Outcome of Laparoscopic versus Vaginal Uterosacral Ligament Vault Suspension at the Time of Hysterectomy.

Abstract

Introduction: A total laparoscopic hysterectomy for pelvic organ prolapse may be beneficial when bilateral salpingo-oophorectomy (BSO) is indicated or preferred. Addressing the apical compartment of prolapse is important. Objective(s): The aim of this study is to compare laparoscopic and vaginal uterosacral ligament suspension when performed at the time of hysterectomy. Method(s): A retrospective cohort study of laparoscopic (LH) and vaginal hysterectomy (VH) with uterosacral ligament suspensions (USLS) was performed over a 3-year period for pelvic organ prolapse. Vaginal USLS were performed bilaterally using a mixture of delayed absorbable and permanent sutures. Laparoscopic USLS were performed with a delayed absorbable barbed suture to the right and left USL after the closure of the vaginal vault. The primary outcomes were vaginal bulge symptoms, anatomical recurrence, measured as any pelvic organ prolapse past the hymen, and retreatment with surgery or pessary. Women were followed up at 6 and 12 months and beyond. Result(s): Between 2019 and 2021 a review was conducted of 55 vaginal hysterectomy and high bilateral suture uterosacral vault suspension procedures and 56 laparoscopic hysterectomy, BSO or salpingectomy and laparoscopic uterosacral vault suspension procedures. Both groups had similar demographics in terms of age, BMI, and parity. At 12 months or more, 92 % in the VH group and 44 % of the LH group reported no symptoms of prolapse, 84% vs 59% had no anatomical recurrence and 0% vs 37% had retreatment. Binomial logistic regression was performed to ascertain the effects of age, menopausal status, pre-operative apical stage and the type of procedure on the likelihood that participants had any prolapse >0 and the likelihood of symptomatic prolapse at 12 months. Only the laparoscopic procedure contributed to the likelihood of prolapse >0 and the likelihood of symptomatic prolapse. Conclusion(s): In this series, vaginal uterosacral ligament suspension at 12 months or longer did better than laparoscopic uterosacral ligament suspension (USLS). In the laparoscopic group, there were more apical and anterior vaginal wall failures. This has resulted in a change in practice such as adding/using a non -absorbable suture leading to further evaluation.