Comparison of Different Laparoscopic Sacropexy Procedures for Advanced Uterine Prolapse: A Retrospective Analysis

Abstract

To compare the long-term outcomes and complications of 3 different variants of laparoscopic sacropexy. Single-center retrospective cohort study. A tertiary university hospital. A total of 483 patients with advanced uterine prolapse who underwent laparoscopic sacrohysteropexy (LSH), laparoscopic supracervical hysterectomy with concomitant laparoscopic sacrocervicopexy (LSCH+LSC), or total laparoscopic hysterectomy with concomitant laparoscopic sacrocolpopexy (TLH+LSC). Demographic data, Pelvic Organ Prolapse Quantification scores, questionnaire results, surgical conditions, postoperative outcomes, and complications were all extracted from medical and follow-up records. Between April 2012 and December 2020, 277 women underwent LSH, 95 women underwent LSCH+LSC, and 111 women underwent TLH+LSC. LSH procedures were associated with statistically significantly least blood loss and least postoperative hospital days and catheterization days (all p <.001). During the median follow-up of 32 months (13-117 months), analysis of the data revealed notable anatomic correction in all groups regarding Pelvic Organ Prolapse Quantification measurements (p <.001), and the anatomic cure rate showed no significant difference among these 3 groups (p=.273). No statistically significant differences were detected for prolapse recurrence (p=.171) and functional improvements among these groups. Neither intraoperative injuries (p=.098) nor total postoperative complications (p=.218) differed considerably, whereas the rate of severe postoperative complications (p <.001) including mesh exposure (p=.004) was significantly higher in the TLH+LSC group than that in the other groups. LSH is the appropriate choice for women with uterine prolapse without contraindications for uterine preservation. For patients with benign uterine lesions and a normal cervix, LSCH+LSC is a safer approach that provides similar anatomic results and improved quality of life scores that are similar to those of TLH+LSC. For patients with lesions in the uterus and cervix, TLH+LSC should be selected.