Complications associated with laparoscopic sacral fixation: a 7-year single center clinical analysis

doi:10.3877/cma.j.issn.1674-6899.2020.04.007

Abstract

Abstract:

Objective

To analyze the clinical data of laparoscopic sacral fixation in our hospital for 7 years, analyze and summarize the related complications and treatment.

Methods

The clinical follow-up data of 238 patients who underwent laparoscopic sacral fixation from Jan. 2012 to Nov. 2019 in the department of gynecology and pelvic floor and oncology of Chongqing maternal and child health hospital were collected, and the changes of Ba, Bp, C, D and other indicators of POP-Q before and after the operation, the quality of life and the score of sexual activity, and the treatment of various complications and complications after the operation were statistically analyzed.

Result

Laparoscopic sacral fixation can treat pelvic organ prolapse with pelvic cavity defects, and the quality of life and sexual life improved after operation.The cure rate of all patients receiving sacral fixation is 98.74%, and the incidence of complications is about 15.55%.The incidence of constipation is about 5.04%, followed by pain, 3.78%, net exposure, new urinary incontinence, presacral bleeding and urinary retention. The incidence of recurrence and serious infection was 0.84%, sexual life disorder, ureteral fold obstruction and urethral injury was 0.42%, all complications were cured.

Conclusions

Laparoscopic sacral fixation is an effective method for the treatment of pelvic defects.There are corresponding complications of operation and mesh.Reasonable treatment can improve the prognosis of patients.

Key words: Pelvic organ prolapse, Laparoscopic sacral fixation, Mesh, Postoperative complications, Treatment

Chengzhi Zhao, Shentao Lu, Ying Wang, Mingbo Liu, Yuhan Sun, Li Lei, Lubin Liu. Complications associated with laparoscopic sacral fixation: a 7-year single center clinical analysis[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2020, 13(04): 223-228.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhqjwkzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1674-6899.2020.04.007

https://zhqjwkzz.cma-cmc.com.cn/EN/Y2020/V13/I04/223

Figures/Tables 5

References 27

1	Pacquée S, Nawapun K, Claerhout F，et al.Long-term assessment of a prospective cohort of patients undergoing laparoscopic sacrocolpopexy[J]．Obstet Gynecol，2019，134(2): 323-332.
2	王延洲，梁志清．腹腔镜下盆底结构重建经验与思考[J/CD]．中华腔镜外科杂志(电子版)，2019，12(5): 264-266.
3	Elneil S, Cutner AS, Remy M，et al.Abdominal sacrocolpopexy for vault prolapse without burial of mesh：a case series[J]．BJOG，2005，112(4): 486-489.
4	Karon M, Chatterjee S．Sacrocolpopexy: patient outcomes support the use of non-crosslinked acellular dermal matrix as an alternative to the synthetic polypropylene mesh[J]．J Gynecol Surg，2019，35(6): 337-344.
5	De Tayrac R, Sentilhes L．Complications of pelvic organ prolapse surgery and methods of prevention[J]．Int Urogynecol J Pelvic Floor Dysfunct，2013，24(11): 1859-1872.
6	Filmar GA, Fisher HW, Aranda E，et al.Laparoscopic uterosacral ligament suspension and sacral colpopexy：results and complications[J]．Int Urogynecol J，2014，25(12): 1645-1653.
7	Theobald P, Chéret Angélique. Laparoscopic sacrocolpopexy: results of a 100-patient series with 8 years follow-up[J]. Gynecological Surgery, 2004, 1(1): 31-36.
8	North CE, Ali-Ross NS, Smith AR，et al.A prospective study of laparoscopic sacrocolpopexy for the management of pelvic organ prolapse[J]．BJOG，2009, 116(9): 1251-1257.
9	Nygaard IE, McCreery R, Brubaker L，et al.Abdominal sacrocolpopexy: a comprehensive review[J]．Obstet Gynecol，2004，104(4): 805-823.
10	Vincent Misraï, Morgan Rouprêt, Florence Cour，et al.De novo urinary stress incontinence after laparoscopic sacral colpopexy[J]．BJU Int，2008，101(5): 594-597.
11	Rozet F, Mandron E, Arroyo C，et al.Laparoscopic sacralcolpopexy approach for genito-urinary prolapse: experience with 363 cases[J]．Eur Urol，2005, 47(2): 230-236.
12	Braun NM, Andraos W, Bettin S．Safety and efficacy of spider anchoring device for apical repair in laparoscopic sacrocolpopexy: Retrospective cohort study[J]．Eur J Obstet Gynecol Reprod Biol，2019，235(1): 88-92.
13	Ross JW, Preston M．Laparoscopic sacrocolpopexy for severe vaginal vault prolapse：five-year outcome[J]．J Minim Invasive Gynecol，2005，12(3): 221-226.
14	Apostolopoulos NV, Alexandraki KI, Gorry A，et al.The early benefits of laparoscopic Sacrocolpopexy[J]．J Gynecol Obstet Hum Reprod，2019，48(10): 799-804.
15	Abdullah B, Nomura J, Moriyama S，et al.Clinical and urodynamic assessment in patients with pelvic organ prolapse before and after laparoscopic sacrocolpopexy[J]．Int Urogynecol J，2017，28(10): 1543-1549.
16	Daneshgari F, Kong W, Swartz M．Complications of mid urethral slings: important outcomes for future clinical trials[J]．J Urol，2008，180(5): 1890-1897.
17	Braun NM, Andraos W, Bettin S．Safety and efficacy of spider anchoring device for apical repair in laparoscopic sacrocolpopexy: retrospective cohort study[J]．Eur J Obstet Gynecol Reprod Biol，2019，235(1): 88-92.
18	Danford JM, Osborn DJ, Reynolds WS，et al.Postoperative pain outcomes after transvaginal mesh revision[J]．Int Urogynecol J，2015，26(1): 65-69.
19	Eisenberg VH, Steinberg M, Weiner Z，et al.Long-term follow-up of sacrocolpopexy mesh implants at two time intervals at least 1 year apart using 4D transperineal ultrasound[J]．Ultrasound Obstet Gynecol，2017，49(3): 398-403.
20	Tan-Kim J, Menefee SA, Luber KM，et al.Prevalence and risk factors for mesh erosion after laparoscopic-assisted sacrocolpopexy[J]．Int Urogynecol J，2011，22(2): 205-212.
21	Osmundsen BC, Clark A, Goldsmith C，et al.Mesh erosion in robotic sacrocolpopexy[J]．Female Pelvic Med Reconstr Surg，2012，18(2): 86-88.
22	Nygaard I, Brubaker L, Zyczynski HM，et al.Long-term outcomes following abdominal sacrocolpopexy for pelvic organ prolapse[J]．JAMA，2013，309(19): 2016-2024.
23	Stepanian AA, Miklos JR, Moore RD，et al.Risk of mesh extrusion and other mesh-related complications after laparoscopic sacral colpopexy with or without concurrent laparoscopic-assisted vaginal hysterectomy: experience of 402 patients[J]．J Minim Invasive Gynecol，2008，15(2): 188-196.
24	Boyd B, Pratt T, Mishra K．Fungal lumbosacral osteomyelitis after robotic-assisted laparoscopic sacrocolpopexy[J]．Female Pelvic Med Reconstr Surg，2018，24(6): 46-48.
25	Zebede S, Dawood A, Alarab M，et al.A streamlined surgical approach to laparoscopic sacrocolpopexy for post-hysterectomy vault prolapse[J]．J Obstet Gynaecol Can，2016，38(5): 446-452.
26	张晓薇，陈礼全．阴道-骶骨固定术手术区域应用解剖研究[J]．中国实用妇科与产科杂志，2009，25(8): 590-593.
27	Braley SC, Schneider PD, Bold RJ，et al.Controlled tamponade of severe presacral venous hemorrhage: use of a breast implant sizer[J]．Dis Colon Rectum，2002，45(1): 140-142.

项目		骶骨固定术(134例)	骶骨固定术＋阴道旁修补术(65例)	骶骨固定术＋阴道旁修补术＋后壁修补术(25例)	骶骨固定术＋后壁修补术(14例)	统计值	P值
年龄[岁；p50(p25，p75)]		50(45，54)	50(46，58.75)	48(45，57)	43(41，44)	8.707	0.069
住院时间[d；p50(p25，p75)]		8.0(7，10)	8.0(7，10)	7.5(7，8)	8.0(8，9)	9.847	0.043
手术时间(min， ±s)		91.21±38.31	102.46±45.56	113.32±37.65	109.26±25.41	7.635	0.057
脱垂程度[例(%)]		?	?	?	?	0.228	0.663
?	Ⅱ期	36(26.9)	23(35.4)	8(32.0)	3(21.4)	?	?
?	Ⅲ期	78(58.2)	31(47.7)	14(56.0)	7(50.0)	?	?
?	Ⅳ期	20(14.9)	11(16.9)	3(12.0)	4(28.6)	?	?
内科合并症[例(%)]		34(25.4)	12(18.5)	8(32.0)	3(21.4)	0.301	0.583
随访时间(月， ±s)		9.57±0.19	7.47±1.76	6.68±0.87	2.07±0.83	0.345	0.347

项目		骶骨固定术(134例)	骶骨固定术＋阴道旁修补术(65例)	骶骨固定术＋阴道旁修补术＋后壁修补术(25例)	骶骨固定术＋后壁修补术(14例)	统计值	P值
年龄[岁；p50(p25，p75)]		50(45，54)	50(46，58.75)	48(45，57)	43(41，44)	8.707	0.069
住院时间[d；p50(p25，p75)]		8.0(7，10)	8.0(7，10)	7.5(7，8)	8.0(8，9)	9.847	0.043
手术时间(min， ±s)		91.21±38.31	102.46±45.56	113.32±37.65	109.26±25.41	7.635	0.057
脱垂程度[例(%)]		?	?	?	?	0.228	0.663
?	Ⅱ期	36(26.9)	23(35.4)	8(32.0)	3(21.4)	?	?
?	Ⅲ期	78(58.2)	31(47.7)	14(56.0)	7(50.0)	?	?
?	Ⅳ期	20(14.9)	11(16.9)	3(12.0)	4(28.6)	?	?
内科合并症[例(%)]		34(25.4)	12(18.5)	8(32.0)	3(21.4)	0.301	0.583
随访时间(月， ±s)		9.57±0.19	7.47±1.76	6.68±0.87	2.07±0.83	0.345	0.347

项目		术前	术后	统计值	P^a值	P^b值
Ba位点		3(0，2)	-3(-3，-3)	-10.556	<0.001	0.267
?	骶骨固定术	0(-1，1.25)	-3(-3，-3)	-3.733	<0.001	?
?	骶骨固定术＋阴道旁修补术	2(1，3)	-3(-3，-3)	-2.566	<0.001	?
?	骶骨固定术＋阴道旁修补术＋后壁修补术	0(-1，3)	-3(-3，-3)	-3.537	<0.001	?
?	骶骨固定术＋后壁修补术	2(-1，3)	-3(-3，-3)	-3.041	0.041	?
Bp位点		-3(-3，0)	-3(-3，-4)	-6.884	<0.001	0.113
?	骶骨固定术	-3(-3，-1)	-3(-3，-3)	-3.859	<0.001	?
?	骶骨固定术＋阴道旁修补术	-1(-3，1)	-3(-3，-3)	-2.536	<0.001	?
?	骶骨固定术＋阴道旁修补术＋后壁修补术	1(-2，2)	-3(-3，-3)	-3.645	<0.001	?
?	骶骨固定术＋后壁修补术	-3(-3，2)	-3(-3，0)	-3.032	0.032	?
C位点		2(0，3)	-5(-6，-5)	-10.783	<0.001	0.271
?	骶骨固定术	2(1，3)	-5(-6，-5)	-8.164	<0.001	?
?	骶骨固定术＋阴道旁修补术	2(0.75，3)	-6(-6，-5)	-5.526	<0.001	?
?	骶骨固定术＋阴道旁修补术＋后壁修补术	0(-1，2)	-6(-7，-5)	-3.630	<0.001	?
?	骶骨固定术＋后壁修补术	2(-2，4)	-6(-7，-6)	-5.032	<0.001	?
D位点		-1(-3，0)	-6(-7，-6)	-8.347	<0.001	0.251
?	骶骨固定术	-1(-2，0)	-6(-7，-6)	-6.264	<0.001	?
?	骶骨固定术＋阴道旁修补术	0(-3，2)	-6(-7，-6)	-3.836	<0.001	?
?	骶骨固定术＋阴道旁修补术＋后壁修补术	-1(-3，0.25)	-7(-7，-6)	-3.425	0.001	?
?	骶骨固定术＋后壁修补术	-3(-4，0)	-7(-8，-7)	-5.403	<0.001	?

项目		术前	术后	统计值	P^a值	P^b值
Ba位点		3(0，2)	-3(-3，-3)	-10.556	<0.001	0.267
?	骶骨固定术	0(-1，1.25)	-3(-3，-3)	-3.733	<0.001	?
?	骶骨固定术＋阴道旁修补术	2(1，3)	-3(-3，-3)	-2.566	<0.001	?
?	骶骨固定术＋阴道旁修补术＋后壁修补术	0(-1，3)	-3(-3，-3)	-3.537	<0.001	?
?	骶骨固定术＋后壁修补术	2(-1，3)	-3(-3，-3)	-3.041	0.041	?
Bp位点		-3(-3，0)	-3(-3，-4)	-6.884	<0.001	0.113
?	骶骨固定术	-3(-3，-1)	-3(-3，-3)	-3.859	<0.001	?
?	骶骨固定术＋阴道旁修补术	-1(-3，1)	-3(-3，-3)	-2.536	<0.001	?
?	骶骨固定术＋阴道旁修补术＋后壁修补术	1(-2，2)	-3(-3，-3)	-3.645	<0.001	?
?	骶骨固定术＋后壁修补术	-3(-3，2)	-3(-3，0)	-3.032	0.032	?
C位点		2(0，3)	-5(-6，-5)	-10.783	<0.001	0.271
?	骶骨固定术	2(1，3)	-5(-6，-5)	-8.164	<0.001	?
?	骶骨固定术＋阴道旁修补术	2(0.75，3)	-6(-6，-5)	-5.526	<0.001	?
?	骶骨固定术＋阴道旁修补术＋后壁修补术	0(-1，2)	-6(-7，-5)	-3.630	<0.001	?
?	骶骨固定术＋后壁修补术	2(-2，4)	-6(-7，-6)	-5.032	<0.001	?
D位点		-1(-3，0)	-6(-7，-6)	-8.347	<0.001	0.251
?	骶骨固定术	-1(-2，0)	-6(-7，-6)	-6.264	<0.001	?
?	骶骨固定术＋阴道旁修补术	0(-3，2)	-6(-7，-6)	-3.836	<0.001	?
?	骶骨固定术＋阴道旁修补术＋后壁修补术	-1(-3，0.25)	-7(-7，-6)	-3.425	0.001	?
?	骶骨固定术＋后壁修补术	-3(-4，0)	-7(-8，-7)	-5.403	<0.001	?

项目		术前	术后	统计值	P^a值	P^b值
PFDI-20		42.8±37.1	16.5±14.6	10.075	<0.001	0.318
?	骶骨固定术	45.4±32.4	13.8±5.1	11.105	<0.001	?
?	骶骨固定术＋阴道旁修补术	41.8±19.5	14.7±7.6	11.326	<0.001	?
?	骶骨固定术＋阴道旁修补术＋后壁修补术	51.4±25.1	13.5±6.3	10.117	<0.001	?
?	骶骨固定术＋后壁修补术	39.6±31.3	10.2±7.4	12.013	<0.001	?
PISQ-12		55.1±38.6	17.3±16.2	15.026	<0.001	0.303
?	骶骨固定术	35.7±13.5	14.3±9.0	14.037	<0.001	?
?	骶骨固定术＋阴道旁修补术	36.3±21.4	11.3±6.2	15.076	<0.001	?
?	骶骨固定术＋阴道旁修补术＋后壁修补术	38.5±19.8	13.1±7.9	13.634	<0.001	?
?	骶骨固定术＋后壁修补术	44.5±25.3	16.3±9.2	14.506	<0.001	?

Please choose a citation manager

Content to export