Comparison between laparoscopic sacral hysteropexy and subtotal hysterectomy plus cervicopexy in pelvic organ prolapse: A pilot study

Meritxell Gracia, Maria Perelló, Eduardo Bataller, Montserrat Espuña, Montserrat Parellada, Dolores Genís, Joan Balasch, Francisco Carmona
Neurourology and Urodynamics 2015, 34 (7): 654-8

AIMS: The primary outcome was to evaluate the subjective success rates of two laparoscopic POP operation techniques: uterine-sparing surgery versus a subtotal hysterectomy plus cervicopexy.

METHODS: Prospective cohort of 45 women with symptomatic POP recruited between January and December 2010 who self-selected surgery group: group A (n = 15), sacral laparoscopic hysteropexy was performed and group B (n = 30), laparoscopically conducted subtotal hysterectomy plus cervicopexy. All patients had a positive answer in the "Epidemiology of prolapse and incontinence" questionnaire (EPIQ, question number 35) and also had a POPQ ≥2nd degree. The primary outcome was the subjective success rate, measured by a negative answer to the Q35 of EPIQ: "Do you have a sensation that there is bulge in vagina or that something is falling out from your vagina" and also by rating their symptoms improvement by the "Patient Global Impression of Improvement". The secondary outcome was the objective success rate assessed by pelvic examination: cure was considered when POPQ <2nd degree in all vaginal compartments at 6 and 12 months.

RESULTS: Baseline demographic characteristics were similar between groups. Subjective success rate was significantly superior in group B both after 6 and 12 months (P = 0.001). Similarly, objective pelvic examination led to a significantly higher rate of successful apical outcome in group B after 6 and 12 months (P = 0.009 and P = 0.002, respectively). Neither major complications nor vaginal mesh erosions were registered.

CONCLUSIONS: The overall success rate was significantly higher in the laparoscopic subtotal hysterectomy plus cervicopexy group, compared with the laparoscopic sacral hysteropexy group.

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