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A Minimally Invasive Technique for the 1-Stage Treatment of Complex Pelvic Floor Diseases

Laparoscopic-Pelvic Organ Prolapse Suspension

Boccasanta, Paolo MD, EBSQC*; Venturi, Marco MD; Agradi, Sergio MD*; Vergani, Contardo MD, FACS; Calabrò, Giuseppe MD*; Missaglia, Claudio MD*; Bordoni, Luca MD*; Longo, Antonio MD*

Female Pelvic Medicine & Reconstructive Surgery: April 3, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/SPV.0000000000000722
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Objective The aim of this prospective study was to assess the safety and effectiveness of a new single laparoscopic operation devised to relieve obstructed defecation, gynecologic and urinary symptoms in a large series of female patients with multiorgan pelvic prolapse.

Methods We submitted 384 female patients to laparoscopic pelvic organ prolapse suspension operation, a new technique based on suspension of the middle pelvic compartment, by using a polypropylene mesh and followed up 368 of them, with defecography performed 12 months after surgery and a standardized protocol.

Results The 368 patients were followed-up for 36.3 (±4.4) months, Recurrence rate was 4.9% for obstructed defecation syndrome and 3.3% for stress urinary incontinence. Complication rate was 2.9%. The mean period of daily activity resumption was 16.3 days (±4.8 days). Anorectal and urogynecologic symptoms and scores significantly improved after the operation (P < 0.001), with no worsening of anal continence. Incidence of postoperative fecal urgency was 0%. Postoperative defecography showed a significant (P < 0.001) improvement of all parameters in 315 patients (82%). Short Form 36 Health Survey score significantly improved after the operation (P < 0.01). An excellent/good overall Satisfaction Index was reported by 78.0% of patients.

Conclusions In our experience the Laparoscopic-Pelvic Organ Prolapse Suspension seems to be safe and effective as a 1-stage treatment of associated pelvic floor diseases. Randomized studies with an appropriate control group and longer follow-up are now needed to assess the effectiveness of this promising technique.

From the *Humanitas Cliniche Gavazzeni. Proctologic and Pelvic Surgery Unit, Bergamo, Italy; and

Ospedale Maggiore Policlinico, Fondazione IRCCS Ca’ Granda, Milano, Department of Pathophysiology and Transplantation, University of Milano, Milano, Italy.

Correspondence: Paolo Boccasanta, MD, EBSQC, Via G.B. Morgagni 39, 20129 Milano, Italy. E-mail: p.boccasanta@gmail.com.

The authors have declared they have no conflicts of interest.

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