Comparison of Unilateral and Bilateral Sacrospinous Ligament Fixation Using Minimally Invasive Anchorage

Abstract

Objective The aim of this study was to determine the effectiveness of a newly developed anchoring system for unilateral sacrospinous ligament fixation (USSLF) and bilateral sacrospinous ligament fixation (BSSLF) procedures.

Material and Methods Ninety-three patients with pelvic prolapse who were treated surgically with the Anchorsure System^® between 2013 and 2018 were included in the study. USSLF was performed in 52 patients (group 1), and BSSLF was performed in 41 patients (group 2). Pelvic organ prolapse was assessed preoperatively and 6 months postoperatively.

Results There were no significant differences between groups 1 and 2 with regard to age, parity, and demographic characteristics. Anatomical improvement rates were similar, irrespective of the type of SSLF used. No bleeding requiring blood transfusion or organ injuries occurred in any patient. Three patients in the group that received BSSLF developed small asymptomatic cystoceles (grade 1 to 2); there was no recurrence of rectoceles or enteroceles. Mild cystocele was found in 1 patient from the USSLF group. There was no significant difference between the groups with respect to the recurrence of cystocele. Recurrence of vaginal vault prolapse was found in 2 patients from the USSLF group (3.84%). There was no significant difference between the groups with regard to recurrence. Febrile morbidity, clinical outcomes, blood loss, duration of operation, intraoperative complications, and length of hospital stay were similar for the two groups.

Conclusions Unilateral and bilateral SSLF techniques produce similar clinical outcomes. USSLF and BSSLF performed using the new anchoring system are safe and effective methods to treat pelvic organ prolapse.

Zusammenfassung

Zielsetzung Ziel dieser Studie war es, die Effektivität eines neuentwickelten Ankersystems für die einseitige und beidseitige Fixation am Lig. sacrospinale zur Behandlung von Prolaps der Beckenorgane zu vergleichen.

Material und Methoden 93 Patientinnen mit Gebärmuttersenkung, die sich zwischen 2013 und 2019 einem chirurgischen Eingriff mit dem Anchorsure System^® unterzogen, wurden in die Studie eingeschlossen. Eine einseitige Fixation wurde bei 52 Patientinnen (Gruppe 1) und eine beidseitige Fixation bei 41 Patientinnen (Gruppe 2) durchgeführt. Das Ausmaß der Beckenbodensenkung wurde jeweils vor der Operation sowie 6 Monate nach dem Eingriff evaluiert.

Ergebnisse Gruppe 1 und Gruppe 2 unterschieden sich nicht signifikant voneinander hinsichtlich des Alters, der Parität und der demografischen Merkmale. Ungeachtet des gewählten Eingriffs war das Ausmaß an anatomischer Verbesserung für beide Gruppen vergleichbar. Keine der Patientinnen erlitt schwere Blutungen mit nachfolgender Bluttransfusion oder Organschädigungen. Drei Patientinnen aus der Gruppe mit bilateraler Fixation entwickelten kleine, asymptomatische Zystozelen (Grad 1 – 2); keine der Patientinnen entwickelte eine Rektozele oder ein Enterozele-Rezidiv. Eine Patientin aus der Gruppe mit einseitiger Fixation entwickelte eine schwach ausgeprägte Zystozele. Es gab keinen statistisch signifikanten Unterschied zwischen den beiden Gruppen hinsichtlich der Entwicklung von Zystozelen. Zwei Patientinnen aus der Gruppe mit einseitiger Fixation erlitten einen erneuten Scheidenprolaps (3.84%). Die zwei Gruppen unterschieden sich nicht signifikant im Hinblick auf das Wiederauftreten von Prolaps. Fieberentwicklung, klinisches Outcome, Blutverlust, Operationsdauer, intraoperative Komplikationen und Krankenhausaufenthalt waren in beiden Gruppen vergleichbar.

Schlussfolgerungen Das klinische Outcome nach einseitiger und bilateraler Fixation war vergleichbar. Die einseitige bzw. bilaterale Fixation am Lig. sacrospinale mit dem neuentwickelten Verankerungssystem stellt ene sichere und effektive Methode zur Behandlung der Beckenbodensenkung dar.

Key words

sacrospinous ligament fixation - anchoring system - total uterine prolapse

Schlüsselwörter

Fixation am Ligamentum sacrospinale - Verankerungssystem - totaler Descensus uteri

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