Laparoskopik pektopeksi ameliyatı sonrası MR'da vajinal eksen: kontrollü bir çalışma

Abstract

Amaçlar: Laparoskopik pektopeksi, kadın genital apikal prolapsusunu tedavi etmek için sakrokolpopeksiye (SCP) uygulanabilir bir alternatif olarak ortaya çıkmıştır. Birkaç önceki çalışmada SCP, laparoskopik lateral mesh süspansiyonu, prolapsus için sakrospinöz ligament fiksasyon ameliyatı geçiren kadınlarda vajinal eksende değişiklikler bildirilmiş olsa da, pektopeksi sonrası vajinal eksende değişiklikler hakkında veri eksikliği vardır. Bu çalışmanın amacı, manyetik rezonans görüntüleme (MRI) kullanılarak apikal genital prolapsusu olan hastalarda laparoskopik pektopeksi ile elde edilen anatomik düzeltme derecesini değerlendirmekti. Yöntemler: Pektopeksi geçiren bireyler ve doğum yapmamış bir kontrol grubu bu prospektif gözlemsel vaka-kontrol araştırmasına dahil edildi. İşlemden önce ve sonra hem kontrol kohortunda hem de çalışma grubunda MRI taramaları yapıldı. Pubokoksigeal çizgi ve alt vajinal segment, levator plakası ve pubokoksigeal çizgi ile alt ve üst vajinal segmentlerin oluşturduğu açılar ölçüldü ve karşılaştırıldı. Bulgular: Alt vajina ile üst vajina arasındaki açı değişimi istatistiksel olarak anlamlıydı, ameliyat öncesi ve sonrası değerler sırasıyla 134,91° ± 6,25° ve 166,82° ± 6,15° idi (p = 0,0001). Alt vajina ile pubokoksigeal çizgi arasındaki açı anlamlı bir değişim gösterdi, ameliyat öncesi ve sonrası değerler sırasıyla 44,64° ± 1,8° ve 65,73° ± 10,19° idi (p = 0,0001). Postoperatif açılar, MRI bulgularına göre nullipar hastalarda benzer değildi. Ameliyat sonrası Ürogenital Distres Envanteri skorları ameliyat öncesi skorlara göre anlamlı derecede düşüktür (p = 0,0001). Sonuç: Pektopeksi prosedürü normal bir vajinal eksen elde etmek için ideal değildir.

Keywords

• Apikal prolapsus
• pelvik organ prolapsusu
• pektopeksi
• laparoskopik lateral mesh süspansiyonu
• sakrospinöz ligament fiksasyonu (SSLF)

Vaginal axis on MRI after laparoscopic pectopexy surgery: a controlled study

Abstract

Aims: Laparoscopic pectopexy has emerged as a feasible alternative to sacrocolpopexy (SCP) for treating female genital apical prolapse. Although several previous studies have reported changes in the vaginal axis in women who have undergone SCP, laparoscopic lateral mesh suspension, sacrospinous ligament fixation surgery for prolapse, there is a lack of data on changes in the vaginal axis after pectopexy. This study aimed to evaluate the degree of anatomical correction achieved by laparoscopic pectopexy in patients with apical genital prolapse using magnetic resonance imaging (MRI). Methods: Individuals who experienced pectopexy and a nulliparous control group were enrolled in this prospective observational case-control investigation. MRI scans were conducted on both the control cohort and the study group before and after the procedure. The angles formed by the pubococcygeal line and the inferior vaginal segment, the levator plate and the pubococcygeal line, as well as the inferior and superior vaginal segments, were measured and compared. Results: The change in angle between the lower vagina and upper vagina was statistically significant, with preoperative and postoperative values of 134.91°±6.25° and 166.82°±6.15°, respectively (p=0.0001). The angle between the lower vagina and pubococcygeal line showed a significant change, with preoperative and postoperative values of 44.64°±1.8° and 65.73°±10.19°, respectively (p=0.0001). Postoperative angles were not similar among nulliparous patients based on the MRI findings. The postoperative Urogenital Distress Inventory scores are significantly lower than the preoperative scores (p=0.0001). Conclusion: The pectopexy procedure is not optimal for achieving a normal vaginal axis.

Keywords

• Apical prolapse
• pelvic organ prolapse
• pectopexy
• laparoscopic lateral mesh suspension
• sacrospinous ligament fixation (SSLF)

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