評論：對於骨盆腔器官脫垂的患者，腹部微創薦骨陰道固定手術已經成為標準治療，在手術過程中會使用人工網膜將陰道懸吊起來，雖然手術可以有效治療骨盆腔脫垂，但是手術後和網膜相關的併發症也可能反而會造成病人的不適，更甚者反倒會嚴重影響病人的生活品質。和網膜相關的併發症包含慢性骨盆腔疼痛、性交疼痛、陰道網膜暴露或侵蝕、甚至是排尿或排便功能障礙。也因此，如何降低網膜相關的併發症是許多醫師極力研究的項目之一。

然而過往的研究數量有限，且研究結果並無確切的結論。因此本篇研究目的是希望能透過針對12189位女性患者的研究，能提供更有效的研究結果。此研究在美國加州統計了於2012至2018年接受腹部微創薦骨陰道固定手術的女性患者，12189位當中共有8398位患者在手術中同時進行了子宮切除。8398位患者中有5027位是採用子宮全切除，3371位患者則是採用子宮次全切除(保留子宮頸)。

研究結果顯示在子宮次全切除的患者，因網膜相關併發症而再次手術的機率顯著性的較低，子宮次全切除的患者在經過平均1111天的追蹤，再手術率為0.7%，而子宮全切除的患者在經過平均1095天的追蹤，再手術率為3.1%。即使是先進行子宮全切除，之後再擇期接受腹部微創薦骨陰道固定手術，網膜相關併發症的機率仍然是比同時進行子宮次全切除的患者要高。

也因此本篇研究得到的結論為：子宮次全切除手術在腹部微創薦骨陰道固定手術中為網膜相關併發症的保護因子。

當然在手術前患者應和醫師詳細的討論手術效果、是否適合自己，及理解術後可能的併發症以及處理方式，再決定是否要接受手術。

Purpose: Although minimally invasive (robotic or laparoscopic) abdominal sacrocolpopexy (MISC) has become the new gold standard for durable pelvic organ prolapse repair after the vaginal mesh controversy, current literature is limited. Our objective was to study reoperation for mesh complications after MISC.

Materials and methods: All women undergoing MISC in California from January 2012 to December 2018 were identified from Office of Statewide Health Planning and Development data sets using appropriate ICD-9/10 (International Classification of Diseases 9th/10th Revision) and CPT® (Current Procedural Terminology) codes. Univariate and multivariable analyses were performed to assess associations between patient demographics, surgical details and our primary outcomes: rates of reoperation for a mesh complication.

Results: Of 12,189 women undergoing MISC 8,398 (68.9%) had concomitant hysterectomy. Total hysterectomy (TH) and supracervical hysterectomy (SCH) were performed in 5,027 (41.2%) and 3,371 (27.6%) cases, respectively. Reoperation rates for mesh complications were lower after SCH vs TH (overall: 0.7%, mean followup time 1,111 days vs 3.1%, mean followup time 1,095 days, p <0.001; subcohort with at least 4 years of followup: 2.1% vs 8.9%, p <0.001). Additionally, mesh complication rates were higher even if TH was performed remotely, as compared to concomitant SCH (5.2% vs 0.7%, p <0.001). The increased risk for reoperation due to mesh complications after TH was preserved on multivariable analysis (OR 4.20, 95% CI 2.72‒6.50, p <0.001).

Conclusions: Concomitant TH at time of MISC is associated with a significantly higher rate of mesh complication as compared to SCH. The increased risk of a mesh complication associated with TH is present even if the TH was performed prior to the MISC.

Keywords: pelvic organ prolapse; robotic surgical procedures; surgical mesh; treatment outcome; uterine prolapse.