Intermediate-term outcomes of laparoscopic pectopexy and vaginal sacrospinous fixation: a comparative study

ABSTRACT Objective To compare the intermediate-term follow-up results of laparoscopic pectopexy and vaginal sacrospinous fixation procedures. Materials and Methods Forty-three women who had vaginal sacrospinous fixations(SSF) using Dr. Aksakal’s Desta suture carrier and 36 women who had laparoscopic pectopexies were re-examined 7 to 43 months after surgery. The PISQ-12 and P-QOL questionnaires were answered by all of the women. Results The apical descensus relapse rates did not differ between the groups (14% in the SSF vs. 11.1% in the pectopexy group). The de novo cystocele rates were higher in the SSF group (25.6% in the SSF vs. 8.3% in the pectopexy group). There were no significant differences in the de novo rectocele numbers between the groups. The treatment satisfaction rates were high in both groups (93% in the SSF vs. 91.7% in the pectopexy group), which was not statistically significant. Moreover, the postoperative de novo urge and stress urinary incontinence rates did not differ; however, the postoperative sexual function scores (PISQ-12) (36.86±3.15 in the SSF group vs. 38.21±5.69 in the pectopexy group) were better in the pectopexy group. The general P-QOL scores were not significantly different between the surgery groups. Conclusion The vaginal sacrospinous fixation maintains its value in prolapse surgery with the increasing importance of native tissue repair. The new laparoscopic pectopexy technique has comparable positive follow-up results with the conventional sacrospinous fixation procedure.

摘要
研究目的：对比腹腔镜阴道穹窿悬吊术（laparoscopic pectopexy）与阴道骶棘韧带固定术（vaginal sacrospinous fixation, SSF）的中期随访结果。
材料与方法：选取43例采用阿克萨卡尔医师的Desta缝合递送器（Desta suture carrier）实施阴道骶棘韧带固定术的患者，以及36例接受腹腔镜阴道穹窿悬吊术的患者，于术后7~43个月进行复查。所有患者均完成女性性功能指数量表12项版（PISQ-12）及盆底生活质量问卷（P-QOL）的填写。
结果：两组的穹窿脱垂复发率无显著差异（阴道骶棘韧带固定术组为14%，腹腔镜阴道穹窿悬吊术组为11.1%）。阴道骶棘韧带固定术组的新发膀胱膨出率更高（25.6% vs 8.3%）。两组的新发直肠膨出例数无显著差异。两组的治疗满意度均较高（93% vs 91.7%），组间差异无统计学意义。此外，术后新发急迫性尿失禁与压力性尿失禁的发生率无组间差异，但腹腔镜阴道穹窿悬吊术组的术后性功能评分（PISQ-12）更优（阴道骶棘韧带固定术组为36.86±3.15，腹腔镜阴道穹窿悬吊术组为38.21±5.69）。两组的总体盆底生活质量评分无显著差异。
结论：随着自体组织修复（native tissue repair）理念的重要性日益凸显，阴道骶棘韧带固定术在盆腔器官脱垂手术中仍具有应用价值。新型腹腔镜阴道穹窿悬吊术与传统阴道骶棘韧带固定术的中期随访阳性结果相当。