Apical Prolapse Surgical Treatment Outcomes: Transabdominal Versus Transvaginal Approach

Abstract

Objective: Apical prolapse is one of the most common acquired disorders among women, and its prevalence is increasing. This study was conducted to compare the results of transabdominal and transvaginal surgical approaches in the treatment of the disorder. Materials and Methods: This prospective interventional study was conducted among 62 patients with prolapse that all were in stage 2 and higher based on Pelvic Organ Prolapse Quantification staging system. Accordingly, 23 persons underwent transabdominal sacrocolpopexy approach and 39 patients underwent transvaginal sacrospinous ligament suspension surgery. All were evaluated in a 2-year follow-up period since 2014 to 2016, postoperatively, in terms of the rate of recovery, complications, and treatment failure. To investigate the subjective satisfaction, the questionnaires for Pelvic Floor Distress Inventory–20, Prolapse-Quality of Life, and Pelvic Organ Prolapse/Urinary Incontinence Sexual–12 were used. Results: In this study, feeling of vaginal mass protrusion (82%) was found as the most common complaint in apical prolapse, followed by urinary tract-illness (11%). The prevalence of short-term surgical complications was reported more than 34% among sacrocolpopexy group, while it was lower than 11% among patients who underwent trans-vaginal surgery (p < 0.05). However, feeling of recovery was not different between two groups (p = 0.23). Also, it was found that more than 26% of cases treated by transabdominal method would be exposed to long-term complications, compared to transvaginal (6.1%), postoperatively (p < 0.05). Conclusions: This study recommends transvaginal sacrospinous ligament suspension approach compared to trans-abdominal sacrocolpopexy for patients who are candidates for apical prolapse surgical treatment due to lower short-term and long-term complications. (J GYNECOL SURG 34:68)