RESUMO
INTRODUCTION: Transvaginal repair of advanced pelvic organ prolapse (POP) often involves vaginal hysterectomy (VH) followed by fixation of the vaginal vault to either the sacrospinous or the uterosacral ligaments. To date, only a few studies have compared the results of these two vaginal vault fixation techniques. OBJECTIVES: To compare short and medium-term results and complications of sacrospinous versus high uterosacral ligament fixation of the vaginal vault after vaginal hysterectomy for the treatment of advanced POP. METHODS: This was a retrospective study obtaining data from the medical records of patients who underwent transvaginal repair of advanced POP with a VH in our institution between the years 2006 and 2017. Demographic and clinical characteristics, perioperative complications and medium-term follow-up data were documented for all patients. RESULTS: We identified 118 women who underwent uterosacral and 46 women who underwent sacrospinous vaginal vault fixation. The overall incidence of perioperative complications was significantly lower in the sacrospinous as compared to the uterosacral fixation group (17.8% vs. 39.3%, P = 0.01). Medium term recurrence rates of moderate to severe POP were similar in both groups (33.3% vs. 35.8%). No significant differences were observed between the two groups in the rates of postoperative urinary or gastrointestinal symptoms. CONCLUSIONS: Sacrospinous fixation of the vaginal vault after vaginal hysterectomy was found to involve a lower rate of perioperative complications as compared to uterosacral ligament fixation. However, the rates of prolapse recurrence and the incidence of postoperative urinary tract and gastrointestinal symptoms were found to be similar in both groups. DISCUSSION: According to the current study, it is not possible to determine a clear superiority for one method of vaginal vault fixation over the other. Both surgical techniques are acceptable, involve reasonable success rates and relatively low postoperative complication rates.