Doit-on réaliser systématiquement une hystérectomie subtotale dans le cadre d’une promontofixation cœlioscopique ?

Abstract

ObjectiveTo evaluate the place of subtotal hysterectomy during laparoscopic sacrocolpopexy. MethodsThis retrospective observational study includes patients undergoing laparoscopic sacrocolpopexy between November 2010 and March 2015 at the Centre Hospitalier Régional de la Citadelle, Liège, Belgium. Patient characteristics, medical and surgical history were collected. Clinical data, operative and intraoperative complications were analyzed. The postoperative results were collected at 6 weeks, 4 months and then every year with a clinical and anatomical evaluation by POP-Q (Pelvic Organ Prolapse - Quantification). ResultsNinety-four patients were included in the study. Sixty-four patients (68.1%) underwent sacrocolpopexy with subtotal hysterectomy, 12 patients (12.7%) had sacrocolpopexy with uterine preservation, 16 patients (17%) had a clinical history of hysterectomy and 2 patients (2.2%) have had sacrocolpopexy with total hysterectomy. The mean age of the patients was 61±20 years, parity 2±2 and BMI 25.2±7.32. The objective success rate, defined by a stage of POP-Q<2, was 93.75% in the sacrocolpopexy group with subtotal hysterectomy vs. 66.7% in the sacrocolpopexy group with uterine preservation (P=0.019). The subjective success rates were 98.4% and 83% respectively (P=0.063ns). ConclusionSacrocolpopexy offers good anatomical results, with better objective and subjective success rates when associated with a subtotal hysterectomy. The decision of hysterectomy should consider the risk/benefit balance and the patient's preferences.