Original ArticleIs Hysterectomy Necessary for Laparoscopic Pelvic Floor Repair? A Prospective Study
Section snippets
Materials and Methods
Patient numbers were selected to detect a mean difference of 60 minutes in operative time. Consecutive patients were recruited from the rooms and public outpatient clinics of the authors. All patients were informed of the prolapse surgery advocated by their surgeon and provided with an information sheet detailing the nature of the study. Patients then selected whether to participate in the study and whether they wished to undergo hysterectomy as part of their surgery (group A) or not (group B),
Results
Global pelvic floor prolapse (≥stage-2 prolapse in at least 2 pelvic compartments) was detected in 27 patients in group A (8 stage 2, 18 stage 3, 1 stage 4) and 25 patients in group B (8 stage 2, 17 stage 3). One patient in each group had primarily anterior compartment defects, 2 in each group had primarily posterior compartment defects, and 1 in group A and 3 in group B had apical support defects alone. No significant differences were detected between groups in demographic (Table 1) or
Discussion
Regardless of the approach to surgery, be it abdominal, vaginal, or a combination of laparoscopic and vaginal techniques, the aims of prolapse surgery remain the same: restore pelvic anatomy, relieve preoperative symptoms without causing new symptoms, correct urinary and/or bowel symptoms where possible, and, finally, provide a long-term cure [10]. Laparoscopic surgery affords the ability to dissect into the anterior and posterior pelvic spaces with a close-up view of the anatomic structures,
Conclusion
This study reinforces the safety and efficacy of the laparoscopic approach to pelvic floor prolapse surgery. Although the prolapse outcomes in the 2 groups did not differ at 2 years, the surgeons in our group would favor removal of the uterus and cervix in most instances to give a better and more complete reconstitution of the pericervical ring, allow access to a high transverse anterior wall defect, and reduce the incidence of reoperation for cervical prolapse/elongation in the future. We
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Routine uterine preservation during sacrocolpopexy for apical prolapse – pro
2023, Progres en UrologieUterine preservation or not during prolapse surgery: Review of the literature
2019, Progres en UrologieUterine preservation vs hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines
2018, American Journal of Obstetrics and GynecologyCitation Excerpt :In one of the studies that compared laparoscopic uterosacral hystereopexy with laparoscopic hysterectomy with USLS, there was more prolapse recurrence within 2 years (stage ≥2) with uterine preservation (52.9% PRES vs 37.5% HYST, P = .02).58 However, in combination with the other trial comparing these surgeries and investigated outcomes at 2 years,57 the difference in prolapse recurrence became nearly insignificant (RR, 1.31, 95% CI, 1.00–1.71, P = .05). Operating room time was shorter with uterine preservation in both of these studies (difference, –23.7 minutes, 95% CI, –36.7 to –10.7 minutes, P < .01), and EBL was slightly but significantly less (–10 mL, 95% CI, –19 to –1 mL, P = .03).57,58
Clinical Practice Guidelines: Synthesis of the guidelines for the surgical treatment of primary pelvic organ prolapse in women by the AFU, CNGOF, SIFUD-PP, SNFCP, and SCGP
2017, Journal of Gynecology Obstetrics and Human ReproductionCitation Excerpt :In the case of sacropexy, hysterectomy increases the operative time (LE3), and blood loss (LE3). Uterine preservation does not increase the risk of recurrence for the apical compartment nor does it appear to reduce the rate of secondary cystocele (LE3) [30]. The performance of a hysterectomy during surgery for POP does not appear to modify sexual function (LE3).
Clinical outcomes in women undergoing laparoscopic hysteropexy: A systematic review
2017, European Journal of Obstetrics and Gynecology and Reproductive Biology
The authors have no commercial, proprietary, or financial, interest in the products or companies described in this article.
Supported by a grant from the AGES/Stryker research fund, Sydney, Australia.