Elsevier

Journal of Minimally Invasive Gynecology

Volume 15, Issue 6, November–December 2008, Pages 729-734
Journal of Minimally Invasive Gynecology

Original Article
Is Hysterectomy Necessary for Laparoscopic Pelvic Floor Repair? A Prospective Study

https://doi.org/10.1016/j.jmig.2008.08.010Get rights and content

Abstract

Study Objective

To evaluate whether the addition of hysterectomy to laparoscopic pelvic floor repair has any impact on the short-term (perioperative) or long-term (prolapse outcome) effects of the surgery.

Design

A controlled prospective trial (Canadian Task Force classification II–1).

Setting

Private and public hospitals affiliated with a single institution.

Patients

A total of 64 patients with uterovaginal prolapse pelvic organ prolapse quantification system stage 2 to 4 had consent for laparoscopic pelvic floor repair from January 2005 through January 2006 (32 patients in each treatment arm). Patients self-selected to undergo hysterectomy in addition to their surgery.

Interventions

Patients were divided into group A (laparoscopic pelvic floor repair with hysterectomy) or group B (laparoscopic pelvic floor repair alone). All patients had laparoscopic pelvic floor repair in at least 1 compartment, whereas 52 patients had global pelvic floor prolapse requiring multicompartment repair. Burch colposuspension and/or additional vaginal procedures were performed at the discretion of the surgeon in each case.

Measurements and Main Results

Symptoms of prolapse and pelvic organ prolapse quantification system assessments were collected preoperatively, perioperatively, and at 6 weeks, 12 months, and 24 months postoperatively. Validated mental and physical health questionnaires (Short-Form Health Survey) were also completed at baseline, 6 weeks, and 12 months. No demographic differences occurred between the groups. Time of surgery was greater in group A (+35 minutes), as was estimated blood loss and inpatient stay, although the latter 2 results had no clinically significant impact. No difference between groups was detected in the rate of de novo postoperative symptoms. At 12 months, 4 (12.9%) patients in group A had recurrent prolapse as did 6 (21.4%) patients in group B. At 24 months these figures were 6 (22.2%) and 6 (21.4%), respectively. These differences were not statistically significant (p = .500 at 12 months and .746 at 24 months). In the group not having hysterectomy, 4 (14.3%) of 28 patients had cervical elongation or level-1 prolapse by the 12-month assessment.

Conclusion

The addition of total laparoscopic hysterectomy to laparoscopic pelvic floor repair adds approximately 35 minutes to surgical time with no difference in the rate of perioperative or postoperative complications or prolapse outcome. Leaving the uterus in situ, however, is associated with a risk of cervical elongation potentially requiring further surgery. Laparoscopic pelvic floor repair is successful in 80% of patients at 2 years.

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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Cited by (52)

  • Uterine preservation vs hysterectomy in pelvic organ prolapse surgery: a systematic review with meta-analysis and clinical practice guidelines

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    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 Reproduction
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    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
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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.

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