The comparision of abdominal (open and laparoscopic) sacrocolpocopex/sacroservicopexy used in apical prolapse treatment and vaginal sacrospinous ligamentopexy operations to the effects of long term pelvic floor muscle strength

The aim of this study is to compare abdominal open, which is one of the treatment of apical prolapse treatment methods, and laparoscopic sacrocolpopexy / sacrocervicopexy operations and sacrospinous ligament operation that is added to vaginal hysterectomy operation and to show the perineometrik measured values as a subjective indicator of its long term effect on pelvic floor muscle strength ??. Primarily, the study was carried out at Abant İzzet baysal University Faculty of Medicine Obstetrics and Gynecology Department between January 2008 and January 2013 with 85 patients who had complaints about Uterine or vaginal vault prolapse. Those were approached by abdominal or vaginal way and sacrocolpopexy/sacrocervicopexy or sacrospinous ligament fixation was performed. During the long term observation process (6 months or more) of those patients, perineometric pressure measurements, as a subjective indicator of the pelvic floor muscle strength, were evaluated with femiscan device. In parients' pelvic examination, pelvic organ prolapse ratings staging (POP-Q), Urinary incontinence pad test, incontinence quality of life measure (IQoL), Pelvic Floor Distress Inventory-20, Pelvic Organ Prolapse/Urinary Incontinence Sexual Function Questionnaire (PISQ-12) results were secondarily evaluated. Descriptive and frequency analysis were performed between the two groups of patients. Statistical analysis of the patients after surgery was assessed using independent t-test, paired t-test and chi-square methods. In data analysis, statistical significance level was determined as p <0.05. Type and duration of operation, intraoperative and postoperative complications were recorded. It was found that there was not a significant difference in muscle strength between two groups. There was no difference in demographic characteristics between the two groups. Although there was no statistical difference between the groups in terms of operation time, a statistical difference was recorded between the operation time of abdominal open and laparoscopic group (p<0.05). Between the sacrocolpopexy and vaginal groups, statistically significant difference was stated in terms of operation time (p<0.05). Statistically significant difference was found in life quality questionnaires of both groups (p<0.05). Between Pelvic Floor Distress Inventory-20 (PFDI-20) questionnaire comparisons of groups, no significant difference was stated. When anterior compartment correction rates were considered, a signficant difference was recorded in abdominal group (p<0.05). There was no difference between the two groups in terms of pad test comparison. In both surgery the group for 6 months-4 years of follow-up the pelvic floor muscle strength effect did not reach significant difference.While the symptomatic improvement was identified as high and similar between the two groups, anatomical recovery was statistically higher in abdominal group. Anterior vaginal wall recurrence was higher in vaginal group, and it was observed that the anterior abdominal group fixed the anterior compartment better than anatomic axis. Keywords: Pelvic organ prolapse, Vaginal hysterectomy sacrospinous fixation, open and laparoscopic abdominal sacrocolpopexy or sacrocervicopexy.