Clinical Efficacy Of LLS And APFR In The Treatment Of Anterior And Middle Pelvic Organ Prolapse

ObjectiveTo retrospectively analyze the clinical efficacy of laparoscopic lateral suspension with mesh(LLS)and anterior pelvic floor reconstruction with mesh(APFR)in the treatment of anterior and middle pelvic organ prolapse,and to explore the relative indications and safety of the two surgical methods.MethodsA total of 64 patients with pelvic organ prolapse who underwent surgical treatment in the Department of Obstetrics and Gynecology of the First Affiliated Hospital of Nanchang University from August 2020 to September 2022 were included.Among them,36 patients who underwent laparoscopic lateral suspension with mesh were the study group,and 28 patients who underwent anterior pelvic floor reconstruction with mesh were the control group.The clinical indicators of the two groups,such as preoperative general conditions,perioperative parameters,POP-Q scores before surgery and 3 months after surgery,and pelvic floor disorders assessment questionnaire(PFIQ-7 and PFDI-20)before surgery and 6 months after surgery,were compared and analyzed to evaluate the clinical efficacy,relative indications and safety of the two surgical methods.Results1.General data before operation: there were no significant differences in mean age,menopause age,pregnancy number,vaginal delivery number,preoperative complications of internal and surgical diseases and degree of prolapse between the two groups(P>0.05).2.Perioperative indexes: Compared with the APFR group,there were statistically significant differences in operation duration,postoperative hospital stay and postoperative catheter indenture time in the LLS group(P<0.05).No significant difference was found in the blood loss of the two groups(P>0.05).3.Clinical efficacy:(1)Objective efficacy: Intra-group comparison: 3 months after surgery,all indicator points of POP-Q staging in both groups were significantly improved compared with those before surgery,with statistical significance(P<0.05).Comparison between the two groups: There was no statistical significance in the position of each indication point in preoperative and postoperative POP-Q stages(P>0.05).(2)Subjective efficacy: 6 months after surgery,PFIQ-7 and PFDI-20 scores were significantly lower in the two groups than before surgery,and there was also a certain difference in the two scores between the two groups after surgery,among which the difference in PFDI-20 score between the two groups was statistically significant(P<0.05).There was no significant difference in preoperative PFIQ-7 and PFDI-20 scores between the two groups(P>0.05).4.Postoperative complications: There was no significant difference in postoperative complications between the LLS group and the APFR group(P>0.05).ConclusionBoth LLS and APFR have good efficacy and safety for anterior and middle pelvic organ prolapse,and both can preserve the uterus.LLS is mainly used in patients with prolapse due to anterior mid-pelvic defects,especially those with uterine prolapse accompanied by anterior vaginal wall prolapse with degree II to III POP-Q staging and those active sexual life.APFR is mainly indicated for patients with anterior vaginal wall accompanied by uterine prolapse of POP-Q stage III to IV.However,compared with APFR,LLS has simpler operation,clearer operating field,shorter learning cycle,fewer postoperative complications,faster postoperative recovery of patients,so it is easier to be promoted and used in clinic.But LLS is not a substitute for APFR in the treatment of POP.