Laparoscopic Management of Uterine Prolapse with Cystocele and Rectocele Using “Gynemesh PS”

摘要

Objective: Our department performed laparoscopic correction of uterine or vault prolapse withncystocele and rectocele using the “Gynemesh PS.” The aim of this study was to evaluate the surgicalnoutcomes and perioperative morbidity after a laparoscopic operation.nMaterials and Methods: From August 2004 to September 2005, we performed laparoscopic pelvicnfloor repairs in 6 cases of vault prolapse and 15 cases of uterine prolapse at the Department of Obstetricsnand Gynecology at the Kyungpook National University Hospital (Daegu, Korea). Uterinenand vault prolapse were repaired by laparoscopic rectocele and cystocele repair using the GynemeshnPS, uterosacral ligament suspension, paravaginal repair, and Burch colposuspension. In uterine prolapse,nwe also carried out a subtotal hysterectomy. The stage of prolapse was classified by means ofnthe pelvic organ prolapse quantification (POPQ) system.nResults: The mean age, Q-index, and parity were 64 years (range, 47–79), 24.6 (range, 18.7 u0002n27.8), and 5 (range, 3 u0002 10), respectively. Mean operation time was 141 minutes (range, 90 u0002 211).nMean estimated blood loss was 53 mL (range, 20 u0002 80). Mean hospital stay was 5 days (range, 3 u0002n9 days). There were no major complications, but postoperative voiding difficulty developed in 1 case.nMean preoperative POPQ stage was 3 and immediate, 6-week, 3-month, 6-month, and 1-year postoperativenPOPQ score was 0. Mean follow-up period was 7.5 months (range, 3 u0002 13). The objectivensuccess rate was 100%.nConclusions: Laparoscopic pelvic floor repair is an effective procedure and enables us to combinenthe advantages of laparotomy with the low morbidity of the vaginal route. In Europe, the sacrocolpopexynwas more popular, but uterosacral ligament suspension is the most natural anatomic repairnof defects and, hence, the least likely to be predisposed to future defects in the anterior ornposterior vaginal wall or to compromise vaginal function. However, further studies are required onnthe long-term efficiency and reliability in order to evaluate the value of this technique.