Komplikationen, Reprolapsraten und funktionelle Ergebnisse nach laparoskopischer Sakropexie: eine Kohortenstudie

Zusammenfassung

Fragestellung: Die tiefe, laparoskopische Sakropexie gewinnt als moderne Methode der Deszensuschirurgie zunehmend an Bedeutung. Ziel der vorliegenden Studie ist es, Komplikationen, Rezidivraten sowie das funktionelle Ergebnis nach laparoskopischer Sakropexie zu beurteilen. Material und Methode: In die Studie wurden 287 Patientinnen mit einem Decensus genitalis > I° und konsekutiver laparoskopischer Sakropexie einbezogen. Bei noch vorhandenem Uterus wurde zusätzlich eine LASH durchgeführt (n = 171). Vordere und hintere Scheidenplastiken, Lateral Repair und Anti-Inkontinenz-Eingriffe wurden bei Bedarf simultan zur Sakropexie durchgeführt. Alle Patientinnen wurden retrospektiv in einem Fragebogen zu Folgeoperationen, De-novo-Harninkontinenz und Prolapsrezidiven befragt. Die Operationszufriedenheit wurde anhand einer 10-Punkte-Skala ermittelt (0 = unzufrieden, 10 = höchst zufrieden). Zusätzlich wurden postoperative Komplikationen anhand der Patientenakten ermittelt. Ergebnisse: Das mittlere Alter betrug 62,4 Jahre (31–91 Jahre). Der mittlere Beobachtungszeitraum umfasste 28 Monate. 84 % (n = 242) beantworteten den Fragebogen. Wir hatten keine schwerwiegenden intraoperativen Verletzungen. Als wichtigste frühe postoperative Komplikation fanden sich Harnwegsinfekte (11,4 %) sowie Wund- bzw. Stumpfinfekte nach LASH (6,6 %). 18,6 % (n = 45) der Patientinnen gaben an, sich Folgeoperationen unterzogen zu haben. In 4 Fällen wurde als Spätkomplikation ein mechanischer Ileus beobachtet. De-novo-Stressinkontinenz gaben 16 Patientinnen an, De-novo-Urgency 8. Mesh-Erosionen fanden sich bei 2 Patientinnen. Die mittlere OP-Zufriedenheit betrug 8,3 Punkte. Schlussfolgerung: Die laparoskopische Sakropexie zeigt insgesamt geringe Rezidiv- und Komplikationsraten sowie ein hohes Maß an Patientenzufriedenheit. Harnwegsinfekte bleiben ein Problem nach gynäkologischen Interventionen. Informationen über mögliche larvierte Inkontinenzen und Rezidive sollten Bestandteil des präoperativen Aufklärungsgesprächs sein.

Abstract

Purpose: Deep laparoscopic sacropexy is a modern method to treat genital prolapse. The aim of this study was to evaluate the intermediate-term outcome after laparoscopic sacropexy with regard to the rate of complications, re-prolapse rate and patient satisfaction. Material and Methods: 287 patients suffering from genital prolapse > I° treated by laparoscopic sacropexy were included in the study. LASH (laparoscopic supracervical hysterectomy) was performed in cases where the uterus was still present (n = 171). Anterior and posterior colporrhaphy, lateral repair and anti-incontinence operations were performed simultaneously if necessary. All patients were asked in a questionnaire about de novo symptoms, recurrence and subsequent operations. Patients were asked to evaluate their satisfaction with the operation using a scale (0 = worst result, dissatisfied, 10 = best result, maximum satisfaction). In addition, the medical records of the patients were analyzed. Results: Mean age at operation was 62.4 years (31–91 years). Mean follow-up was 28 months. 84 % (n = 242) of patients completed the questionnaire. No severe intraoperative complications occurred. Infections of the lower urinary tract occurred in 11.4 %, wound infections and stump infection after LASH in 6.6 %. 18.6 % (45/242) patients underwent subsequent operations. Four patients developed a mechanical ileus. 16 patients reported de novo stress incontinence and eight patients de novo urgency. Re-prolapse was reported in 7.8 %. Mesh erosion was seen in two cases. Mean operative satisfaction score was 8.3. Conclusion: Laparoscopic sacropexy shows good intermediate-term results with low re-prolapse and complication rates and high patient satisfaction. Infections of the lower urinary tract constitute a problem after gynecological surgery. Information on preoperative risks and benefits should include accurate advice on de novo incontinence and re-prolapse rates.

Schlüsselwörter

Sakrokolpopexie - Netzeinlage - Laparoskopie - Descensus genitalis - Senkungschirurgie

Key words

sacropexy - mesh - laparoscopy - genital prolapse - prolapse surgery

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