Modified first-level reconstruction and reinforcement during laparoscopic total hysterectomy for prevention of post-operative pelvic organ prolapse: a randomized clinical trial.

OBJECTIVE: This paper investigated that the clinical value of modified first-level reconstruction reinforcement in the prevention and treatment of pelvic floor dysfunction after laparoscopic total hysterectomy.

METHODS: A total of 360 patients undergoing laparoscopic total hysterectomy from December 2018 to September 2021 were selected and divided into three groups (A, B, C) according to POP-Q criteria: This is a randomized clinical trial in which women with first- and second-degree pelvic organ prolapse, and women without pelvic organ prolapse were each randomized into 3 arms of the study. According to the informed consent of patients, three groups are as following: Arm 1: 60 cases in the non-suspension group (vaginal stump was only sutured continuous absorbable suture); Arm 2: 60 cases in traditional suspension group (as in Arm 1, plus suspension of vaginal stump with non-absorbable sutures to cardinal and round ligaments); Arm 3: 60 cases in the modified suspension group (vaginal stump reinforced with horizontal reconstruction). POP-Q score, sexual life quality questionnaire, urinary incontinence questionnaire and pelvic floor ultrasound were compared before and at 6 and 12 months after operation.

RESULTS: (1) in the non-prolapse group and the prolapse group, the POP-Q score of the modified suspension group c was superior to that of the non-suspension group and the traditional suspension group b at 6 and 12 months after surgery (P < 0.05), and the postoperative POP-Q score of the prolapse group was significantly improved compared with that before surgery. (2) In both the non-prolapse and the prolapse study groups, the participants that were randomized to the modified suspension treatment (arm 3) had significantly better sexual function scores than those in arm 1 and arm 2 six and twelve months after surgery (p <0.05). (3) Similarly, participants in both the non-prolapse and the prolapse groups that were randomized to the modified suspension treatment arm (arm 3) were significantly less prone to. urinary incontinence than those randomized to arm 1 and arm 2 at 6 and 12 months after surgery.

CONCLUSIONS: Compared with traditional vaginal stump suture and traditional vaginal stump suspension, the modified first-level reconstruction and consolidation method can effectively prevent and cure pelvic floor dysfunction after laparoscopic total hysterectomy, and significantly improve the quality of life of patients.