A comparison of modified laparoscopic uterine suspension and vaginal hysterectomy with sacrospinous ligament fixation for treating pelvic organ prolapse

摘要

Objectives: To compare the efficacy and adverse events between modified laparoscopic uterine suspension and vaginal hysterectomy and sacrospinous ligament fixation. Methods: The study reviewed the clinical data of 50 postmenopausal patients who underwent modified laparoscopic uterine suspension (the hysteropexy group) and 50 patients who underwent vaginal hysterectomy with sacrospinous ligament fixation (the hysterectomy group) conducted by the same group of surgeons (2018.1-2019.6) retrospectively. We compared the two groups’ baseline characteristics, perioperative details, complications, and POP-Q values before the operations and at 12 months after the operations. The effects on quality of life according to valid questionnaires (PFIQ-7 and PFDI-20) were compared. The patients were followed up for 12 months. Results: There were no significant differences in the perioperative details or baseline characteristics, except that more cases of concurrent vaginal wall (anterior and posterior) and concurrent perineal repair were observed in the hysteropexy group than in the hysterectomy group (9 versus 0, P =0.02; 33 versus 6, P 0.001). The anatomical measures of points Ba, Bp, and C ( P 0.001), and the quality of life measures (P 0.001 for PFIQ-7 and PFDI-20) after the operations exhibited significant improvements in the two groups. The total vaginal lengths (TVL) were dramatically decreased after the surgery in the hysterectomy group, but no differences were observed in the hysteropexy group. The two groups didn’t show a significant difference in the recurrence of prolapse anatomically or symptomatically, but a dramatically higher number of patients in the hysterectomy group were found to have experienced postoperative vaginal bleeding, excessive granulation tissue and right buttock pain. Conclusions: The postoperative outcomes, anatomical results, and improvement of function and symptoms of modified laparoscopic uterine suspension were similar to those of vaginal hysterectomy with sacrospinous ligament fixation. Moreover, modified laparoscopic uterine suspension had fewer postoperative complications, so it could be used as an additional choice for POP, although the long-term outcomes haven’t been determined yet.