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A new laparoscopic retroperitoneal posterior culdoplasty technique.

OBJECTIVE
To test the hypothesis that laparoscopic retroperitoneal culdoplasty executed with a CO2 laser is comparable to the same operation performed with mechanical laparoscopic instruments and to extend a previously reported series of laparoscopic posterior culdoplasties.


STUDY DESIGN
A prospective, cohort, comparison, clinical study was conducted to determine relative risk on 30 subjects who met inclusion criteria for this trial. Group I patients (n = 15) were subjected to laparoscopic culdoplasty with a CO2 laser, group II subjects (n = 15) were exposed to the same intervention with 5-mm laparoscopic mechanical instruments. Both groups were observed for intraoperative, immediate postoperative and delayed complications. During the postoperative follow-up period, the following parameters were recorded: dyschesia, dyspareunia, sexual dysfunction, pelvic pain (preoperative and postoperative rating scale for pain used).


RESULTS
There was no significant difference in clinical and demographic data between the two groups. All planned laparoscopic culdoplasties for symptomatic enterocele were successfully carried out, with no conversions to laparotomy or vaginal surgery. In group I, average operating time was 1 hour, 11 minures, and in group II it averaged 47 minutes (P = .03). There were no intraoperative complications or blood transfusions. During the early recovery period, 26% in group I vs. 6% in group II (P = .04) reported transitional urine retention. Two of those patients from group I developed symptoms of lower urinary tract infections. In group I, one patient (3%) (P = .10) developed a recurrence of enterocele, grade 2. In group II, one patient (3%) (P = .10) experienced difficulty during sexual intercourse following laparoscopic culdoplasty. In all patients but two, symptoms of dyschesia, dyspareunia and sexual dysfunction related to anatomy distortion and pelvic pain were cured.


CONCLUSION
Laparoscopic retroperitoneal posterior culdoplasty executed with mechanical instruments yielded a clinical outcome similar to that of surgery performed with a CO2 laser. The operative time was statistically significantly longer when the operation was performed with a laser. Using a laser increases the potential for complications associated with the laser itself and increases the cost of the operation. Ninety-three percent of patients remained symptom free after surgery.