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Outcomes of laparoscopic management of multicompartmental pelvic organ prolapse

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Abstract

Background

Pelvic organ prolapse (POP) is an increasing medical problem with complex diagnostics and controversial surgical management. It causes a series of dysfunctions in the gynecological, urinary, and anorectal organs. Numerous procedures have been proposed to treat these conditions, but in recent years, ventral mesh rectocolposacropexy (VMRCS) has emerged as the procedure of choice for the surgical treatment of POP, especially by a laparoscopic approach. This surgical technique limits the risk of autonomic nerve damage, and the colpopexy allows the correction of concomitant prolapse of the middle compartment. However, symptoms derived from anterior compartment prolapse remain a major morbidity and sometimes require an additional procedure. The aim of this study is to evaluate the results of laparoscopic prosthetic rectocolposacropexy (LRCS) and colposacropexy (LCS) procedures performed to manage combined multicompartmental POP.

Methods

Between November 2008 and December 2017, 38 patients with symptomatic POP underwent rectocolposacropexy (RCS) or colposacropexy (CS) by a laparoscopic approach. Demographics, mortality, morbidity, hospital stay, and functional outcomes were retrospectively analyzed.

Results

The median operating time was 200 min (IQR 160–220). Additional simultaneous surgery for POP was performed in nine cases: five suburethral slings and four hysterectomies were performed. No mortality was recorded. The conversion rate was 7.89%. There were two intraoperative complications (5.26%): one enterotomy and one urinary bladder tear. Late complications occurred in 5.26% of cases. After a mean follow-up of 20 months, constipation was completely resolved or improved in 83.33% of patients, urinary stress incontinence was resolved or improved in 52.94%, and gynecological symptomatology was resolved or improved in 93.75%. The recurrence rate was 5.26%.

Conclusions

Laparoscopic mesh rectocolposacropexy and colposacropexy are safe and effective techniques associated with very low morbidity. In the medium term, they provide good results for POP and associated symptoms, but urinary symptomology has a worse outcome.

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Authors and Affiliations

  1. Department of General Surgery, Medina del Campo Hospital, Valladolid, Spain

    J. C. Martín del Olmo, M. Toledano, M. L. Martín Esteban, M. A. Montenegro, J. R. Gómez & P. Concejo

  2. Department of Obstetrics and Gynecology, Medina del Campo Hospital, Valladolid, Spain

    M. Rodríguez de Castro

  3. Department of Urology, Medina del Campo Hospital, Valladolid, Spain

    F. del Rio

  4. Madrid, Spain

    J. C. Martín del Olmo

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  1. J. C. Martín del Olmo
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Correspondence to J. C. Martín del Olmo.

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Disclosures

Dr. Martín del Olmo, Dr. Toledano, Dra. Martín Esteban, Dra. Montenegro, Dra. Concejo, Dr. Gómez, Dra. Rodríguez de Castro, and Dr. del Río declare that they have no conflicts of interest or financial ties to disclose.

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Martín del Olmo, J.C., Toledano, M., Martín Esteban, M.L. et al. Outcomes of laparoscopic management of multicompartmental pelvic organ prolapse. Surg Endosc 33, 1075–1079 (2019). https://doi.org/10.1007/s00464-018-6357-z

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  • DOI: https://doi.org/10.1007/s00464-018-6357-z

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