Retrospective Study
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Endosc. May 16, 2017; 9(5): 211-219
Published online May 16, 2017. doi: 10.4253/wjge.v9.i5.211
Nerve preserving vs standard laparoscopic sacropexy: Postoperative bowel function
Stefano Cosma, Paolo Petruzzelli, Saverio Danese, Chiara Benedetto
Stefano Cosma, Chiara Benedetto, Department of Surgical Sciences, University of Torino, 10126 Torino, Italy
Paolo Petruzzelli, Saverio Danese, Department of Gynecology and Obstetrics, City of Health and Science, 10126 Torino, Italy
Author contributions: Cosma S contributed to study conception, design, data acquisition, analysis, interpretation, and writing of article; Benedetto C contributed to editing, reviewing and final approval of article; Petruzzelli P and Danese S performed surgery.
Institutional review board statement: This retrospective study was performed without direct contact with patients and no individual patient information was revealed. The described experimental procedure (nerve preserving laparoscopic sacropexy) had already been approved by the Local Ethics committee for our preliminary anatomoclinical published research and subsequently introduced in the clinical practice of the department. Therefore, this study had no need of further review by the local Institutional Review Board.
Informed consent statement: All study participants provided informed written consent before undergoing surgery and for personal data processing.
Conflict-of-interest statement: All authors declare that they have no conflict of interest.
Data sharing statement: Anonymous dataset is available from the corresponding author at cosmastefano@libero.it.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Stefano Cosma, MD, PhD, Department of Surgical Sciences, University of Torino, Via Ventimiglia 3, 10126 Torino, Italy. cosmastefano@libero.it
Telephone: +39-011-3131711 Fax: +39-011-3134142
Received: November 24, 2016
Peer-review started: November 27, 2016
First decision: January 16, 2017
Revised: February 19, 2017
Accepted: March 12, 2017
Article in press: March 13, 2017
Published online: May 16, 2017
Processing time: 172 Days and 18 Hours
Abstract
AIM

To compare our developed nerve preserving technique with the non-nerve preserving one in terms of de novo bowel symptoms.

METHODS

Patients affected by symptomatic apical prolapse, admitted to our department and treated by nerve preserving laparoscopic sacropexy (LSP) between October, 2010 and April, 2013 (Group A or “interventional group”) were compared to those treated with the standard LSP, between September, 2007 and December, 2009 (Group B or “control group”). Functional and anatomical data were recorded prospectively at the first clinical review, at 1, 6 mo, and every postsurgical year. Questionnaires were filled in by the patients at each follow-up clinical evaluation.

RESULTS

Forty-three women were enrolled, 25/43 were treated by our nerve preserving technique and 18/43 by the standard one. The data from the interventional group were collected at a similar follow-up (> 18 mo) as those collected for the control group. No cases of de novo bowel dysfunction were observed in group A against 4 cases in group B (P = 0.02). Obstructed defecation syndrome (ODS) was highlighted by an increase in specific questionnaires scores and documented by the anorectal manometry. There were no cases of de novo constipation in the two groups. No major intraoperative complications were reported for our technique and it took no longer than the standard procedure. Apical recurrence and late complications were comparable in the two groups.

CONCLUSION

Our nerve preserving technique seems superior in terms of prevention of de novo bowel dysfunction compared to the standard one and had no major intraoperative complications.

Keywords: Apical prolapse; Bowel dysfunction; Laparoscopic sacrocolpopexy; Nerve sparing; Vaginal vault prolapse

Core tip: Laparoscopic sacropexy is associated with postoperative bowel dysfunction (constipation, obstructed defecation syndrome) in 10%-50% of cases, with significant worsening in the quality of life. Iatrogenic denervation of the autonomic pelvic nerves was reported as a relevant cause of this kind of dysfunction. The aim of this observational study was to evaluate the safety and efficacy of our nerve preserving technique.