LAPAROSCOPIC PROMONTOFIXATION IN THE TREATMENT OF GENITAL APICAL PROLAPSE

Laparoscopic promontofixation is one of the effective methods of surgical treatment of genital apical prolapse. However, this technique has a number of disadvantages: the duration of the operation, working in a tense carboxyperitoneum with a lowered head end, the difficulty of mastering and reproducing the original technique of the operation, the mandatory possession of endoscopic suture skills, removal of the uterus as one of the stages of the operation, the risk of specific complications associated with a mesh prosthesis.
This study is devoted to assessing the effectiveness and safety of the use of laparoscopic promontofixation in the treatment of genital apical prolapse.
The study included 198 patients. The degree of apical prolapse was assessed before surgery, according to the POP-Q classification. All patients underwent laparoscopic promontofixation. The patients were examined after surgery in terms of 1, 6, 12 months. This prospective, non-randomized study was conducted on the basis of the Department of Endoscopic and Reconstructive Gynecology of the Regional Perinatal Center of Aktau.
The average operation time is 120 minutes. Of the intraoperative complications, there were 3 (1.5%) bleeding as a result of injury to the median sacral artery, which was stopped by its compression and bipolar coagulation. In 2 (1%) cases, suppuration of the mesh prosthesis occurred, this complication was at the stage of mastering the technique, long-term antibacterial therapy was required. In 3 (1.5%) cases, the separation of the mesh prosthesis occurred, with a clinical relapse of the disease, and 2 out of 3 patients we ourselves re-operated. In 2 (1%) cases, the prosthesis was eroded, which required partial excision of the prosthesis into the vagina, followed by local treatment. In addition, in 26 (13%) cases laparoscopic promontofixation was performed in patients who had previously undergone surgery for pelvic organ prolapse, 7 (3.5%) of 26 previously operated patients did not have a uterus and cervix. In addition, 36 (18.1%) patients had constipation in the postoperative period, which was apparently caused by nerve injury and a large dissection area in the posterior vaginal wall, as a rule, most patients had constipation independently stopped 3-4 months after surgery. In addition, 118 (59.5%) patients noted a decrease in the severity of the phenomena of imperative urge to urinate.
Laparoscopic promontofixation is an effective and safe technique in the treatment of genital apical prolapse. After performing promontofixation, the quality of life of patients significantly improves, the frequency of functional disorders of the pelvic organs decreases. Laparoscopic promontofixation is a complex surgical technique that requires special training and good technical skills from the surgeon, knowledge of pelvic anatomy, in-depth knowledge of the problem of prolapses, knowledge of modern synthetic materials, as well as modern suture material.

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