Laparoscopic uterosacral ligament uterine suspension compared with vaginal hysterectomy with vaginal vault suspension for uterovaginal prolapse

Diwan, Aparna; Rardin, Charles R.; Strohsnitter, William C.; Weld, A S.; Rosenblatt, P.L.; Kohli, Neeraj

doi:10.1007/s00192-005-1346-x

Cited by 88 publications

(60 citation statements)

References 10 publications

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“…Therefore, 15 studies were excluded. Twenty-three studies were available in which outcome data for 1,764 women who underwent a vaginal hysterectomy for prolapse symptoms were analyzed separately, with a follow-up of between 9 and 60 months [4,5,6,[9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28].…”

Section: Study Selectionmentioning

confidence: 99%

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Vaginal surgery for uterine descent; which options do we have? A review of the literature

2008

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Several vaginal procedures are available for treating uterine descent. Vaginal hysterectomy is usually the surgeon's first choice. In this literature review, complications, anatomical and symptomatic outcomes, and quality of life after vaginal hysterectomy, sacrospinous hysteropexy, the Manchester procedure, and posterior intravaginal slingplasty are described. All procedures had low complication rates, except posterior intravaginal slingplasty, with a tape erosion rate of 0-21%. Minimal anatomical success rates regarding apical support ranged from 85% and 93% in favor of the Manchester procedure. Data on symptomatic cure and quality of life are scarce. In studies comparing vaginal hysterectomy with sacrospinous hysteropexy or the Manchester procedure, vaginal hysterectomy had higher morbidity. Because no randomized, controlled trials have been performed comparing these surgical techniques, we can not conclude that one of the procedures prevails. However, one can conclude from the literature that vaginal hysterectomy is not the logical first choice.

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Section: Study Selectionmentioning

confidence: 99%

“…In a review of the literature, it was concluded that a vaginal hysterectomy is unlikely to cause bladder and bowel dysfunction [60]. The occurrence of de novo stress incontinence after a vaginal hysterectomy for uterine descent was reported in between 0% and 22% of women [6,14,17,23,24].…”

Section: Anatomical Curementioning

confidence: 99%

Vaginal surgery for uterine descent; which options do we have? A review of the literature

2008

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“…Several alternative operations for prolapse repair with uterine preservation, using either a vaginal or an abdominal approach, have been proposed (1,2,(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Sacral Uteropexy with Cravat Technique--Experience and Results

et al. 2014

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ARTICLE INFO ______________________________________________________________ ______________________Objective: The aim of the present study was to evaluate the safety and efficacy of a "Cravat'' technique for the management of uterine prolapse in patients who want to preserve uterus, involving suspension of the uterus from the sacral promontory by using polypropylene mesh. Materials and Methods:A prospective observational study between January 2011 and September 2013 was conducted. Prior to surgery, prolapse assessment was undertaken with Baden-Walker halfway system to grade the degree of prolapse at all sites. Patients with severe uterine prolapse (stage II-IV) who want to preserve uterus, were operated with Cravat technique. All patients were evaluated at 2 weeks and 6 weeks after surgery and followed for 6 months. Outcomes were evaluated objectively by vaginal examination using Baden-Walker halfway classification, and subjectively classifying patients as 'very satisfied', 'satisfied' and 'not satisfied' at the 6th month postoperatively. Results: Sacral uteropexy was successfully performed by laparoscopy in 32/33 patients (one needed to be converted to laparotomy). Nine patients also had a concurrent procedure as colporaphy anterior, colporaphy posterior or transobturator tape. Postoperative recovery has been uneventful with subjective and objective cure rates were 96.9% and 93.9%, respectively at six month. One recurrence of total prolapse needed to be reoperated and two patients with sacrouteropexy still remained at stage 2 prolapse. There have been no cases of graft exposure, rejection or infection with a median follow-up of 23.9 months. Conclusions: Laparoscopic sacral uteropexy with "Cravat technique" was found to be safe and simple procedure.

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“…Laparoscopic ventrosuspension involves suturing of the round ligament to the rectal sheath; however, this is associated with a poor success rate, with one case series of nine women reporting recurrence of prolapse in eight women within 3 months of surgery. 14 Laparoscopic uterosacral plication, first described in 1997, involves placing three purse-string sutures from the uterosacral ligaments to the posterior cervix: 15 Wu 16 reported a case series of seven women with no recurrence of prolapse at 9-17 months follow-up. Laparoscopic suture hysteropexy with closure of the pouch of Douglas and plication and reattachment of the uterosacral ligaments to the cervix has been reported by Maher et al, 17 with an objective success rate of 79% in 43 women after a mean follow-up of 12 months.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse

Price

Slack

Jackson

2009

BJOG

115

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Objective The aim of this study was to evaluate the outcome of laparoscopic hysteropexy, a surgical technique for the management of uterine prolapse, involving suspension of the uterus from the sacral promontory using bifurcated polypropylene mesh.Design The investigation was designed as a prospective observational study (clinical audit).Setting The study was undertaken at a tertiary referral urogynaecology unit in the UK.Population The participants comprised 51 consecutive women with uterovaginal prolapse, who chose laparoscopic hysteropexy as one of the available surgical options.Methods The hysteropexy was conducted laparoscopically in all cases. A bifurcated polypropylene mesh was used to suspend the uterus from the sacral promontory. The two arms of the mesh were introduced through bilateral windows created in the broad ligaments, and were sutured to the anterior cervix; the mesh was then fixed to the anterior longitudinal ligament over the sacral promontory, to elevate the uterus.Main outcome measures Cure of the uterine prolapse was evaluated subjectively using the International Consultation on Incontinence Questionnaire for vaginal symptoms (ICIQ-VS), and objectively by vaginal examination using the Baden-Walker halfway system and the pelvic organ prolapse quantification (POP-Q) scale. Operative and postoperative complications were also assessed.Results The mean age of the 51 women was 52.5 years (range 19-71 years). All were sexually active, and at least three of them expressed a strong desire to have children in the future. All were available for follow-up in clinic at 10 weeks, and 38 have completed the questionnaires. In 50 out of 51 women the procedure was successful, with no objective evidence of uterine prolapse on examination at follow-up; there was one failure. Significant subjective improvements in prolapse symptoms, sexual wellbeing and related quality of life were observed, as detected by substantial reductions in the respective questionnaire scores.Conclusions Laparoscopic hysteropexy is both a feasible and an effective procedure for correcting uterine prolapse without recourse to hysterectomy. It allows restoration of the length of the vagina without compromising its calibre, and is therefore likely to have a favourable functional outcome.

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Laparoscopic uterosacral ligament uterine suspension compared with vaginal hysterectomy with vaginal vault suspension for uterovaginal prolapse

Cited by 88 publications

References 10 publications

Vaginal surgery for uterine descent; which options do we have? A review of the literature

Vaginal surgery for uterine descent; which options do we have? A review of the literature

Laparoscopic Sacral Uteropexy with Cravat Technique--Experience and Results

Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse

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