Laparoscopic pectopexy with native tissue repair for pelvic organ prolapse

doi:10.21203/rs.3.rs-2218583/v1

Download PDF

Research Article

Laparoscopic pectopexy with native tissue repair for pelvic organ prolapse

https://doi.org/10.21203/rs.3.rs-2218583/v1

This work is licensed under a CC BY 4.0 License

Journal Publication

published 07 Mar, 2023

Read the published version in Archives of Gynecology and Obstetrics →

You are reading this latest preprint version

Purpose

The use of mesh for vaginal repair is currently problematic; consequently, there is increased interest in native tissue repair. Combining native tissue repair with sufficient mesh-applied apical repair might provide effective treatment. We describe the study focusing on the combination of pectopexy and native tissue repair.

Methods

Between April 2020 and November 2021, 49 patients with symptomatic stage III or IV were treated with laparoscopic pectopexy combined with native tissue repair. The mesh was solely used for apical repair. All other clinically relevant defects were treated with native tissue repair. The perioperative parameters including surgical time, blood loss, hospital stay, and complications were recorded. The anatomical cure rate was evaluated according to the Pelvic Organ Prolapse Questionnaire (POP-Q) assessment. Validated questionnaires of the Pelvic Floor Distress Inventory (PFDI-20), and the Pelvic Floor Impact Questionnaire (PFIQ-7), were recorded to evaluate the symptom severity and quality of life.

Results

The mean duration of follow-up was 15 months. All domains of POP-Q, PFDI-20, and PFIQ-7 scores improved significantly after surgery. No major complications, mesh exposure, or mesh complication occurred during the follow-up period.

Conclusion

Laparoscopic pectopexy combined with native tissue repair, resulting in favorable clinical findings, is an effective surgical method.

pelvic organ prolapse

pectopexy

native tissue repair

Pelvic organ prolapse (POP) is a sort of sickness in which the supporting structure of the pelvic floor is damaged for numerous reasons, resulting in improper position and function of pelvic organs[1]. With the deepening of global aging, the prevalence of POP has increased dramatically. Large reviews of the literature have found that 3–6% of women have symptomatic POP, while up to 50% of women experience anatomic prolapse[2]. It is reported in the literature that 12–19% of women will have POP surgery by age 85 in their lifetime, and 19% of women may undergo surgery again because of prolapse recurrence[3].

POP comprises anterior, middle, and posterior pelvic organ prolapse. Among these, anterior vaginal wall prolapse is common in POP and is also difficult to treat. Transvaginal mesh implantation (TVM) can repair the defects of the middle pelvis and anterior pelvis at the same time, notably for the central and lateral deformities of the anterior pelvis[4], however, the difficulties induced by mesh also increase the rate of reoperation. Due to the dispute over the use of mesh, native tissue repair in pelvic surgery has once again become the preferred choice in various nations. For a long time, native tissue repair is regarded to be insufficient. However, several studies have indicated that from a clinical point of view, it offers superior benefits than mesh in the long run[5, 6].

Apical repair is the key part of pop surgery, and the common clinical procedures include sacral colpopexy, sacral ligament suspension, uterosacral ligament suspension, and sacrospinous ligament fixation. Among them, laparoscopic sacralcolpopexy(LS) is considered the standard method for treating pelvic organ prolapse[7]. LS, however, requires extensive training and is challenging to perform. There have been documented clinical cases of significant presacral bleeding leading to death, and postoperative defecation problem is a common occurrence. Additionally, periostitis is an uncommon occurrence that is linked to the sacral anchorage's weak anterior longitudinal ligament and the risk that an operation would pierce the periosteum[8]. Therefore, surgeons are dedicated to finding a more perfect surgical approach. To avoid the problems of LS outlined above, Banerjee and Noe proposed pectopexy in 2011[9]. This procedure has similar results to sacralcolpopexy.

Combined with the aforesaid surgical characteristics, for severe POP patients, we try to use the mesh material solely for apical support, and at the same time perform native tissue repair to correct other pelvic abnormalities. This study aims to introduce the surgical procedure and evaluate its efficacy and safety.

The study included 49 patients with a POP-Q stage greater than 2 who underwent laparoscopic pectopexy surgery between April 2020 and November 2021. Transvaginal ultrasonography and pap smear test were performed on all patients. Patients with suspected cancer underwent endometrial sampling. Exclusion criteria included a history of pelvic inflammatory disease, a suspicion of malignancy, pregnancy, prior POP or continence surgery, and patients who refused to be operated using this technique. All surgical procedures were performed by an experienced gynecologist. The study was granted by the Medical Ethics Committee of Beijing Chao-Yang Hospital in accordance with the Declaration of Helsinki.

Data on the patient’s age, BMI, parity status, surgical history, and gynecological examination were documented during the preoperative evaluation. Preoperatively, the validated prolapse quality of life (P-QOL), Pelvic Floor Distress Inventory Questionnaire (PFDI-20), and Pelvic Floor Impact Questionnaire (PFIQ-7) form utilized in our study were completed. The P-QOL questionnaire is a straightforward, reliable, and simple-to-understand questionnaire for assessing symptom intensity, the impact of these symptoms on quality of life, and treatment outcomes in women with pelvic organ prolapse[10].In the first postoperative month and the third month, the patients were summoned for a revisit. Patients completed postoperative reproductive quality of life surveys at the third month postoperatively, and the data were collected. The preoperative and postoperative quality of life data were statistically compared. All clinical data were retrieved retrospectively from the institution's electronic medical record. Perioperative data were also gathered, including surgical time, expected blood loss, operative complications, duration of stay, and postoperative follow-up data at 1 and 3 months.

The primary outcome was anatomical cure defined as less than stage 1 (all vaginal sites at least 1 cm above the hymen on Valsalva), as scored by the POP-Q system.

The secondary outcomes included the symptom severity, and quality of life according to the Pelvic Floor Distress Inventory (PFDI-20), and Pelvic Floor Impact Questionnaire (PFIQ-7) scores at each visit point. Increasing scores of PFDI-20 and PFIQ-7 indicate impaired function.

2.1. Operative technique

The abdomen was inflated with carbon dioxide at 12 mmHg pressure and four laparoscopic ports were placed: a 10-mm umbilical, a 10-mm suprapubic port, and two 5-mm lateral ports. We opened the peritoneal layer along the right round ligament toward the pelvic wall. We started the peritoneum dissection at the side of the right external iliac vein, and we carried out this incision in the medial and caudal direction under intermittent coagulation. We dissected soft tissue in this field using blunt dissection. Hence, we identified an approximately 5 cm segment of the right Cooper’s ligament (iliopectineal ligament) adjacent to the iliopsoas muscle’s insertion. We repeated the same steps on the left side of the patient. Then, we opened the peritoneal layers on both sides toward the anterior peritoneum of the uterus to prepare the lower anterior segment of the uterus for mesh fixation. A large diameter non-absorbent lightweight mesh(PFM Medical, Germany) is trimmed into a butterfly shape which was used to suspend the uterus. After all these dissections, the bottom of the mesh was sutured to the front of the cervix with 3–5 nonabsorbable polyester 2 − 0 sutures. The mesh then surrounds the isthmus of the uterus. Sew the ends of the two short arms to the back of the cervix. Suture the two long arms of the mesh to the two iliopubic ligaments using 2 nonabsorbable 2 − 0 sutures. We then closed the peritoneal layer with 2 − 0 absorbable suture material.

After apical suspension, we assessed the anterior and posterior vaginal walls. We add anterior or posterior surgery and perineal reconstruction if stage 2 or higher cystocele or rectocele is present according to POP-Q.

2.2 Statistical analysis

Analysis was performed with IBM SPSS 20.0 (IBM Corp., Armonk, NY, USA) package program. Normally distributed numerical variables were expressed as mean ± standard deviation, and non-normally distributed numerical variables were expressed as median (25th–75th percentile). The t-test was performed for normally distributed numerical variables and the Wilcoxon signed ranks test for the non-normally distributed variable. For the test of two-way hypotheses, the level of significance p < 0.05 was accepted as sufficient.

All data including baseline demographic and clinical characteristics (age, parity, BMI, and perioperative data) were presented in Table 1. A total of 49 patients underwent laparoscopic pectopexy. Among them, 18 patients underwent anterior and posterior vaginal wall colporrhaphy, 6 patients underwent anterior vaginal wall colporrhaphy, 10 patients underwent vaginal posterior wall colporrhaphy, and 6 patients underwent perineal repair. No intraoperative complications were detected for all patients.

Table 1

Demographic and perioperative data
Variables	Mean ± SD
Age(years)	64.85 ± 11.94
Gravity	3.22 ± 1.41
Parity	1.87 ± 1.00
Total operation time (minutes)	197.44 ± 32.9
BMI (kg/m2 )	24.51 ± 2.3
Estimated blood loss(ml)	40.41 ± 37.58
Hospital stay (days)	6.75 ± 1.89
Intraoperative complications	0

3.1 The POP-Q point measurements showed statistically significant improvements at 3-month post-surgery compared with preoperative measurements(Table 2). On the anterior vaginal wall, the Aa point improved from 0.49 ± 1.21 to -2.34 ± 0.61, and the Ba point from 1.65 ± 0.96 to -2.61 ± 0.46 (p < 0.001). The Ap point on the posterior vaginal wall increased from − 0.08 ± 1.33 to -2.5 ± 0.5, and the Bp point increased from 0.69 ± 1.74 to -2.69 ± 0.44 (p < 0.001). The C point increased from 2.35 ± 1.10 to -4.83 ± 0.65 and the D point increased from 0.65 ± 1.05 to -6.05 ± 0.78 significantly (p < 0.001). Total vaginal length TVL also presents significant improvement as compared with preoperation.

Table 2

Pre- and postoperative (3-month follow-up) pelvic organ prolapse quantification
Variables	Preoperative assessment			Postoperative assessment			p
Variables	mean ± SD	Median(minimum-maximum)		mean ± SD	Median(minimum-maximum)		p
Aa	0.49 ± 1.21		1.00(-2.0-3.0)	-2.34 ± 0.61		-2.00(-3.0–1.0)	< 0.001
Ba	1.65 ± 0.96		2.00(-2.0-3.0)	-2.61 ± 0.46		-3.00(-3.0–2.0)	< 0.001
Ap	-0.08 ± 1.33		0.00(-2.0-3.0)	-2.52 ± 0.57		-3.00(-3.0–1.0)	< 0.001
Bp	0.69 ± 1.74		1.00(-2.0-3.0)	-2.69 ± 0.44		-3.00(-3.0–2.0)	< 0.001
C	2.35 ± 1.10		2.00(0.0–5.0)	-4.83 ± 0.65		-5.00(-6.0–4.0)	< 0.001
D	0.65 ± 1.05		0.00(-1.0-3.0)	-6.05 ± 0.78		-6.00(-8.0–5.0)	< 0.001
TVL	6.71 ± 0.71		7.00(6.0–8.0)	7.29 ± 0.59		7.00(6.0–8.0)	< 0.001

3.2 Comparison of quality of life scores

Functional outcomes, assessed by comparing the pre-and post-operative scores, were shown in Table 3. A significant improvement at 3-month follow-up was noted as compared to baseline score using the following validated questionnaires: PFDI-20, and PFIQ-7 scores. The median value of the preoperative PFDI-20 score was 79.62 ± 35.69 and the postoperative score was 9.97 ± 10.73. The difference was statistically significant (p < 0.001). Preoperative and postoperative median PFIQ-7 scores were 89.69 ± 60.05 and 11.7 ± 10.16 respectively and the difference was statistically significant (p < 0.001).

Table 3

Quality of life results of patients
Variables	Preoperative assessment			Postoperative assessment			p
Variables	mean ± SD	Median(minimum-maximum)		mean ± SD	Median(minimum-maximum)		p
PFDI-20	79.62 ± 35.69		81.25(8.25–154.0)	9.97 ± 10.73		7.12(0-35.25)	< 0.001
PFIQ-7	89.69 ± 60.05		76.18(9.52–228.5)	11.7 ± 10.16		9.52(0-57.12)	< 0.001

3.3 One patient was found to have lower extremity intermuscular vein thrombosis 4 days after the operation, which was cured after active treatment, while no perioperative complications occurred in the rest of the patients. During the follow-up period, recurrence of apical prolapse was not observed. In our study, the patients did not have any problems with defecation. One patient developed de novo stress urinary incontinence 1 month after the operation and eventually underwent mid-urethral suspension surgery. No mesh-related erosion was observed.

POP is a health and social problem that mainly affects middle-aged and elderly women. The number of people seeking treatment for pelvic floor dysfunction will rise by 45% in the next 30 years, according to data from the United Nations World Population Aging[11].

POP is classified as anterior, middle, and posterior pelvic defect or prolapse based on the location of the defect. The incidence of anterior pelvic prolapse is two and three times that of posterior as well as middle pelvic prolapse, respectively[12].

Autologous tissue repair and vaginal mesh implantation are the most common surgical treatments for anterior pelvic prolapse. According to the previous standard of anatomical structure recovery, the success rate of anterior pelvic autologous tissue repair is low and the recurrence rate is high. Because of its high recurrence rate and surgical failure rate, biological grafts and mesh are gradually used in the surgical treatment of anterior pelvic prolapse. Vaginal implantation of mesh can significantly improve the recovery rate of the anatomical structure of pelvic floor tissue, which is widely used in anterior pelvic prolapse, but it also brings a lot of mesh-related problems.

The definition of the success of POP surgery has always been controversial, and the different definitions directly affect the statistics of the success rate of POP surgery. Studies have shown that although the anatomical cure rate of anterior pelvic autologous tissue repair is low, it can well alleviate the symptoms of prolapse, and the incidence of complications is low[13]. Moreover, if the improvement of clinical symptoms and quality of life of patients is taken as the criteria for the success of POP, the success rate of anterior pelvic autologous tissue repair is considerable[14].

Patients with vaginal apical defects are often associated with anterior and posterior vaginal wall prolapse. Adequate vaginal apical support is the key to the operation of severe POP. The apical reduction can correct 50% of the anterior vaginal wall prolapse and 30% of the posterior vaginal wall prolapse[15].

Patients with POP often have multiple anatomical defects at the same time, so it is necessary to make a comprehensive evaluation before the operation to determine the location and degree of the defect and to select one or more classical surgical procedures to repair the defective tissue.

Sacrum fixation has always been considered the gold standard for the treatment of apical prolapse. However, in laparoscopic sacral fixation, the important anatomical structures such as the sigmoid colon, right ureter, hypogastric nerve, and anterior sacral vein are very close. Complications associated with these important structures may lead to adverse consequences. At the same time, laparoscopic sacrum fixation is a technically difficult surgical method. In 2011, Banerjee reported that laparoscopic pectopexy was used to treat POP. The laparoscopic synthetic mesh was used to symmetrically fix the vaginal stump or cervix to the lateral part of the bilateral iliopubic ligament at the S2 level, to restore the prolapsed vaginal tip or cervix to the normal anatomical position, correct and repair the defects of the pelvic floor, and achieve good clinical results. At present, many studies have shown that laparoscopic pectopexy has similar anatomical effects as sacral fixation[16, 17], shorter operation time, and lower incidence of complications, which can be used as a new method for the treatment of pelvic defects.

In our study, laparoscopic pectopexy combined with native tissue repair has achieved good results in the treatment of moderate and severe pelvic prolapse.

The results of this study showed that the anatomical reduction achieved ideal results 3 months after the operation, and the indication points of POP-Q were basically in the normal range compared with those before the operation. In this study, there was no recurrence of vaginal apical prolapse in 49 patients after the operation, only one patient developed de novo stress urinary incontinence one month after the operation. Because multiple operations were performed at the same time to correct and improve the pelvic floor function, the minimum total operation time was 125 minutes and the maximum was 270 minutes.

The exposure rate of transvaginal mesh placement for POP surgery was 4%-19%[18, 19], while the incidence of complications associated with abdominal placement of mesh was low[20]. No mesh exposure associated with synthetic mesh was reported during laparoscopic pectopexy. In our study, the mesh was only used for the treatment of apical prolapse, and there was no additional mesh for cystocele and rectocele repair. No mesh-related exposure was observed after 1-year follow-up.

Defecation problems and de novo stress urinary incontinence ranging from 17–37% and 4–50%, respectively, are the most frequently reported complications associated with sacrocolpopexy[7, 21]. No bowel injury was caused by suturing the mesh to the lateral side of the bilateral iliopubic ligament at the S2 level, and there was no symptom of defecation disturbance during the follow-up in this study.

Hysterectomy is widely believed to be an independent risk factor for recurrent vaginal vault prolapse. The main reason is the destruction of the integrity and continuity of the supporting tissue, such as the pubocervical and rectovaginal fascia. Hysterectomy itself may not correct the underlying problem of insufficient apical support[22, 23]. Therefore, whether the uterus should be removed is controversial. In our study, uterine preservation surgery was performed on all patients. The advantage of preserving the uterus is to maintain pelvic anatomy, reduce complications related to hysterectomy, reduce intraoperative blood loss, shorten operation time and hospital stay, reduce mesh erosion rate and increase patients' self-confidence, and provide physical and psychological benefits for women.

The purpose of the treatment of pelvic organ prolapse is to restore the normal anatomical position of pelvic organs, improve organ function and improve the quality of life of patients. Studies have shown that laparoscopic pectopexy can improve the quality of life after operation[17, 24]. In this study, the PFIQ-7 and PFDI-20 scores were compared before and 3 months after the operation, and the quality of life of the patients was significantly improved after treatment.

During the average follow-up period of 15 months, for pelvic organ prolapse of grade 2 and grade 3 or above, the application of mesh for top-supported pectopexy combined with natural tissue repair produced good clinical results, which provided a new choice for the clinic to reduce the use of mesh.

In conclusion, laparoscopic pectopexy combined with natural tissue repair is a safe and effective treatment in apical prolapse surgery with low complication rates and a short duration of the operation. Prospective randomized trials will permit the evaluation of the potential benefits as a minimally invasive surgical approach.

Ethics and Consent Statement

Ethical approval was granted by the Medical Ethics Committee of Beijing Chao-Yang Hospital in accordance with the Declaration of Helsinki, and the written informed consent was obtained from each participant involved.

Author contributions

Pei Yu analyzed the data and wrote the paper; Chongdong Liu conceived and designed the experiments and revised the paper. All authors contributed to data analysis, drafting or revising the article, gave final approval of the version to be published, and agree to be accountable for all aspects of the work.

Conflicts of interest

The authors have no conflicts of interest.

Funding information

This research has not received any relevant financial support.

Weintraub AY, Glinter H, Marcus-Braun N (2020) Narrative review of the epidemiology, diagnosis and pathophysiology of pelvic organ prolapse. Int Braz J Urol 46(1):5–14. doi: 10.1590/S1677-5538.IBJU.2018.0581
Collins S, Lewicky-Gaupp C (2022) Pelvic Organ Prolapse. Gastroenterol Clin North Am 51(1):177–193. doi: 10.1016/j.gtc.2021.10.011
Smith FJ, Holman CDAJ, Moorin RE, Tsokos N (2010) Lifetime Risk of Undergoing Surgery for Pelvic Organ Prolapse. Obstet Gynecol 116(5):1096–1100. doi: 10.1097/AOG.0b013e3181f73729
Schimpf MO, Abed H, Sanses T, White AB, Lowenstein L, Ward RM et al (2016) Graft and Mesh Use in Transvaginal Prolapse Repair A Systematic Review. Obstet Gynecol 128(1):81–91. doi: 10.1097/aog.0000000000001451
Kowalski JT, Mehr A, Cohen E, Bradley CS (2018) Systematic review of definitions for success in pelvic organ prolapse surgery. Int Urogynecol J 29(11):1697–1704. doi: 10.1007/s00192-018-3755-7
Noe GK, Alkatout I, Schiermeier S, Soltecz S, Anapolski M (2019) Laparoscopic anterior and posterior native tissue repair: a new pelvic floor approach. Minim Invasive Therapy Allied Technol 28(4):241–246. doi: 10.1080/13645706.2018.1510420
Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J (2016) Surgery for women with apical vaginal prolapse. Cochrane Database Syst Rev 10(10):Cd012376. doi: 10.1002/14651858.Cd012376
Lee RK, Mottrie A, Payne CK, Waltregny D (2014) A review of the current status of laparoscopic and robot-assisted sacrocolpopexy for pelvic organ prolapse. Eur Urol 65(6):1128–1137. doi: 10.1016/j.eururo.2013.12.064
Banerjee C, Noé KG (2011) Laparoscopic pectopexy: a new technique of prolapse surgery for obese patients. Arch Gynecol Obstet 284(3):631–635. doi: 10.1007/s00404-010-1687-7
Al-Badr A (2013) Quality of Life Questionnaires for the Assessment of Pelvic Organ Prolapse: Use in Clinical Practice. Low Urin Tract Symptoms 5(3):121–128. doi: 10.1111/luts.12006
Luber KM, Boero S, Choe JY (2001) The demographics of pelvic floor disorders: Current observations and future projections. Am J Obstet Gynecol 184(7):1496–1503. doi: 10.1067/mob.2001.114868
Handa VL, Garrett E, Hendrix S, Gold E, Robbins J (2004) Progression and remission of pelvic organ prolapse: A longitudinal study of menopausal women. Am J Obstet Gynecol 190(1):27–32. doi: 10.1016/j.ajog.2003.07.017
Schiavi MC, Perniola G, Di Donato V, Visentin VS, Vena F, Di Pinto A et al (2017) Severe pelvic organ prolapse treated by vaginal native tissue repair: long-term analysis of outcomes in 146 patients. Arch Gynecol Obstet 295(4):917–922. doi: 10.1007/s00404-017-4307-y
Chmielewski L, Walters MD, Weber AM, Barber MD (2011) Reanalysis of a randomized trial of 3 techniques of anterior colporrhaphy using clinically relevant definitions of success. Am J Obstet Gynecol 205(1):69e1–69e8. doi: 10.1016/j.ajog.2011.03.027
Lowder JL, Park AJ, Ellison R, Ghetti C, Moalli P, Zyczynski H et al (2008) The role of apical vaginal support in the appearance of anterior and posterior vaginal prolapse. Obstet Gynecol 111(1):152–157. doi: 10.1097/01.AOG.0000297309.25091.a0
Biler A, Ertas IE, Tosun G, Hortu I, Turkay U, Gultekin OE et al (2018) Perioperative complications and short-term outcomes of abdominal sacrocolpopexy, laparoscopic sacrocolpopexy, and laparoscopic pectopexy for apical prolapse. Int Braz J Urol 44(5):996–1004. doi: 10.1590/S1677-5538.IBJU.2017.0692
Noe KG, Schiermeier S, Alkatout I, Anapolski M (2015) Laparoscopic pectopexy: a prospective, randomized, comparative clinical trial of standard laparoscopic sacral colpocervicopexy with the new laparoscopic pectopexy-postoperative results and intermediate-term follow-up in a pilot study. J Endourol 29(2):210–215. doi: 10.1089/end.2014.0413
Milani AL, Vollebregt A, Roovers JP, Withagen M (2013) [The use of mesh in vaginal prolapse]. Ned Tijdschr Geneeskd 157(31):A6324
Walter JE (2019) A comparison of the use of mesh to native tissue in the management of vaginal vault prolapse. Best Pract Res Clin Obstet Gynaecol 54:73–88. doi: 10.1016/j.bpobgyn.2018.11.006
Siddiqui NY, Grimes CL, Casiano ER, Abed HT, Jeppson PC, Olivera CK et al (2015) Mesh sacrocolpopexy compared with native tissue vaginal repair: a systematic review and meta-analysis. Obstet Gynecol 125(1):44–55. doi: 10.1097/aog.0000000000000570
El Hamamsy D, Fayyad AM (2015) New onset stress urinary incontinence following laparoscopic sacrocolpopexy and its relation to anatomical outcomes. Int Urogynecol J 26(7):1041–1045. doi: 10.1007/s00192-015-2641-9
Gutman R, Maher C (2013) Uterine-preserving POP surgery. Int Urogynecol J 24(11):1803–1813. doi: 10.1007/s00192-013-2171-2
Meriwether KV, Antosh DD, Olivera CK, Kim-Fine S, Balk EM, Murphy M et al (2018) Uterine preservation vs hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines. Am J Obstet Gynecol. ;219(2):129 – 46 e2. doi: 10.1016/j.ajog.2018.01.018
Tahaoglu AE, Bakir MS, Peker N, Bagli İ, Tayyar AT (2018) Modified laparoscopic pectopexy: short-term follow-up and its effects on sexual function and quality of life. Int Urogynecol J 29(8):1155–1160. doi: 10.1007/s00192-018-3565-y

Download PDF

Journal Publication

published 07 Mar, 2023

Read the published version in Archives of Gynecology and Obstetrics →

Reviewers agreed at journal
04 Dec, 2022
Reviewers invited by journal
07 Nov, 2022
Editor invited by journal
01 Nov, 2022
Editor assigned by journal
01 Nov, 2022
First submitted to journal
30 Oct, 2022

You are reading this latest preprint version

Laparoscopic pectopexy with native tissue repair for pelvic organ prolapse

Status:

Journal Publication

Version 1

Abstract

Purpose

Methods

Results

Conclusion

1. Introduction

2. Materials And Methods

2.1. Operative technique

2.2 Statistical analysis

3. Results

3.2 Comparison of quality of life scores

4. Discussion

Declarations

References

Status:

Journal Publication

Version 1