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Laparoscopic Uterosacral Ligament Hysteropexy vs. Total Vaginal Hysterectomy with Uterosacral Ligament Suspension for Anterior and Apical Prolapse: Surgical Outcome and Patient Satisfaction.

Research paper by Rani Haj RH Yahya, Henry H HH Chill, Gabriel G Levin, Adi Reuveni AR Salzman, David D Shveiky

Indexed on: 26 Feb '19Published on: 26 Feb '19Published in: Journal of Minimally Invasive Gynecology



Abstract

To compare anatomical and clinical cure rates as well as patient satisfaction between uterine-preserving laparoscopic uterosacral ligament suspension and total vaginal hysterectomy with uterosacral ligament suspension in women with apical and anterior prolapse. Canadian task force classification II-2 SETTING: The study was conducted at a female pelvic medicine and reconstructive surgery service, part of a tertiary teaching hospital between July 2010 and December 2015. Women with pelvic organ prolapse who underwent surgical treatment for their condition. All women underwent laparoscopic uterosacral ligament suspension or total vaginal hysterectomy with uterosacral ligament suspension for apical and anterior prolapse. Concomitant procedures included anterior and posterior repair as well as mid-urethral sling when indicated. Pre-and post-operative POP-Q measurements were taken. Primary outcome was clinical cure rate. Secondary outcomes included anatomical cure rate and outcomes of site-specific POP-Q points Ba, C and Bp for the whole cohort. Patient satisfaction was measured by the Patient Global Impression of Improvement (PGI-I) questionnaire. During the study period, 106 women underwent trans-vaginal hysterectomy with uterosacral ligament suspension and 53 women had laparoscopic uterosacral ligament suspension. At a mean follow-up of 14.7(SD=13.23) months for the vaginal group and 17.5(SD=15.84) months for the laparoscopic group (P=0.29), there was a significant improvement of POP-Q points Ba, C and Bp (p<0.0001 for all comparisons, in both groups). Clinical cure rate was 96% in the vaginal group and 98% in the laparoscopic group (p=0.5). Anatomical cure rate was 85.4% in the vaginal group and 93.75% in the laparoscopic group (p=0.11) Patient satisfaction was measured to be high in both groups. In appropriately selected patients, laparoscopic uterosacral ligament suspension is a valid uterine preserving option for women with anterior and apical prolapse, with high anatomical and clinical cure rates and patient satisfaction. Copyright © 2019. Published by Elsevier Inc.