ABDOMINAL SACROCOLPOPEXY: A LONG TERM FOLLOW UP STUDY

W. Hilger, MD, P. Norton, MD, M. Poulson

   Objective: To determine the long-term results after abdominal sacrocolpopexy (ASC) for pelvic organ prolapse.

   Materials and Methods: We used a retrospective chart review to identify a cohort of women who had undergone ASC performed by two surgeons in a community teaching hospital from 1985 to 1992. Two surgeons performed the ASC procedures attaching a single strip of Marlex mesh from the sacrum to the apex of the vagina. Of the sixty-nine women identified, 12 had died and 10 had no current address, leaving 47 available for study. As third party observers we surveyed the cohort by mail using a validated, condition-specific, symptom questionnaire (Pelvic Floor Distress Inventory) and questionnaire detailing demographics, complications, and return of symptoms (retrospective). Those who returned the questionnaires were invited to undergo a physical exam (POP-Q) to assess prolapse and 11 were examined. Failure of ASC was defined as having symptoms of pelvic organ prolapse (a positive response the most sensitive question on PFDI) or those who had a re-operation. The data was analyzed ! using Student-T test and Fisher’s Exact test.

   Results: The 38 of 47 (81%) women who returned questionnaires had a mean age of 59.2 years (range 40-77), parity 4.03 (1-9), BMI 26.22 (18.59-40.21), and stage of prolapse 2.20 (0-4) at time of surgery. These results did not differ significantly from the original surgical cohort nor the 11 patients who consented to examination. Mean surgical time for the 38 patients was 3.2 hours (1.1-6 hours). In addition to the ASC 25 of 38 had an anti-incontinence procedure and 1of 38 had a paravaginal repair. The mean time of follow-up was 13.8 years (12-17). Mesh erosion and re-operation for prolapse occurred after the procedure in 1/38 (2.6%) and 3/38 (7.9%) patients respectively. Failure of ASC occurred in 10/38 patients (26.3%), and of these 3 were re-operations. There were no significant differences between failures and successes for mean age at surgery (58.3 v. 59.5), BMI at surgery (26.2 v. 26.6), mean time of follow-up (13.5 v. 13.8), however, there was a trend towards a differ! ence in mean original stage (2.8 v 2.4). Although the number of women examined was small, those identified as failures by PFDI questionnaire had a mean stage of 1.6 (1-2) and as successes a mean stage of 1.3 (0-2).

   Conclusion: This long term follow-up study of ASC is the first to report a mean follow-up beyond 6 years. The ASC procedure had a 73% subjective success rate in our surgical cohort with a mean follow-up of 13.8 years. In this cohort, success was not affected by BMI, stage, or age at time of surgery.

   Key Words: Abdominal Sacrocolpopexy, prolapse, long-term follow-up.