Laparoscopic Uterosacral Ligament Suspension for the Prevention of Uterovaginal Prolapse Associated with Burch Colposuspension

Abstract

Study Objective: To assess the surgical outcomes and postoperative quality of life of concurrent laparoscopic uterosacral ligament suspension (LUSLS) and Laparoscopic Burch Colposuspension (LBC) and evaluate if the addition of LUSLS to LBC could prevent recurrent uterovaginal prolapse.Design: Retrospective chart review of 70 patients who had LBC with prophylactic LUSLS by a single surgeon.Setting: Urban gynaecologic laparoscopy practice of single gynaecologist.Patients: Seventy (70) women undergoing laparoscopic Burch Colposuspension with uterosacral ligament suspension concurrently.11 patients (16%) had previously had a hysterectomy. These patients were then subdivided into an anterior group who had only anterior compartment surgery with BC and LUSLS with (16) and without (16) Total Laparoscopic Hysterectomy (TLH), and a posterior group containing patients who had additional posterior compartment surgery with (14) and without (24) TLH.Intervention: Laparoscopic Burch colposuspension and uterosacral ligament suspension procedures.Measurements and Main Results: Preoperative and postoperative (6wk, 12 month, 24 month and 36 month) POP- Q evaluations were performed by a single examiner and recorded. Pelvic Floor Distress Inventory-SF20 (PFD) was administered postoperatively. Six patients had subsequent surgery representing a reoperation rate of 8.5%. Significant complications occurred in 6 (8.5%) patients with 5 retropubic haematomas and 1 cystotomy associated with TLH. There were 2 (2.8%) reoperations in the anterior group; 0 with no TLH, 2 reoperations with TLH There were 4 (5.7%) reoperations in the posterior group with 2 in the no TLH group and 2 in the TLH group. Mean PFDI scores were low at 8.9 in the posterior group and 7.9 in the anterior group. There was no recurrence of stress incontinence in either group.Conclusion: Prophylactic LUSLS performed with LBC together with site specific repair at the primary surgery offers a very low reoperation rate and good postoperative quality of life. It does not appear to interfere with the proven success rate of LBC and is easy to perform. Study Objective: To assess the surgical outcomes and postoperative quality of life of concurrent laparoscopic uterosacral ligament suspension (LUSLS) and Laparoscopic Burch Colposuspension (LBC) and evaluate if the addition of LUSLS to LBC could prevent recurrent uterovaginal prolapse. Design: Retrospective chart review of 70 patients who had LBC with prophylactic LUSLS by a single surgeon. Setting: Urban gynaecologic laparoscopy practice of single gynaecologist. Patients: Seventy (70) women undergoing laparoscopic Burch Colposuspension with uterosacral ligament suspension concurrently.11 patients (16%) had previously had a hysterectomy. These patients were then subdivided into an anterior group who had only anterior compartment surgery with BC and LUSLS with (16) and without (16) Total Laparoscopic Hysterectomy (TLH), and a posterior group containing patients who had additional posterior compartment surgery with (14) and without (24) TLH. Intervention: Laparoscopic Burch colposuspension and uterosacral ligament suspension procedures. Measurements and Main Results: Preoperative and postoperative (6wk, 12 month, 24 month and 36 month) POP- Q evaluations were performed by a single examiner and recorded. Pelvic Floor Distress Inventory-SF20 (PFD) was administered postoperatively. Six patients had subsequent surgery representing a reoperation rate of 8.5%. Significant complications occurred in 6 (8.5%) patients with 5 retropubic haematomas and 1 cystotomy associated with TLH. There were 2 (2.8%) reoperations in the anterior group; 0 with no TLH, 2 reoperations with TLH There were 4 (5.7%) reoperations in the posterior group with 2 in the no TLH group and 2 in the TLH group. Mean PFDI scores were low at 8.9 in the posterior group and 7.9 in the anterior group. There was no recurrence of stress incontinence in either group. Conclusion: Prophylactic LUSLS performed with LBC together with site specific repair at the primary surgery offers a very low reoperation rate and good postoperative quality of life. It does not appear to interfere with the proven success rate of LBC and is easy to perform.