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Abstract

This study was undertaken for four purposes. The first was to further explore surgical correction rates for uterovaginal prolapse utilizing uterosacral ligaments. The second was to compare the efficacy of correction by this method via both transvaginal and laparoscopic routes. The third was to assess and compare postoperative quality of life issues between the two groups. Our last goal was to introduce the novel approach of laparoscopic uterine suspension in situ. One hundred sixty-three women were included in a retrospective cohort study. All women underwent surgical correction of their symptomatic vaginal or uterine prolapse utilizing uterosacral ligaments in conjunction with other pelvic reconstruction procedures between 1994 and 1998. Patients were examined to assess anatomic cure at least one year after surgery and sent a questionnaire to assess quality of life issues at least 6 months after surgery (range 6–48, mean 21 months). Further follow-up at 6–10 years was done and results are noted. Urogynecology and advanced pelvic surgery teaching hospital. One hundred sixty-three women with vaginal or uterine prolapse underwent pelvic reconstruction. Uterosacral ligament suspension was utilized for the correction of uterovaginal prolapse. This goal was accomplished either by laparoscopy or by vaginal approach. Surgical correction of Level I support was found on all patients in both groups. Surgical breakdown of Level II support necessitating additional surgery was found on 5% of both groups at the earlier review. Total immediate postoperative complications were similar in all groups, as was postoperative morbidity. There was no statistically significant difference between the groups with regards to both quality of life issues and perception of surgical success, with marked improvement in all groups. It is interesting to note that there was a statistically significant finding linking tobacco abuse with surgical failure. The 6–10 year data shows a fall-off of success to 91%. A complete statistical analysis of success with POPQ points and QOL evaluation will be presented. This study lends significant support to earlier work relating success of suspending the vaginal vault utilizing uterosacral ligaments. This study also indicates that vaginal vault suspension can be safely and effectively accomplished via both vaginal and laparoscopic routes, with effective in situ uterine suspension by laparoscopy. There is a fall-off of success associated with the site specific repairs with in situ patient’s fascial supports over time which may leave some room for use of graft materials. Patient satisfaction and marked improvement in quality of life result from correction of pelvic prolapse utilizing uterosacral ligaments.