Colposacropexia laparoscópica y cistocele / No disponible

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[Influence of age on laparoscopic colposacropexy]. / Influencia de la edad en el rendimiento de la colposacropexia laparoscópica.

OBJECTIVES: To evaluate the influence of age on laparoscopic colposacropexy (LCS) outcome and complications for pelvic organ prolapse. MATERIAL AND METHODS: A retrospective and comparative study of 105 patients who underwent standard LCS for Baden-Walker graded pelvic organ prolapse from February 2002 to March 2015. They were categorized into two groups according to age. Group 1 consisted in ≤ 50 years old patients and included 55 women. Group 2 included 50 women who were ≥ 60 years old. Outcomes and complications were compared in both groups. RESULTS: Previous history of abdominal surgery or surgery for pelvic floor disorders was significantly greater in group 2 (43.6 vs 70%). There was no significant difference regarding urinary stress incontinence, urge incontinence or severe organ prolapse between groups (47.2 vs 36%; 1.8 vs 8% and 90.9 vs 92% for Groups 1 and 2 respectively). Although a statistically significant greater proportion of vaginal vault prolapse was present in the elderly group (16.3 vs 38%), the same LCS surgical technique was used in both groups of patients. Despite operating time was significantly greater in the younger group (205.8 ± 53.4 minutes in Group 1 vs 182 ± 42.3 minutes in Group 2), hospital stay was similar in both groups (2.9 ± 1.1 days vs 3.0 ± 1.9 days in group 1 and group 2 respectively). Postoperative complications were not severe and there were no clinically significant differences between groups (20 vs 14%). We found no statistically differences between groups when comparing cure rates (87 vs 92%) in groups 1 and 2 respectively, patient satisfaction and postoperative anatomical findings. CONCLUSIONS: LCS has shown excellent cure rates in both young and elder female patients with pelvic organ prolapse.

La colposacropexia laparoscópica en el tratamiento del cistocele / Laparoscopic sacrocolpopexy for the treatment of cystoceles

Objetivo: Estudiar los resultados de la colposacropexia sobre el cistocele. Material y métodos: Setenta y siete pacientes con cistocele sometidas a colposacropexia. Con seguimiento mínimo de 6 meses, se practicó la exploración y la detección de síntomas de prolapso, urinarios rectales y sexuales. La curación objetivo se definió como un grado < II en la clasificación de Baden-Walker. Resultados: La edad media ± desviación estándar era de 53,8 ± 8,9 años. El tiempo medio operatorio de 193,6 ± 44 min. Las complicaciones intraoperatorias existieron en el 11,6% y las postoperatorias en el 19,4%. La estancia media fue de 2,7 días (1-8). Con un seguimiento medio de 15,5 ± 12,8 meses, la curación subjetiva se alcanzó en el 89,6% y la mejoría en el 6,4%. Hubo en el seguimiento un 11,6% de pacientes con cistoceles con criterios de recidiva anatómica. Setenta y cinco pacientes se declararon satisfechas o moderadamente satisfechas (97,7%). Conclusión: La colposacropexia es también efectiva para corregir el compartimento anterior (AU)

Objective: To study the results of sacrocolpopexy in our hospital for the treatment of cystoceles. Material and methods: A total of 77 patients were treated by laparoscopic sacrocolpopexy. With a minimum mean follow-up of 6 moths, a clinical examination was performed to detect symptoms of prolapse or urinary, sexual and rectal symptoms. Objective cure was defined as < grade 2 prolapse in the Baden-Walker classification. Results: The mean age was 53.8 ± 8.9 years. The mean operating time was 193.6 ± 44 minutes. Intra-operative and post-operative complications rates were 11.6% and 19.4%, respectively. The mean length of hospital stay was 2.7 (1-8) days. With a mean follow-up of 15.3 ± 12.8 months, the subjective cure rate was 89.6% and the improvement rate was 6.4%. The rate of anatomical recurrence of cystocele was 11.6%. Seventy-five patients reported they were satisfied or moderately satisfied (97.7%). Conclusion: Laparoscopy sacrocolpopexy appears to be an effective method for the treatment of cystocele (AU)

Histerectomía radical laparoscópica total en el cáncer de cérvix. Factibilidad, morbilidad y supervivencia / Total laparoscopic radical hysterectomy in cervical cancer. Feasibility, morbidity and survival

Objetivo: Evaluación retrospectiva de la factibilidad, la morbilidad perioperatoria y supervivencia a medio plazo de la histerectomía radical laparoscópica total en el cáncer de cérvix. Material y métodos: El estudio incluye 31 casos consecutivos de cáncer de cérvix en estadio clínico IA2 (n = 4), IB1 (n = 21), IIA (n = 2) y IB2 (n = 3) programados para histerectomía radical laparoscópica total. Se analizan las características histológicas de los tumores, la evolución de la técnica quirúrgica, las variables perioperatorias, las complicaciones postoperatorias y los resultados de supervivencia a medio plazo. Resultados: La tasa de factibilidad fue del 96%. La complicación operatoria más frecuente fue la cistotomía accidental (3 casos). La tasa de complicaciones postoperatorias fue del 20% (6 casos), incluido 1 caso de reintervención quirúrgica. El tiempo operatorio medio fue de 258 min (rango: 180-360). La tasa de transfusión sanguínea fue del 17% (5 casos) y la estancia hospitalaria fue de 7,8 días (rango: 2-29). Al mes de la intervención el 72% de las pacientes habían normalizado la función miccional. El tamaño tumoral medio fue de 26,5 mm y la tasa de ganglios pélvicos positivos fue del 17% (n = 5). El tiempo medio de seguimiento fue de 26 meses. La tasa de recidivas fue del 17% (n = 5) y la supervivencia libre de enfermedad fue del 100% para los estadios IB2, el 82,6% para los estadios IB1/IIA y 66,7% para los estadios IB2. Conclusiones: La histerectomía radical laparoscópica total es una técnica factible en la mayoría de los pacientes con cáncer de cérvix, requiere más tiempo operatorio que la vía abdominal, pero presenta menor morbilidad perioperatoria, menor necesidad de transfusiones y menor estancia hospitalaria. La supervivencia a medio plazo es equiparable a la vía abdominal convencional

Objective: To assess feasibility, perioperative morbidity and medium term survival of total laparoscopic radical hysterectomy in cervical cancer. Material and methods: A total of 31 consecutive patients diagnosed FIGO clinical stage IA2 (n = 4), IB1 (n = 22), IIA (n = 2) and IB2 (n = 3) in Son Llàtzer hospital (Palma de Mallorca) that were programmed for a total laparoscopic radical hysterectomy were studied. We analyzed tumor histological characteristics, surgical technique, perioperative variables, postoperative complications and mid-term survival results. Results: Feasibility rate was 96%. The most frequently operative complication was accidental bladder incision (3 cases). Postoperative complications rate was 20% (6 cases) which includes one surgical reintervention. Average operative time was 258 minutes (range: 180-360). Blood transfusion rate was 17% (n = 5) and mean hospital stay was 7.8 days (range: 2-29). After one month after surgery 72% of patients had a normal miccional function. Mean tumoral size was 26.5 mm and lymphatic positive nodes rate was 17% (n = 5). Mean follow-up time was 26 months. Tumor relapse rate was 17% (n = 5) and survival-free disease of 100% for IA2 stage, 82.6% of IB1/IIA stages and 66.7% for IB2 stage. Conclusions: Total laparoscopic radical hysterectomy is a feasible technique in most of the patients with cervical cancer. It needs more operative time than abdominal route but it presents less perioperative morbidity, less blood transfusion and less hospitalization days. The medium term survival is comparable with conventional abdominal route