Trial Lecture - time and place
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Adjudication committee
- 1st opponent: Associate Professor Tomi Mikkola, Helsinki University Hospital
- 2nd opponent: Associate Professor Niels Klarskov, University of Copenhagen
- Committee Chair: Adjunct Professor Marie Ellström Engh, University of Oslo
Chair of the Defence
Adjunct Professor Anne Flem Jacobsen
Principal Supervisor
Dr. Rune Svenningsen
Summary
A woman´s lifetime risk of surgery for Pelvic Organ Prolapse (POP) is estimated to 6-18%, and postoperative recurrence rates have been reported as high as 30%. Some studies have indicated that women with POP, who during previous vaginal childbirth have suffered avulsions of the levator ani muscle (LAM), are especially prone to POP recurrence.
The aims of this thesis, performed at the Department of Gynecology at Oslo University Hospital, were therefore to investigate long-term recurrence risks as well as one-year anatomical and subjective outcomes in women treated with native tissue POP repairs, focusing on the Manchester Procedure, a “complete” (three vaginal compartment) repair preserving the uterus. We also wanted to estimate the prevalence of LAM avulsions and their potential impact on baseline data and postoperative outcomes.
Two cohorts were analyzed; A historical cohort of women treated at our Department with native tissue POP repairs from 2002 to 2005 (n=699) and a prospective cohort of 204 women planned for a Manchester procedure taking place between October 2014 and January 2018.
This thesis finds that native tissue POP surgery comprises low long-term recurrence rates, significantly lower after the Manchester Procedure (2.8%) compared to partial (one or two compartment) repairs (8.9%) (p<0.01). Satisfactory anatomical outcomes were obtained, in particular after the Manchester Procedure compared to partial repairs (86.7 vs.78.3%) (p=0.02).
Subjective outcomes at one-year follow-up were over-all excellent, 95% were subjectively satisfied after the Manchester Procedure. LAM avulsions were highly prevalent, identified in 50%, but were not associated with preoperative symptom load or postoperative outcomes (anatomical or subjective).
Consequently, women with POP can be treated properly using native tissue repair techniques regardless of the integrity of the LAM, especially when procedures involving all three compartments, such as the Manchester Procedure, are used.
Additional information
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