Laparoscopic hysteropexy versus vaginal hysterectomy for the treatment of uterovaginal prolapse: a prospective randomized pilot study

Abstract

Laparoscopic hysteropexy is a safe surgical alternative to vaginal hysterectomy with a similar risk of repeat apical surgery at 1 year. Longer follow-up data from larger studies are required.

Does sacrocolpopexy present heterogeneity in its surgical technique? A systematic review

“…In another two studies, vaginal dissection was limited to the posterior wall, and probably done very superficially, without an effort to reach near the pelvic floor . Incomplete descriptions were found in one study, which stated that anterior and posterior dissection took place, but without any further details, and in another study, in which uterine conservation was the norm, and dissection was probably only done pericervically to wrap the mesh around the cervix . In six studies, there was no description whatsoever regarding the extent of dissection performed on the vaginal walls.…”

“…In most included studies—12/22—the preferred mesh material was polypropylene . Mersilene, PTFE, and PVDF meshes were used by one included study, each.…”

“…11,17 In all the other 15 studies, surgeons were described as highly experienced or senior surgeons. The total number of surgeons performing the procedures in each study was only informed in three studies [18][19][20] and varied between 2 19 and 31 surgeons. 18…”

“…12 On the other hand, there were studies that utilized a lower number of stitches, from a single stitch in the posterior wallcoincidentally employed by a study that performed posterior-only dissection and that kept such dissection at a superficial level 25 -up to two to three sutures in each wall in another three trials. 17,19,20 On the remaining 11 studies, there was either no description regarding the number of sutures used, or the step was left at the surgeon's discretion. 9,26 Table 4 presents the number of sutures employed by the included studies, together with other suture characteristics and mesh fixation details.…”

“…Non-absorbable sutures were the material of choice in 11 studies-PTFE in two studies, 12,26 Prolene in two studies, 24,25 Polyester in one, 21 an unspecified monofilament suture in two, 16,27 an unspecified unabsorbable suture in four. 10,18,22,28 Four studies used only tackers or staples for sacral attachment, 17,19,20,23 and another three studies used either tackers/staples or non-absorbable sutures, at the discretion of the surgeon. 9,11,30 3.10 | Type and shape of mesh used…”