Cervical Elongation Among Patients Undergoing Vaginal Hysterectomy for Prolapse Versus Other Benign Indications [22H

Abstract

INTRODUCTION: Surgeons have cited anterior colpotomy as a barrier to performing vaginal hysterectomy (VH); cervical elongation (CE) may make this difficult. This study aims to understand CE and its significance among patients undergoing VH for pelvic organ prolapse (POP) versus those undergoing VH for other benign indications. METHODS: VH from 2015-2017 were identified through CPT codes. Study variables were obtained from operating room and pathology reports. CE was identified according to four definitions reported in three different studies. Twenty-three patients per study arm were estimated to be necessary to detect a statistically significant difference in CL >33.8mm between VH patients with versus without POP. RESULTS: Chart review yielded 217 cases. Number of included VH cases was 128. There were 51 VH for POP, and 77 VH for other indications. CE prevalence was higher among patients undergoing VH for POP based on uterine corpus to cervical length ratio (UC:CL) > 0.79 (25.5% versus 15.6%) and CL > 33.8mm (66.7% versus 51.9%). Other CE parameters demonstrated no statistically significant difference between groups. In regression analysis, postmenopausal status was not associated with CL > 3.38 (OR 0.138, 95% CI 0.02-0.941); and VH not for POP were more likely to have longer-than-average operating time (mean=210). CONCLUSION: CE was more prevalent in patients undergoing VH for POP compared to those having VH for other indications. CE was not associated with perioperative outcomes. These results refute existing literature regarding CE, particularly that CE may not be of consequence with regards to clinical outcomes during and after VH.