To investigate the clinical efficacy and safety of laparoscopic uterine suspension and fixation to anterior sheath of rectus abdominis in the treatment of pelvic organ prolapse (POP).

From October 1, 2014 to January 31, 2017, a total of 21 POP patients who received laparoscopic uterine suspension and fixation to anterior sheath of rectus abdominis were included into study group. Meanwhile, another 21 POP patients who received vaginal hysterectomy and vaginal wall repair surgery were included into control group. Patients of both two groups were admitted to Heping County People′s Hospital and First Affiliated Hospital of Jinan University. The degree of POP was assessed by the pelvic organ prolapse quantification (POP-Q), and 5 indicators of Aa, Ba, Ap, Bp and C points of the POP-Q scoring system were measured before the operation of two groups and at the 4th day after operation of study group. The operation duration, intraoperative blood loss and hospital stay between two groups were compared by independent-samples t test. Five indicators of Aa, Ba, Ap, Bp and C points of the POP-Q scoring system were measured by paired-samples t test. The constituent ratio of POP-Q degrees of uterine prolapse, anterior vaginal wall prolapse and posterior vaginal wall prolapse were compared by Wilcoxon rank sum test. The objective recurrence rates between two groups were detected by Fisher exact test. The study protocol was approved by the Ethnical Review Board of Investigation in Human Beings of Heping County People′s Hospital and First Affiliated Hospital of Jinan University. Informed consent was obtained from each participant.

① There were no significant differences between two groups in general clinical characteristics such as age, parity, menopause duration and body mass index (BMI) (P>0.05). ② There were no significant differences between two groups in constituent ratio of POP-Q degrees of uterine prolapse, anterior vaginal wall prolapse and posterior vaginal wall prolapse (P>0.05). ③ The operation duration in study group was (76.7±15.6)min, which was significant shorter than (123.8±17.9) min in control group, intraoperative blood loss in study group was (37.9±6.4) mL, which was significant less than (138.8±28.9) mL in control group, hospital stay in study group was (6.3±2.8) d, which was significant shorter than (9.4±3.8) d, and all the above differences were statistically significant (t=-8.654, P<0.001; t=-14.150, P<0.001; t=-2.452, P=0.023). ④ The results of POP-Q scoring system in study group before the operation and at the 4th day after the operation were as follows. Point Aa (point in the anterior vaginal wall, 3 cm from hymen) were located at (-0.5±1.3) cm and (-2.3±0.5) cm, point Ba (point in the anterior vaginal prolapse) were located at (2.1±1.6) cm and (1.9±0.4)cm, point Ap (point in the posterior vaginal wall, 3 cm from hymen) were located at (-1.1±1.3) cm and (-2.8±0.3) cm, point Bp (point in the posterior vaginal prolapse, farthest from hymen) were located at (0.3±1.8) cm and (-2.6±0.4) cm, point C (point in the anterior fornix of vagina or vaginal stump) were located at (3.6±1.7) cm and (-7.7±0.6) cm, respectively; and all the differences between two groups were statistically significant (t=12.408, 14.791, 6.355, 8.820, 28.302; P<0.001). ⑤ The objective recurrence rates of two groups were 33.3% (7/21) and 23.5% (4/17), and the difference between them was not statistically significant (P=0.167).

The surgery of laparoscopic uterine suspension and fixation to anterior sheath of rectus abdominis is a safe and effective approach for the treatment of POP. Compared with traditional operation, it has obvious advantages in the aspects of operation duration, intraoperative blood loss and postoperative hospital stay, but the long-term complications remain to be followed up.