Long-term follow-up after laparoscopic reparation of pelvic organ prolapses in a large teaching gynecological center

Abstract

Objective

To provide a description of laparoscopic approach to correct pelvic organ prolapses and evaluate the risk factors associated with the prolapse recurrence.

Study design

We retrospectively analyzed 418 patients with symptomatic pelvic organ prolapse who underwent a laparoscopic reparation at our university center from 2010 to 2020. Prolapses were assessed by Baden-Walker system (stage I–IV). The association between the potential prognostic factors and the recurrence was analyzed using Cox regression.

Results

We included 418 patients. Most patients (97.6%) had at least one vaginal delivery and 92 (22%) had a previous prolapse surgery. In 29.74% of cases levator ani muscle avulsion was observed. We performed a cervicosacropexy in 336 (80.38%) cases, a sacrohysteropexy in 13 (3.11%), and a sacrocolpopexy in 69 (16.5%). Also, concomitantly, 66 (15.79%) patients with stress and occult urinary incontinence underwent TOT surgery. Surgical complications were low (9.51%) and the majority were minor. Median follow-up was 37 months (IQR 10.5, 61.4 months), and the global recurrence rate was 9.57%. Only 4.06% of cases required reintervention. In Cox regression analysis only levator ani muscle avulsion remained as a recurrence-associated factor.

Conclusion

Our series is one of the largest and with the longest follow-up. Recurrence rate was low, and comparable to other large series. The only independent factor related to recurrence was the levator ani muscle avulsion.