Should we add unilateral sacrospinous ligament fixation to vaginal hysterectomy in management of stage 3 and stage 4 pelvic organ prolapse?

Elif Ağaçayak,Yasemin Ceter,Sibel Sak,Senem Yaman Tunç,Gamze Akın,Fatih Mehmet Fındık,Talip Gül,Serdar Başaranoğlu,Mehmet Sait İçen

doi:10.4274/tjod.93546

Abstract

Objective:To compare ‘‘vaginal hysterectomy alone’’ with ‘‘vaginal hysterectomy with prophylactic unilateral sacrospinous ligament fixation’’ in terms of intraoperative complications and 1-year anatomic outcomes and symptoms in patients aged over 50 years who presented with stage 3 or 4 pelvic organ prolapse (POP).Materials and Methods:Thirty-five patients underwent vaginal hysterectomy alone and 32 patients underwent vaginal hysterectomy with unilateral sacrospinous ligament fixation because of benign pathology between January 2012, and June 2014, were retrospectively analyzed in this study. The patients’ demographic data and preoperative and intraoperative findings were obtained from the hospital records and noted. The patients were invited by phone to a follow-up visit to assess their 1-year anatomic outcomes and symptoms.Results:There was no significant demographic difference between the patients who underwent vaginal hysterectomy alone and those who had a vaginal hysterectomy with sacrospinous ligament fixation. Both length of operation and hospital stay were significantly longer in the patients who underwent vaginal hysterectomy with sacrospinous ligament fixation (p<0.001); intraoperative complications requiring blood transfusion were also significantly more frequent in these patients compared with the patients who underwent vaginal hysterectomy only (p=0.048). Recurrence of vaginal vault prolapse was significantly more frequent in the patients with vaginal hysterectomy alone compared with those who had both vaginal hysterectomy and sacrospinous ligament fixation (p=0.035).Conclusion:Unilateral sacrospinous ligament fixation might be added to vaginal hysterectomy in patients with stage 3 or 4 POP who are predicted to have long survival times. However, further studies with a larger sample size are needed in this area of research.

Highlights

Pelvic organ prolapse (POP) affects approximately 50% of women aged over 50 years
To compare ‘‘vaginal hysterectomy alone’’ with ‘‘vaginal hysterectomy with prophylactic unilateral sacrospinous ligament fixation’’ in terms of intraoperative complications and 1-year anatomic outcomes and symptoms in patients aged over 50 years who presented with stage 3 or 4 pelvic organ prolapse (POP)
The aim of this study was to compare ‘‘vaginal hysterectomy with prophylactic unilateral Sacrospinous ligament fixation (SLF)’’ with ‘‘vaginal hysterectomy alone’’ in terms of intraoperative complications and 1-year anatomic outcomes and symptoms in patients aged over 50 years who presented with stage 3 or 4 pelvic organ prolapse

Summary

Introduction

Pelvic organ prolapse (POP) affects approximately 50% of women aged over 50 years. Its lifetime prevalence is 30-50%. The incidence of uterovaginal and vaginal vault prolapse is observed to be high among the elderly because pelvic floor structures loosen with age. Various therapeutic techniques have been suggested to be performed at the time of vaginal hysterectomy to avoid potential recurrence of prolapse. Several surgical techniques have been suggested to be performed at the time of vaginal hysterectomy to avoid potential recurrence of prolapse. SLF refers to suspension of the vaginal vault from the sacrospinous ligament, which extends from the ischial spine, to the coccyx and the lower portion of the sacrum. This technique was first defined by Sederl in 1958. The aim of this study was to compare ‘‘vaginal hysterectomy with prophylactic unilateral SLF’’ with ‘‘vaginal hysterectomy alone’’ in terms of intraoperative complications and 1-year anatomic outcomes and symptoms in patients aged over 50 years who presented with stage 3 or 4 pelvic organ prolapse

Methods

Results

Conclusion