Analysis of the effect of laparoscopic vaginal sacral fixation and vaginal hysterectomy combined with pelvic floor reconstruction and reinforcement in the treatment of pelvic organ prolapse

Ma Wenqiao; Li Ping; Hu Xiaoli; Wang Haibo; Li Rongxian

doi:10.3969/j.issn.1674-3245.2025.02.031

Abstract：Objective To analyze the effectiveness of vaginal total hysterectomy combined with pelvic floor reconstruction and reinforcement surgery and laparoscopic vaginal sacral fixation surgery in treating pelvic organ prolapse in elderly women.Methods Data of elderly patients with pelvic organ prolapse who were treated from January 2018 to March 2021 were collected and divided into vaginal hysterectomy combined with pelvic floor reconstruction and reinforcement group(TVH reconstruction)(n=65)and laparoscopic vaginal sacrocolpopexy group(LSC)(n=41)according to the surgical procedure.The perioperative indicators such as operation time and blood loss were compared between the two groups.The quality of life was evaluated by the Pelvic Floor Disease Life Quality Impact Questionnaire-Short Form 7(PFIQ-7),and the quality of sexual life was evaluated by the PISQ-12.The occurrence of postoperative complications was followed up.Results The operation time of LSC group was(152.68±23.75)min and the postoperative hospitalization time was(7.12±1.35)days,which were longer than those of TVH reconstruction group(63.27±14.33)min and(6.07±0.82)days.The intraoperative blood loss was(59.48±17.31)ml,which was less than that of TVH reconstruction group(81.29±19.03 ml)(t=24.195,4.986,5.947,P＜0.05).The PFIQ-7 score of LSC group was better than that of TVH reconstruction group at 6 months after operation(t=2.265,P＜0.05).There was no significant difference in PFIQ-7 and PISQ-12 between the two groups at the last follow-up(t=0.587、1.918,P＞0.05).The complication rate of LSC group was higher than that of TVH reconstruction group,and the recurrence rate was lower than that of TVH reconstruction group,with statistically significant differences(x2=5.955、1.880,P＜0.05).Conclusion Laparoscopic colposacopexy and vaginal hysterectomy combined with pelvic floor reconstruction and reinforcement can both treat pelvic organ prolapse in elderly women.LSC significantly improves the short-term quality of life and has a low recurrence rate.TVH reconstruction has no risk of mesh exposure.The long-term quality of life of the two procedures is similar.The surgical procedure can be selected after full communication based on the patient's age,economic status,and needs.