underwent laparoscopic nerve-sparing sacrocolpopexy or sacrocervicopexy between March 2012 and May 2017 in Baskent University Adana Dr. Turgut Noyan Application Research Center. The study was initiated after Ethics Committee of Baskent University approved due to the Project Number KA16/381.
The study included only patients who underwent laparoscopic nerve-sparing sacrocolpopexy or
Results
The sociodemographic features and preoperative symptoms of the patients are shown in Table 1. The mean age of the entire study population was 58 ± 11.3 years, and the mean ages of the group with a previous hysterectomy, cervicosacrocolpopexy and sacrocolpopexy groups were found as 60.4 ± 8.2, 41.4 ± 2.7, and 62.8 ± 7.3 years, respectively.
Laparoscopic hysterectomy with concomitant sacrocolpopexy was performed in 73 cases, sacrocolpopexy was performed in those with a history of hysterectomy (n =
Discussion
Nerve-sparing sacropexy seems to be the most appropriate technique in the surgical treatment of POP thanks to both the high anatomic success as encountered in mid-term follow-up examinations, and also the low rates of intraoperative and postoperative complications. Anatomic success rates of 77–91 % have been reported after laparoscopic sacrocolpopexy in POP surgery (12). The mid-term anatomic success was found as 90.4 % in our study, and this rate is close to the upper limit of the rates
Acknowledgments
There is no conflict of interest. The authors declare no relationships with any companies, whose products or services may be related to the subject matter of article. This research was funded from the Baskent University Research Fund, Project Number KA16/381. Due to the retrospective nature of the study, informed consent was not applicable. No study subjects or cohorts have been previously reported.
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