71 Laparoscopic sacrocolpopexy and laparoscopic uterosacral ligament suspension: Operative outcomes and recurrence rate

Abstract

Laparoscopic sacrocolpopexy (LSC) has been shown to have a 5-year re-operation rate of 3.5% for apical pelvic organ prolapse (Sarlos et al). Some patients desire mesh-free repair due to concerns about mesh complications. Laparoscopic uterosacral ligament suspension (L-USLS) is one approach to repair apical pelvic organ prolapse and does not involve mesh. We present our institutional outcomes and recurrence rate for LSC and L-USLS. Our primary objective is to the operative outcomes between LSC and USLS (estimated blood loss, operative time, and length of hospitalization). Our secondary objective is the rate of perioperative complications and rate of symptomatic recurrent prolapse. This was a retrospective chart review of 255 women who underwent LSC or L-USLS at one institution between 3/2017 and 8/2019 for apical pelvic organ prolapse. Patient demographics, surgical data, complications, and post-operative follow up data were abstracted. Student’s t-test and Chi-squared test were used as appropriate. In total, 142 women underwent LSC and 113 women underwent L-USLS. Women in the LSC group were older (65 vs 59 years old, P< 0.01) and were more likely to have a prior hysterectomy (75% vs 11%, P< 0.01) or prior pelvic organ prolapse repair (30% vs 8, P< 0.01). Baseline POP-Q (Pelvic organ prolapse quantification) Stage were similar between groups. Women in the L-USLS group were more likely to undergo hysterectomy (88% vs 25%, P< 0.01) and posterior repair (45% vs 18%, P< 0.01). Estimated blood loss (EBL) was lower in the LSC group (56 mL vs 120 mL, P< 0.01), and operative time was longer in the LSC group (158 min vs 142 min, P< 0.01). Length of hospitalization was similar between the groups; patients were discharged on POD 0 or 1 in 92% of the L-USLS group and 97% of LSC group. The rate of perioperative complications between L-USLS and LSC was similar (7% vs 6%, P=0.81). In addition, urinary retention requiring discharge with a catheter was similar between the groups (24% vs 26%, P=0.69). Mesh erosion occurred in one patient in the LSC group. Pelvic pain was reported by 1 patient in the L-USLS group and 6 patients in the LSC group. One patient in the LSC group required takedown of sacrocolpopexy mesh due to persistent pain. The mean follow up was 23 weeks (range 0-33 months). Symptomatic recurrent prolapse of any compartment, which was defined as patient report of bulge symptoms or re-operation, occurred in 7 patients in the L-USLS group and 11 patients in the LSC group (6% vs 7%, P=0.63). Symptomatic apical pelvic organ prolapse occurred in 5 patients in the L-USLS group and 3 patients in the LSC group. In our cohort, LSC was associated with decreased blood loss and increased operative time compared to L-USLS. There was no difference in length of stay, perioperative complications, or recurrence rate between the groups