85: Vaginal versus laparoscopic uterosacral ligament suspension: Does approach matter?

Abstract

The primary aim of this study is to compare the 6 month anatomic outcomes in women who underwent vaginal uterosacral ligament suspension (vUSLS) with women who had a laparoscopic uterosacral suspension (lUSLS). Secondarily, we compared perioperative complications between both approaches. IRB approval was obtained to conduct this retrospective cohort study of women who underwent a vUSLS or lUSLS at a single institution between January 1, 2013 and December 2015. The primary outcomes were the POPQ C and Aa points 6 months after surgery. Patient demographics, preoperative POPQ exams, baseline PFDI scores, surgical data, postoperative voiding function and postoperative POPQ examination were recorded from the electronic medical record. During the 3-year study period, 96 women underwent uterosacral apical suspension. Four had incomplete records and were excluded. Of the remaining 92 women, 64 (70%) underwent a vUSLS and 28 (30%) underwent a lUSLS. The mean age was lower in the lUSLS group compared to the vUSLS group (48.9 ± 13.3 years vs 61.4 ± 12.2 years, respectively, p = < 0.0001). More women in the lUSLS group were African American than in the vUSLS group (50% vs 23%, respectively, p = 0.039). Those in the lUSLS group had a lower comorbidity burden as measured by the age-adjusted Charlson Comorbidity Index (ACCI 1.68 ± 1.47 vs 3.25 ± 1.75, p < 0.0001). The average BMI in this study was 29.6 ± 6.52kg/m2, with no statistical difference between the 2 groups (p = 0.29). There was no significant difference in preoperative POPQ point C and TVL between the groups (p = 0.34 and 0.64, respectively). The lUSLS group had a lower POPQ Aa compared to the vUSLS group (-0.09 ± 1.19 vs 0.83 ± 1.77, respectively, p = 0.13). The average PFDI-20 score was 108.49 ± 51.51 and was similar between groups (p = 0.07). There were no significant differences in postoperative voiding dysfunction or other postoperative complications (p = 0.11 and 0.42, respectively). At 6 months, all women had point C ≤ -TVL/2. Multivariate linear regression models were developed to control for potential confounders, including operative approach of USLS. After controlling for age, parity, BMI, preop TVL and C points, concomitant procedures, and hysterectomy, the lUSLS group had a statistically more proximal C point at six months compared to vUSLS (p = 0.01). In a separate model controlling for preoperative Aa, point Aa was not significantly different at 6 months regardless of the USLS approach. Although operative times were similar among surgical groups, EBL was significantly lower in the lUSLS group compared to vUSLS (121.43 ± 75.68ml vs 184 ± 103.81ml, respectively, p = 0.002). After controlling for hysterectomy, concomitant procedures, operative time, and ACCI, EBL remained significantly lower in the lUSLS group (p = 0.001). This study suggests that lUSLS may be associated with an improved postoperative apical point C at 6 months. EBL was significantly higher in the vUSLS group, but there were no other differences in postoperative complications. A larger prospective study is needed to determine if lUSLS is associated with improved postoperative subjective and anatomical outcomes.