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• W3008720919 abstract "Currently there are two techniques commonly used during mesh placement between the vagina and sacral promontories in a sacrocolpopexy. Non-tunneling is the complete incision of peritoneum from sacral promontory down to the vaginal apex. Tunneling, on the other hand, requires only two small incisions on the sacral promontory and vaginal apex followed by undermining of the peritoneum. We hypothesized that the autonomic innervation between the presacral area and pelvic side wall can be better preserved during the tunneling technique. The objective of this study was to compare the effect of tunneling vs non-tunneling mesh placement, and colorectal and POP related symptoms during robotic-assisted sacrocolpopexy (RASC). A single-institution, single-surgeon randomized clinical trial was performed from August 2016 to September 2017. Sixty patients were enrolled and randomized to 2 groups. All patients had a POP-Q examination and were asked to fill out a Pelvic Floor Disability Index (PFDI-20) questionnaire prior to the procedure and at 6 and 12 weeks postoperatively. The differences between the groups from pre-op to post-op assessments were calculated by Welch’s two-sample t-test. Twenty-eight patients completed the study (Figure 1). The average follow-up time was 8.7 weeks. There was no difference in baseline characteristics and surgery times (p=0.12) between the two groups. There were statistically significant differences between pre-op and post-op POP-Q stages and Pelvic Organ Prolapse Distress Inventory (POPDI-6) scores of patients for both groups. Improvement after the surgery was similar between the two groups (p=0.07). There also were statistically significant differences between the tunneling and non-tunneling groups in colorectal symptom scores based on the colorectal-anal distress inventory (CRAD-8) (p=0.026). Non-tunneling CRAD-8 scores declined by an average of 9.4 (p=.003) while tunneling scores declined by an average of 20.8 (p=.0002) (Table 1). Our study results suggest that the tunneling technique, when compared to the non-tunneling technique used during mesh placement of RSCP demonstrates a greater improvement in colorectal symptoms. Both groups demonstrated similar anatomic improvement of POP-Q stage and POPDI score. One potential explanation might be the better preservation of sympathetic innervation of pelvic organs during the tunneling technique. Further larger studies are warranted to explore our hypothesis.View Large Image Figure ViewerDownload Hi-res image Download (PPT)" @default.
• W3008720919 created "2020-03-06" @default.
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• W3008720919 date "2020-03-01" @default.
• W3008720919 modified "2023-10-14" @default.
• W3008720919 title "29: Effect of tunneling on colorectal and prolapse symptoms during sacrocolpopexy" @default.
• W3008720919 doi "https://doi.org/10.1016/j.ajog.2019.12.069" @default.
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