Page 53 - WJOLS - Surgery Journal

Million Teshome
in this review. With experienced surgeon the operation time more blood loss and longer hospital stays. These findings are
usually is comparable to open techniques. 3,4 inherent in the procedure and most studies have shown that
Blood loss: As compared to laparotomy, laparoscopy is the recurrence and correction of the anatomical defect are similar
associated with less blood loss to the patient even though with laparoscopic sacrocolpopexy. But with these disadvantages
proper quantification of the actual blood was not done in most still it can be used effectively if there is lack of experience with
revised articles. In cohort study done on 113 patients estimated laparoscopy and when there is no laparoscopic instrument.
blood loss (172 +/– 166 mL vs 234 +/– 149 mL; P = .04) after Laparoscopic sarcocolpopexy is nowadays favored by
laparoscopy and after laparotomy respectively. This difference patients because It is mainly minimally invasive and as shown
mainly attributed to injury to blood vessels can easily be avoided in many of the studies associated with less blood loss which is
due to clear vision via laparoscope usually the amount of blood significant and is also associated with less hospital stay to
loss will be minimum, of course one of the complication of patients also statically significant difference as compared to
laparoscopy is accidental injury to great vessels which can be the open technique.
reduced with proper training and experience. 3,4 Operation time is also prolonged in most of the studies and
Hospital stay: as discussed in the different studies is complications like mesh erosion is similar in both groups. As
significantly shorter 1-1.8 days in the laparoscopy group as surgeons experience and skill increases some of the
compared to the laparotomy group which is 4-5.8 days complications can be minimized and this method can be used to
(p < 0.005). This is very important advantage of laparoscopy treat pelvic organ prolapse.
because it saves much time for the patient to resume daily
activities early and also saves much cost for hospitals by CONCLUSION
decreasing bed occupancy, the cost effectiveness to the patient Both laparoscopic and open sarcocolpopexy can be used for
is not properly shown in the different studies and need further the treatment of pelvic organ prolapse but laparoscopic
evaluation. 3 approach has slight advantage over the open method mainly
Success rate can be determined in two ways objective
success that is after properly scheduled follow-up visits the less blood loss and operation time with sound cosmetic result.
In experienced hands laparoscopic sarcocolpopexy can be used
physician will perform physical examination and determine the effectively with favorable outcome.
success of the treatment. Based on the presence or the absence
of descent of the pelvic organs subjective success rate is the REFERENCES
patient’s perception about her symptoms of prolapse, sense of
well-being and sexual function after the procedure. Objective 1. Holly E, Richter R Edward Varner in Berek and Novak’s
success for both method ranges from 85-92% there is no gynecology,14th ed, 2007:Lippincot Williams andWilkins, 897.
significant difference in both methods while subjective success 2. Reda Afifi, Aymansayed, Posthysterectomy vaginal vault
rate is considered 79-85 %. 3-7 prolapse, review: The obstetrician and gaenecologist 2005;7:
Other complications like bladder, rectal injuries are not 89-97.
common but are similar in both methods. 7 3. Paraiso MF, Walters MD, Rackley RR, Melek S. Laparoscopic
Conversion rate in case of difficulty reported in some of the and abdominal sacral colpopexies a comparative cohort study.
Am J Obstet Gynecol 2005;192(5):1752-58.
literature ranges from 0-11%, but this conversion rate is 4. Comparison of Laparoscopic and abdominal sacrocolpopexy
decreased when the operator is well skilled. for the treatment of vaginal vault prolapse. Hsiao C,
Recurrence rate after both laparoscopic and laparotomy Latchamsetty K, Govier E Kobashi. Journal of Endourology.
sacrocolpopexy is usually similar it ranges 12-46%. Most of the August 1, 2007;21(8):926-30.
patients were followed from 3 months up to 13 years as the 5. Ganatra AM, Rozet F, Sanchez-Salas R, Barret E, Galiano M,
number of years increases the chance of recurrence increases Cathelineau X, Vallancien G The Current Status of Laparoscopic
regardless of the method used to correct the prolapse. Sacrocolpopexy: A Review. Eur Urol 2009 Feb 4.
Laparoscopic sarcocolpopexy is also associated with high-rate 6. Higgs PJ, Chua HL, Smith AR BJOG. Long-term review of
of satisfaction. 3,4,6,8 laparoscopic sacrocolpopexy 2005;112(8):1134-38.
7. Claerhout F, De Ridder D, Roovers JP, Rommens H, Spelzini F,
DISCUSSION Vandenbroucke V, Coremans G, Deprest J. Medium-Term
Anatomic and Functional Results of Laparoscopic Sacro-
Pelvic organ prolapse was being treated by different methods colpopexy Beyond the Learning Curve. Eur Urol. 2008 Dec 17.
but after the introduction of laparoscopy many surgeons are 8. Marchionni M, Bracco GL, Checcucci V, Carabaneanu A, Coccia
utilizing this new advanced technology to treat their patients. EM, Mecacci F, Scarselli G. True incidence of vaginal vault
Laparotomy can be performed for this problem with equal prolapse. Thirteen years of experience. J Reprod Med 1999;
success rate but with disadvantages of scar over the abdomen, 44(8):679-84.

54