230 Views

Laparoscopic Uterosacral Ligament Suspension Compared with Sacrocolpopexy

Presenting Author(s)

Katrina Hage (she/her/hers)

Medical Student
University of Arizona College of Medicine
Tucson, Arizona, United States

Co-Author(s)

VW

Veronica Winget, MD

Resident
University of Arizona
tucson, Arizona, United States
DL

Dagnie Lamb, MD

Resident
University of Arizona
Tucson, Arizona, United States
IA

Ilana Addis, MD (she/her/hers)

Professor
University of Arizona
Tucson, Arizona, United States
MK

Maithili Khandekar, n/a

Medical Student
University of Arizona
Tucson, Arizona, United States
John Heusinkveld, MD

Associate Professor
University of Arizona
tucson, Arizona, United States

Objectives: The objective of this study was to analyze the short-term and intermediate term outcomes of Total Laparoscopic Hysterectomy with Uterosacral Ligament Suspension (TLH+USLS) operations using permanent suture performed at our institution by one surgeon from July 2020 through June 2021, and to compare those results with a historical cohort of patients undergoing laparoscopic sacrocolpopexy (LSC).

Methods: Under an IRB-approved protocol we performed a retrospective review of the medical records of all patients who underwent TLH+USLS during a 12-month period from July 2020 through June 2021. We compared outcomes to those of of 229 patients who underwent LSC with or without hysterectomy between October 2014 and June 2020.

Results: A total of 41 patients underwent TLH+USLS. Demographic data were similar between the two groups and are shown in Table 1. Complications and prolapse recurrences are shown in Table 2. The prolapse recurrence and reoperation rates for all 229 patients who underwent LSC were 5.6% and 3%, respectively. When this group was narrowed to include only patients who underwent hysterectomy with LSC, the rates or recurrence and reoperation were 12% and 7.6%, respectively. The rates of prolapse recurrence and reoperation for TLH+USLS were 19% and 12%, respectively. When these patients were compared to all patients undergoing LSC, the relative risks for recurrence and reoperation were 3.4 (p =0.003) and 3.5 (p =0.02). When the comparison group was restricted to include only the patients who underwent hysterectomy plus LSC, the relative risks of recurrence and reoperation were 1.6 (p = 0.31) and 1.6 (p = 0.44). The risk of complications was similar for the two groups.

Conclusions: TLH+USLS using permanent suture appears to be a safe and effective intervention with intermediate term results similar to those obtained using sacrocolpopexy when the comparison group is restricted to patients who underwent a hysterectomy at the same time as their LSC. The mesh erosion rates were very low in our cohort; however, these data support the use of TLH+USLS as an alternative to LSC for patients desiring a mesh-free prolapse repair.