Pelvic pain after laparoscopic lateral suspension for pelvic organ prolapse: an unrecognized problem?

Comparison of laparoscopic lateral suspension and high uterosacral ligament suspension for apical prolapse: a retrospective clinical study

BACKGROUND

The aim of this retrospective clinical study is to assess clinical outcomes and patient satisfaction between laparoscopic lateral suspension (LLS) with mesh and laparoscopic high uterosacral ligament suspension (LHUS) for apical prolapse with or without anterior prolapse.

METHODS

Patients who underwent LLS with mesh or LHUS from 2019 to 2023 at the Second West China Hospital of Sichuan University were enrolled in this retrospective study. The objective outcomes were evaluated on the basis of the anatomical success rate according to the Pelvic Organ Prolapse Quantification System (POP-Q). The subjective outcomes were assessed using the Pelvic Floor Distress Inventory (PFDI-20) questionnaire, Pelvic Floor Impact Questionnaire (PFIQ-7), Patient Global Impression of Improvement (PGI-I) scores, and complications rate. Complications were defined according to the Clavien-Dindo scale. The outcomes of the postoperative 3, 6, and 12 months were analyzed retrospectively.

RESULTS

The objective and subjective outcomes indicated improvements in both groups. There was no statistically significant difference between the two groups in the change of subjective outcomes. The short-term objective and subjective outcomes for both techniques were found to be comparable. The anatomical success rate for apical and anterior prolapse was 93.85% in the LHUS group and 93.44% in the LLS group at a median follow-up of 12 months. LLS demonstrated a superior effect on the degree of postoperative point Ba (the distance from the most protruding point to the hymen on the anterior vaginal wall) improvement compared with LHUS.

CONCLUSIONS

LHUS and LLS are both effective, safe surgical techniques for the treatment of apical prolapse, with or without concomitant anterior prolapse, exhibiting low complication rates and high short-term anatomical cure rates. LLS demonstrated certain advantages over LHUS in terms of anterior prolapse improvement and symptom relief.

Enhanced recovery after surgery (ERAS) in prolapse repair: A prospective study on pre-emptive uterosacral/cervical block

OBJECTIVE

Enhanced recovery after surgery (ERAS) protocols have been introduced in gynecology. Postoperative pain management after vaginal procedures remains a relevant issue. In the present study we aimed to evaluate the effectiveness of pre-emptive uterosacral/cervical block (PUCB) for postoperative pain control in patients with uterovaginal prolapse undergoing vaginal hysterectomy and pelvic floor repair. We also evaluated the impact on the length of recovery.

METHODS

This was a pilot study analyzing 40 women who underwent pelvic organ prolapse repair through uterosacral ligament suspension. Patients who chose to undergo PUCB were considered as cases, otherwise as controls. After general or spinal anesthesia induction, the treatment group received the PUCB with ropivacaine plus clonidine injections at 2, 4, 8, and 10 o'clock of the cervix. The control group did not receive additional treatment. Pain intensity was measured at rest and after forceful cough at 1, 4, 8, 12, 24, and 48 h postoperatively.

RESULTS

We found a significant reduction in pain values at 1 h (rest and forceful cough) and 24 h (forceful cough) in the PUCB group. The incidence of moderate/severe pain was inferior in the PUCB group at 1 h (rest) and 24 h (rest and forceful cough). There were no differences in terms of the use of rescue opioids (0% vs. 5%; P = 0.311) and length of hospital stay (2.5 ± 0.6 vs. 2.3 ± 0.6; P = 0.180).

CONCLUSIONS

For the first time, we demonstrated the impact of pre-emptive uterosacral/cervical block on pain control up to 24 h after surgery. Clonidine as a sensory blockade extender appears promising in enhancing the efficacy of local anesthetics.