34: Unilateral sacrospinous ligament hysteropexy: a single-center experience

Abstract

The primary objective of this study was to describe our experience with unilateral sacrospinous ligament hysteropexy (SSLH) performed via an incision through the anterior vaginal wall for treatment of uterovaginal prolapse. Additionally, we sought to identify factors associated with symptomatic recurrence. An IRB approved retrospective chart review was performed identifying women who underwent SSLH (CPT code 57282) from January 2013 to March 2017 performed at the University of Rochester Medical Center. Subjects were excluded if graft augmentation was used, they had a prior hysterectomy, or if bilateral suspension was performed. Demographics, comorbidities, and perioperative data were extracted from the electronic medical records. Descriptive statistics were performed and data were compared between subjects who felt their prolapse symptoms were resolved and those who felt they recurred using t test, Wilcoxon rank sum test, chi-square test, or fisher exact test as appropriate. The cohort (n = 59) consisted of predominantly white (93%), non-smoking (54%), post-menopausal women (92%) with private insurance (59%). Median age was 63 years (range, 43 – 80 years), median body mass index (BMI) was 26.8 kg/m2 (range, 18.9 – 43.1 kg/m2), and median pelvic organ prolapse quantification (POPQ) stage was 3 (range, 2 – 3) at the time of surgery. The median operative time was 80 mins (IQR: 67, 94.5 mins) including concomitant anterior (n = 49), enterocele (n = 1), and/or posterior repairs (n = 12). Concomitant retropubic sling was performed in 3 subjects. Median estimated blood loss (EBL) was 50 mL (IQR: 25, 50 mL) and median time in the post-anesthesia care unit (PACU) was 72 min (IQR: 57, 101 mins). The average milligram morphine equivalents (MME) administered in PACU was 2.1 ± 3.1 MME. Most women (81%) were discharged home on the day of surgery. We observed a recurrence rate of 25.4% which was not significantly associated with surgeon (p = 0.23), subject’s age (p = 0.51) or BMI (p = 0.56), EBL (p = 0.99), operative time (p = 0.80), number of vaginal deliveries (p = 0.71), use of permanent and/or absorbable sutures (p = 0.21), prior vaginal surgery (p = 0.15), or pre-operative POPQ stage (p = 0.73). Post-operative complications included urinary retention (n = 2), de novo stress urinary incontinence (n = 2), and urinary tract infection (n = 4). Nineteen subjects admitted to buttock pain in the first week after surgery, 4 requested additional narcotic medication, and 1 had a suture release due to persistent pain. Unilateral sacrospinous ligament hysteropexy is a well-tolerated treatment option for uterovaginal prolapse. The suspension is an efficient and effective procedure when performed through the anterior vaginal wall with a low incidence of complications and a recurrence rate of 25%.