Comparison of patient reported outcomes, pelvic floor function and recurrence after laparoscopic sacrohysteropexy versus vaginal hysterectomy with McCall suspension for advanced uterine prolapse.

ABSTRACT

OBJECTIVE: To compare medium/long-term outcomes in terms of pelvic floor function, patient reported prolapse recurrence and repeat prolapse surgery after laparoscopic sacrohysteropexy (LSHP) and vaginal hysterectomy with McCall suspension (VH&McCall) which is the most commonly performed surgical option for severe uterine prolapse from past to present. STUDY DESIGN: Files of patients who underwent LSHP and VH&McCall for advanced utero-vaginal prolapse (stage 3 & 4) at the Department of Gynecology in Ankara University School of Medicine between 2008 and 2018 were reviewed (n = 517). Data of women who were followed up for at least 1-year and containing both the full-filled Patient Global Impression of Improvement (PGI-I) survey and Turkish validated Pelvic Floor Distress Inventory-20 (PFDI-20), were included. RESULTS: A total of 132 women were included in the study; 46 women who underwent LSHP and 86 women who underwent VH&McCall. Even though the median age of the LSHP group was significantly lower than the median age of VH&McCall group (42 vs. 67 years; P<;0.001), recurrence and repeat surgery rates were found to be similar after both surgical approaches as well as the scores of PGI-I and PFDI-20. However, in women who were operated before their sixties, symptomatic recurrence was found to be significantly lower after LSHP than VH&McCall (16.2 % vs. 47.4 %, respectively; P = 0.024) as well as repeat prolapse surgery (2.7 % vs. 26.3 %, respectively; P = 0.014). PGI-I and PFDI-20 scores also suggested better pelvic floor function after LSHP significantly (p = 0.004 & p = 0.003 respectively). When adjusted for age, VH&McCall significantly increased the risk of symptomatic prolapse recurrence compared to LSHP (OR 4.65; 95 % CI 1.326-16.312; P = 0.016). CONCLUSION: LSHP and VH&McCall might seem to be surgical options for individualized management with similar pelvic floor function & recurrence in the medium/long-term follow-up, but the age adjusted risk analysis showed higher rates of symptomatic recurrence after VH&McCall. Moreover, the better outcomes after LSHP in the younger subset, revealed the need of further clarification with well-designed prospective studies.