Evaluation of initial outcomes of Laparoscopic Pectopexy in the treatment of severe apical prolapse at Binh Dan Hospital

Abstract

Background: Pelvic organ prolapse (POP) is a health problem affecting approximately 40% of postmenopausal women over 50 years old who have given birth, significantly impacting their quality of life. Apical prolapse (uterine prolapse, vaginal vault prolapse) causes discomfort, including vaginal bulging, palpable or visible prolapsed tissue, pelvic pain, dyspareunia, or obstructed sexual intercourse. Treatment is particularly necessary for patients with severe prolapse at stage II or higher. In 2007, Banerjee and Noé described a novel laparoscopic surgical method for treating pelvic organ prolapse. This technique uses the lateral portions of the pectineal ligament to anchor mesh on both sides of the cervix or vaginal vault, known as pectopexy. The method demonstrated comparable efficacy to sacrocolpopexy, the traditional surgery that anchors the uterus to the sacral promontory. Methods: This is a prospective case series study, from March 2019 to July 2024 on 30 patients. Pectopexy was performed to treat mid- compartment pelvic prolapse. The patients were evaluated for anatomical improvements in all three compartments of the pelvic floor after 1 and 3 months. Quality of life metrics (P-QoL), pelvic floor function (PFIQ-7, PFDI- 20), and sexual dysfunction (FSFD) scores were also assessed. We use SPSS 26 software, with Annova, Mann-Whitney test Results: In this study, the average operative time was 142.6 ± 49.3 minutes, with an average blood loss of 93.3 ± 56.8 mL and a mean hospital stay of 4.6 ± 1.6 days. Pectopexy significantly apical prolapse with a success rate of 93.3% after 5.4 months of follow-up. Improvements in cystocele and rectocel were also observed, with success rates of 91.3% and 92.9%, respectively. Postoperative complications included new-onset stress urinary incontinence (12.5%), constipation (10%) and pelvic pain (22.2%). Conclusions: Pectopexy is highly effective in treating severe mid-compartment pelvic organ prolapse. Adjacent pelvic floor compartments, including the anterior and posterior compartments, also showed improvements following surgery. However, longer follow-up is necessary to confirm the long-term efficacy of this method compared to traditional sacrocolpopexy. DOI: 10.59715/pntjmp.4.3.13