Abstract
Aim: To systematically review published data on vault prolapse occurrence after total laparoscopic hysterectomy versus abdominal hysterectomy for benign uterine pathology. Materials and Methods: Medline and PubMed were searched for clinical studies reporting on vault prolapse occurrence after laparoscopic or abdominal hysterectomy. The studies included were randomized and non-randomized clinical trials reporting on the occurrence of vaginal vault prolapse as a long-term complication of either abdominal or laparoscopic hysterectomy for nonmalignant conditions. Results: The search yielded only one study reporting on vaginal cuff prolapse after laparoscopic assisted vaginal hysterectomy (LAVH) or total abdominal hysterectomy (TAH). The additional articles that were retrieved using the ‘search for related articles’ function as well as from references of eligible studies were 581. Of these, 473 studies were excluded by title, 45 by abstract, 32 by full text, seven for which the full text could not be retrieved, and 24 by language. For this study two groups of women were followed up after LAVH (n=150) and TAH (n=146). No statistically significant difference in the likelihood of vault prolapse was revealed between the two groups (p = 0.592).Conclusion: In the literature, various measures are recommended to avoid vaginal vault prolapse such as the suspension of the vaginal apex to the cardinal and uterosacral ligament or to the sacrospinous ligaments at the time of hysterectomy. More studies are needed with a greater number of cases and longer follow up to assess whether abdominal or laparoscopic hysterectomy is more appropriate to prevent vaginal vault prolapse.
Highlights
Total hysterectomy is one of the most common gynecological surgical operations
The literature was searched for clinical studies reporting on vault prolapse occurrence after laparoscopic or abdominal hysterectomy
The studies included were randomized and non-randomized clinical trials reporting on the occurrence of vaginal vault prolapse as a long term complication of either abdominal or laparoscopic hysterectomy
Summary
Total hysterectomy is one of the most common gynecological surgical operations. The indications for the procedure are in general divided into malignant or benign conditions, the latter including menorrhagia, fibroids, adenomyosis, dysmenorrhea, chronic pelvic pain, non-suspecting adnexal mass and uterine prolapse, concerning the vast majority of the operations performed [1-4].The classical surgical approach for hysterectomy is either the abdominal or the vaginal one. Total hysterectomy is one of the most common gynecological surgical operations. One long-term complication for both abdominal and laparoscopic hysterectomy is vault prolapse. The etiology is multifactorial and includes advanced patient age [13, 14], genetic predisposition [15, 16], multiparity [17], preexisting pelvic floor defect [18, 19], previous surgery [14], lifestyle, and chronic diseases that increase intra-abdominal pressure [19]. Another factor probably affecting the vaginal vault prolapse is the surgeon’s training on the various techniques of hysterectomy as well as his knowledge concerning the supporting mechanism of the uterus and vagina [20]
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