Uterine Preserving Laparoscopic Lateral Mesh Suspension for Uterovaginal Prolapse

Abstract

Abstract Objective: To evaluate the technique of laparoscopic lateral colpo-uterine suspension using a mesh for uterovaginal prolapse; to specify its indications, advantages and complications and to assess its success rate. Patients and methods: This retrospective cohort study included all women treated by uterus preserving laparoscopic lateral suspension with mesh for symptomatic uterovaginal prolapse between January 2008 and June 2016 in tertiary referral hospital Farhat Hached Sousse (Tunisia). The data collected were: preoperatively and postoperatively functional symptoms and prolapse grade (POP-Q) grading system, the degree of preoperative discomfort and postoperative satisfaction, complications rate classified according to the Clavien grading system for surgical morbidity. Results: One hundred and twelve patients were included. Twenty nine women were lost to follow up and were, therefore, excluded from the study. The mean age of the patients was 49.02 ± 6.92 years (29-69). After a mean follow-up of 21 months, the success rate of anatomical reduction with this technique was about 94.8% and 4 cases of recurrent vaginal prolapse was noted, 2 were partially improved. A grade 0 was found in 58.4% and 70.1% of cases respectively at the anterior and middle floor. The rate of success for the anterior and middle floor was respectively 94.8% and 97.4%. Seventy patients (84.3%) were satisfied by the functional outcome and the degree of postoperative satisfaction was 8.1 ± 1.38 (4-10) out of 10. No laparoconversion was necessary. One bladder perforation occurred during dissection requiring preoperative sutures. Three delayed complications were observed (3.6%): two cases of parietal mesh erosions, one case of bladder granulomas. There were no cases of vaginal mesh erosions. Conclusions: The results of this study demonstrate that laparoscopic lateral colpo-uterine suspension in the treatment of genital prolapse has good anatomical and functional results, and is simple, reproducible and safe. But, we need level 1 data comparing this technique to other established surgical procedures for uterovaginal prolapse.