Importance of vaginal packing after laparoscopic sacrocolpopexy – retrospective study
Authors:
A. Marinič Veverková; V. Kališ; M. Smažinka
; M. Havíř; Z. Rušavý
Authors‘ workplace:
Gynekologicko-porodnická klinika LF UK a FN Plzeň
Published in:
Ceska Gynekol 2024; 89(1): 11-15
Category:
Original Article
doi:
https://doi.org/10.48095/cccg202411
Overview
Objective: To compare the subjective and objective results of laparoscopic sacrocolpopexy (LSC) with and without the introduction of a vaginal packing one year after surgery. Methodology: This is a retrospective cohort study of 125 women after laparoscopic sacrocolpopexy operated on in 2013–2016 with complete annual follow-up. Patients with a total hysterectomy were excluded from the study. Basic patient characteristics, preoperative POP-Q and surgery data were collected. The subjective outcome of the surgery was assessed using the PGI-I (patient global impression of improvement). The anatomic outcome of the surgery was evaluated using the composite definition of surgical failure based on POP-Q (Ba ≥ –1, C ≥ –3, Bp ≥ –1). Patients were divided into two groups according to whether or not they had vaginal packing after surgery. Statistical analysis was performed using c2, Wilcoxon and Fischer test according to the distribution of normality. Results: A total of 125 women were enrolled in the study; 48 (38.4%) after LSC, 58 (46.4%) with concomitant supracervical hysterectomy and 19 (15.2%) after sacrohysterocolpopexy. Vaginal packing was introduced for 24–48 hours after surgery in 86 (68.8%) women. The groups did not differ in age, body mass index, smoking or preoperative pelvic organ prolapse quantification system. We did not observe statistically significant differences in PGI-I first year after surgery. The difference in anatomic surgical failure did not reach statistical significance, although more failures were observed in the group without packing (12.8 vs. 3.5%; P = 0.09). The mean C-point value one year after surgery was lower in the non-tamponade group (–7 vs. –7.5; P < 0.009). No mesh extrusion or serious complications were recorded in the monitored group. Conclusion: Vaginal packing after LSC probably does not affect patient satisfaction after surgery, however, it may be associated with better anatomical outcome one year after the surgery. The results of the study must be confirmed by a more detailed prospective evaluation.
Keywords:
pelvic organ prolapse – vaginal packing – sacrocolpopexy – sacrohysterocolpopexy
Sources
1. Obinata D, Yamaguchi K, Ito A et al. Lower urinary tract symptoms in female patients with pelvic organ prolapse: efficacy of pelvic floor reconstruction. Int J Urol 2014; 21 (3): 301–307. doi: 10.1111/iju.12281.
2. Barber MD, Maher C. Epidemiology and outcome assessment of pelvic organ prolapse. Int Urogynecol J 2013; 24 (11): 1783–1790. doi: 10.1007/s00192-013-2169-9.
3. Wu JM, Matthews CA, Conover MM et al. Lifetime risk of stress urinary incontinence or pelvic organ prolapse surgery. Obstet Gynecol 2014; 123 (6): 1201–1206. doi: 10.1097/AOG.00 00000000000286.
4. Weber AM, Walters MD, Piedmonte MR et al. Anterior colporrhaphy: a randomized trial of three surgical techniques. Am J Obstet Gynecol 2001; 185 (6): 1299–1306. doi: 10.1067/mob.2001. 119081.
5. Denman MA, Gregory WT, Boyles SH et al. Reoperation 10 years after surgically managed pelvic organ prolapse and urinary incontinence. Am J Obstet Gynecol 2008; 198 (5): 555.e1–555.e5. doi: 10.1016/j.ajog.2008.01.051.
6. Fialkow MF, Newton KM, Lentz GM et al. Lifetime risk of surgical management for pelvic organ prolapse or urinary incontinence. Int Urogynecol J Pelvic Floor Dysfunct 2008; 19 (3): 437–440. doi: 10.1007/s00192-007-0459-9.
7. Holt E. US FDA rules manufacturers to stop selling mesh devices. Lancet 2019; 393 (10182): 1686. doi: 10.1016/S0140-6736 (19) 30938-9.
8. Nygaard IE, McCreery R, Brubaker L et al. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol 2004; 104 (4): 805–823. doi: 10.1097/01.AOG.0000139514.90897.07.
9. Smazinka M, Kalis V, Havir M et al. Obesity and its long-term impact on sacrocolpopexy key outcomes (OBELISK). Int Urogynecol J 2020; 31 (8): 1655–1662. doi: 10.1007/s00192-019-04 076-8.
10. Kalis V, Smazinka M, Rusavy Z et al. Laparoscopic sacrocolpopexy as the mainstay management for significant apical pelvic organ prolapse (LAP) study. Eur J Obstet Gynecol Reprod Biol 2020; 244: 60–65. doi: 10.1016/ j.ejogrb.2019.10.049.
11. Mulayim B, Sendag F. Modified laparoscopic lateral suspension: the mulayim technique. J Minim Invasive Gynecol 2019; 26 (3): 407–408. doi: 10.1016/j.jmig.2018.07.014.
12. Noé GK, Schiermeier S, Papathemelis T et al. Prospective international multicenter pectopexy trial: interim results and findings post surgery. Eur J Obstet Gynecol Reprod Biol 2020; 244: 81–86. doi: 10.1016/j.ejogrb.2019.10. 022.
13. Pal M, Bandyopadhyay S. Extraperitoneal uterosacral ligament suspension by using the cervix as a traction device. Int Urogynecol J 2020; 31 (8): 1701. doi: 10.1007/s00192-019-041 47-w.
14. Gagyor D, Kalis V, Smazinka M et al. Pelvic organ prolapse and uterine preservation: a cohort study (POP-UP study). BMC Womens Health 2021; 21 (1): 72. doi: 10.1186/s12905-021- 01208-5.
15. Subramanya J, Curtiss N, Balachandran A et al. Should we use a vaginal pack to reduce blood loss at the time of prolapse surgery? Eur J Obstet Gynecol Reprod Biol 2016; 206: 181–183. doi: 10.1016/j.ejogrb.2016.09.025.
16. Kalis V, Rusavy Z, Ismail KM. Laparoscopic sacrohysteropexy: the Pilsner modification. Int Urogynecol J 2020; 31 (6): 1277–1280. doi: 10.1007/s00192-019-04150-1.
17. Srikrishna S, Robinson D, Cardozo L. Validation of the Patient Global Impression of Improvement (PGI-I) for urogenital prolapse. Int Urogynecol J 2010; 21 (5): 523–528. doi: 10.1007/s00192-009-1069-5.
18. Haylen BT, Maher CF, Barber MD et al. An International Urogynecological Association (IUGA) / International Continence Society (ICS) joint report on the terminology for female pelvic organ prolapse (POP). Int Urogynecol J 2016; 27 (2): 165–194. doi: 10.1007/s00192-015-29 32-1.
19. Rachaneni S, Dua A. Interventions to reduce morbidity from vault hematoma following vaginal hysterectomy: a systematic review and meta-analysis. Int Urogynecol J 2019; 30 (7): 1061–1070. doi: 10.1007/s00192-018-38 29-6.
20. Porta-Roda O, Cornet-Cortada A, Font-Vilamitjana A et al. Vaginal packing after vaginal hysterectomy: systematic review and recommendations. Int Urogynecol J 2023; 24 (4): 789–796. doi: 10.1007/s00192-022-05331-1.
21. Thiagamoorthy G, Khalil A, Cardozo L et al. The value of vaginal packing in pelvic floor surgery: a randomised double-blind study. Int Urogynecol J 2014; 25 (5): 585–591. doi: 10.1007/s00192-013-2264-y.
22. Westermann LB, Crisp CC, Oakley SH et al. To packor not to pack? A randomized trial of vaginal packing after vaginal reconstructive surgery. Female Pelvic Med Reconstr Surg 2016; 22 (2): 111–117. doi: 10.1097/SPV.0000000000000238.
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