Similar outcomes from A-repair vs paravaginal repair reported

Similar outcomes from A-repair vs paravaginal repair reported | Image Credit: © valiantsin - © valiantsin - stock.adobe.com.

Anterior vaginal wall repair (A-repair) and paravaginal repair (PVR) for laparoscopic pelvic organ prolapse (POP) surgeries have similar outcomes at 1 to 2 months, 3 to 6 months, and 1 year postoperatively, according to a recent study published in Tzu Chi Medical Journal.¹

POP presents in approximately 3% to 6% of female patients based on symptoms and 50% based on vaginal examination. Rates will continue to rise as the aging population increases, leading to adverse impacts on patients’ quality of life.

An anterior vaginal defect is the most common form of POP, leading to symptoms such as a lump in the pubic area, voiding difficulties, and incontinence. A-repair is often employed to treat this condition through a minimally invasive approach.²

PVR may also be used to manage anterior vaginal defects.¹ However, data has indicated a potential need for anterior colporrhaphy after PVR to reduce the risk of recurrence, and the differences in surgical outcomes compared to A-repair are unclear.

Investigators conducted a study to compare surgical outcomes of A-repair vs PVR. Women aged 20 to 80 years receiving laparoscopic colpopexy, hysteropexy, or cervicopexy for POP at the participating hospital between May 1, 2013, and May 31, 2022, were eligible for inclusion. Those without A-repair or PVR were excluded from the analysis.

Individual patient characteristics, anatomical considerations, and surgeon’s preference were considered when deciding to perform A-repair or PVR. When deciding which treatment method to perform, relevant factors included specific anatomical defects, vaginal wall relaxations, and the presence of lateral defects.

A-repair was usually employed when prioritizing fixing defects in the anterior vaginal wall, and often involved plication or reconstruction of the anterior vaginal wall. PVR was usually employed when prioritizing repairs of the attachments of the vagina to the pelvic sidewall, and often involved reattaching the vagina to its original position.

Relevant demographic data included age, parity, prior hysterectomy, menopausal status, diabetes mellitus, and hypertension. Surgical characteristics included hospital stay, blood loss, and surgical time.

Pelvic support was measured using the Pelvic Organ Prolapse Quantification (POP-Q) system, with POP-Q scores of the anterior compartment at 1 to 2 months, 3 to 6 months, and 1 year after surgery reported as the primary outcome. POPQ under stage 2 defined postoperative success.

There were 33 patients included in the final analysis, 23 of whom received A-repair and 10 received PVR. The patients were aged a mean 62.48 ± 10.36 and 66.9 ± 8.12 years, respectively, and had mean body mass indexes of 24.2 ± 4.80 and 24.2 ± 1.76, respectively. Vaginal delivery was reported by all patients.

Other than a higher previous hysterectomy rate in the PVR group, baseline characteristics did not significantly differ between groups. The primary procedure in the A-repair group was colpopexy and hysteropexy with a rate of 95.7%, vs cervicopexy in the PVR group with a rate of 80%. Surgical characteristics did not significantly differ between groups.

POP-Q scores included Aa, Ba, and total vaginal length. The A-repair and PVR groups both had significantly improved Aa and Ba scores at 1 to 2 months and 3 to 6 months postoperatively, but the PVR group did not have significant improvement in Aa and Ba scores at 1 year postoperatively. No significant differences between group analyses were observed.

A 100% postoperative success rate was reported in both groups at 1 to 2 months postoperatively. At 3 to 6 months postoperatively, success rates were 88.8% in the A-repair group and 100% in the PVR group. Both groups had success rates of 100% at 12 months postoperatively.

These results indicated similar postoperative surgical outcomes between A-repair and PVR for treating POP. Investigators recommended further large-scale trials and long-term outcomes to confirm these results.

References

1. Chen PC, Tsui WL, Ding DC. Comparison of the surgical outcomes between paravaginal repair and anterior colporrhaphy: A retrospective case-control study. Tzu Chi Med J. 2024;36(4):412-417. doi:10.4103/tcmj.tcmj_237_23
2. Maher C, Feiner B, Baessler K, Christmann-Schmid C, Haya N, Brown J. Surgery for women with anterior compartment prolapse. Cochrane Database Syst Rev. 2016;11.