Outcomes of Anterior Wall Prolapse after Laparoscopic Cerclage Sacrohysteropexy

Objectives: To evaluate if patients with anterior vaginal prolapse with baseline point Ba greater than or equal to 2 cm more distal than point C (Primary Population) will be significantly more likely to experience recurrence and/or persistence of an anterior wall defect than patients with baseline point Ba at less than 2 cm in relation to point C (Secondary Population) after surgical treatment with laparoscopic cerclage sacrohysteropexy

Methods: This is a retrospective cohort study of patients with symptomatic prolapse from 2019 to 2021 who underwent laparoscopic cerclage sacrohysteropexy. Preoperative and postoperative Pelvic Organ Prolapse Quantification System (POP-Q) scores were collected, and patients were given POPDI-6 and patient global impression of improvement (PGI-I) questionnaires to complete preoperatively and at follow up visits. Data for the Primary Population were compared to the Secondary Population. Anatomical success was defined as a composite of anterior, posterior and apical success. Anterior and posterior compartment success were defined as Ba and Bp ≤0, respectively. Apical success was defined as C ≤ half the total vaginal length (TVL). Additional analysis was conducted using more stringent definition of apical success, defined as C ≤-2/3 TVL. Post operative PGI-I scores and change from preoperative to postoperative POPDI-6 scores were reported. Continuous data are reported as median (interquartile range) and compared with the Wilcoxon rank-sum test. Categorical data are reported as frequency (proportion) and compared with a Chi-square or Fisher’s Exact test.

Results: Of the 124 patients who underwent laparoscopic cerclage sacrohysteropexy, 53 met the criteria for the Primary Population. There were no significant differences in baseline characteristics between the groups (Table 1). Median follow up time was 6 months for the Primary Population and 8 months for the Secondary Population. Anterior wall success (Ba ≤ 0) was achieved by 100% of the Primary Population and 98% of the Secondary Population. Using the most stringent definition of apical success (C ≤ -total vaginal length/2), success was noted in 87% of the Primary Population and 83% in the Secondary Population, with 100% and 98%, respectively, having point C at < -1 at most recent follow up exam. There was a decrease in patient reported POPDI-6 scores, with a median change of –25 in both groups.

Conclusions: Laparoscopic cerclage sacrohysteropexy reduces anterior and apical prolapse regardless of baseline point Ba. Additional follow-up time with further analysis is necessary to assess whether this procedure is a durable repair for long-term prolapse reduction and patient satisfaction.