Outcomes of laparoscopic hysteropexy and supracervical hysterectomy plus cervicopexy: A retrospective study

ObjectiveTo compare objective and subjective outcomes of laparoscopic sacral colpopexy with supracervical hysterectomy (L‐SCP) and robotic sacral hysteropexy (R‐SHP).MethodsThis is a multicenter retrospective propensity score matched study. In the period between January 2014 and December 2018, we enrolled 161 patients with apical prolapse stage 2 or above, alone or with multicompartment descensus.ResultsAfter propensity‐match analysis, there were 44 women for each group. Patients of the two groups had similar preoperative characteristics. No difference was found in terms of estimated blood loss, hospital stay, operative time, and intraoperative or postoperative complications. Subjective success rate, 12 months after surgery, was statistically better in the L‐SCP group (P = 0.034): 81.8% and 97.8% women had Patient Global Impression of Improvement scores less than 3, in R‐SHP and L‐SCP, respectively. The objective cure rate was high in both groups without any significant differences in recurrence rate (P = 0.266).ConclusionBoth procedures are safe and effective in pelvic organ prolapse treatment. Patients who no longer desire uterine preservation could be encouraged to consider L‐SCP. R‐SHP is an alternative in women who are strongly motivated to preserve their uterus in the absence of abnormal uterine findings.

Section: Variables R-shp (Cases) L-scp (Controls) P-valuementioning

confidence: 99%

Sacrocolpopexy after sub‐total hysterectomy vs. sacral hysteropexy for advanced urogenital prolapse: A propensity‐matched study

Arcieri

Morlacco

Montebelli

et al. 2023

Section: Re Sultsmentioning

confidence: 99%

“…Twelve studies, two RCT 32,34 and 10 nRCS, 37,40,41,[45][46][47]51,52,56,65 reported information on the operative time for a total of 4461 pa- blood loss and methods used to assess it. Blood loss outcomes were reported in one RCT 34 and nine nRCS 37,40,41,[45][46][47]51,56,65 for a total of 4267 patients: 1764 hysterectomies and 2503 uterus-preserving procedures. In the pooled analysis, the intraoperative blood loss was lower in the uterine preservation group than in the hysterectomy group with a median difference of 61.7 mL (95% CI 31.3-92.1 mL; P < 0.001; I 2 = 97.39%) (Figures 6b and 7b).…”

Section: Re Sultsmentioning

confidence: 99%

“…Nine studies, two RCT 32,34 and seven nRCS, 37,40,41,[45][46][47]56 reported the length of hospital stay for a total of 4148 patients: 1709 hysterectomy and 2439 uterine preservation procedures. The length of hospital stay was shorter in the uterine preservation group compared with the hysterectomy group with a pooled mean difference of 0.35 days (95% CI 0.04-0.65; P < 0.001; I 2 = 91.53%) (Figures 6c and 7c).…”

Section: Re Sultsmentioning

confidence: 99%

“…Objective success was defined as postoperative POP-Q stage of 2 or less in all compartments. Data were available in 15 studies, two RCT 32,36 and 13 nRCS, [44][45][46]50,51,54,56,[58][59][60]64,66,67 for a total of 2516 patients: 1180 hysterectomy and 1336 uterine preservation procedures. No difference in objective success was observed between the two groups with an OR for objective success in the hysterectomy versus the uterine preservation group of 1.38 (95% CI 0.92-2.07; P = 0.126; I 2 = 30.45%) (Figures 8a and 9a).…”

Section: Re Sultsmentioning

confidence: 99%

See 2 more Smart Citations

Clinician perspectives on hysterectomy versus uterine preservation in pelvic organ prolapse surgery: A systematic review and meta‐analysis

Porcari,

Zorzato,

Bosco

et al. 2024

BackgroundPrevious reviews on hysterectomy versus uterine‐sparing surgery in pelvic organ prolapse (POP) repair did not consider that the open abdominal approach or transvaginal mesh use have been largely abandoned.ObjectivesTo provide up‐to‐date evidence by examining only studies investigating techniques currently in use for POP repair.Search StrategyMEDLINE and Embase databases were searched from inception to January 2023.Selection CriteriaWe included randomized and non‐randomized studies comparing surgical procedures for POP with or without concomitant hysterectomy. Studies describing open abdominal approaches or transvaginal mesh implantation were excluded.Data Collection and AnalysisA random effect meta‐analysis was conducted on extracted data reporting pooled mean differences and odds ratios (OR) between groups with 95% confidence intervals (CI).Main ResultsThirty‐eight studies were included. Hysterectomy and uterine‐sparing procedures did not differ in reoperation rate (OR 0.93; 95% CI 0.74–1.17), intraoperative major (OR 1.34; 95% CI 0.79–2.26) and minor (OR 1.38; 95% CI 0.79–2.4) complications, postoperative major (OR 1.42; 95% CI 0.85–2.37) and minor (OR 1.18; 95% CI 0.9–1.53) complications, and objective (OR 1.38; 95% CI 0.92–2.07) or subjective (OR 1.23; 95% CI 0.8–1.88) success. Uterine preservation was associated with a shorter operative time (−22.7 min; 95% CI –16.92 to −28.51 min), shorter hospital stay (−0.35 days, 95% CI –0.04 to −0.65 days), and less blood loss (−61.7 mL; 95% CI –31.3 to −92.1 mL). When only studies using a laparoscopic approach for both arms were considered, no differences were observed in investigated outcomes between the two groups.ConclusionsNo major differences were observed in POP outcomes between procedures with and without concomitant hysterectomy. The decision to preserve or remove the uterus should be tailored on individual factors.

Laparoscopic sacrocolpopexy with concurrent hysterectomy or uterine preservation: A metanalysis and systematic review

Tius,

Arcieri,

Taliento

et al. 2024

BackgroundLiterature is lacking strong evidence about comparisons of efficacy and quality of life‐related outcomes between laparoscopic total and/or supracervical hysterectomy (LTH/LSCH) with laparoscopic sacrocolpopexy (LSC) and minimally invasive sacrohysteropexy (LSH).ObjectiveTo summarize and compare available data on this topic providing a useful clinical tool in the treatment decision process.Search StrategyWe performed a systematic research of PubMed (MEDLINE), Web of Science, and Gooogle Scholar.Selection CriteriaWe included studies that compared at least one efficacy outcome (objective or subjective outcome) between LTH/LSCH with LSC and LSH. Data on surgery‐related morbidities were also extracted where available.Data Collection and AnalysisA random‐effect meta‐analysis was conducted reporting pooled mean differences and odds ratios (OR) between groups using Review Manager V.7.9.0.Main ResultsWe included a total of nine observational studies. LTH/LSCH with LSH was associated with a significantly higher objective success (apical compartment OR 7.95; 95% confidence interval [CI] 2.23–28.33; I2 = 0%; P = 0.001; anterior compartment OR 2.23; 95% CI 1.26–4.30; I2 = 12%; P = 0.007) and subjective success (OR 3.19; 95% CI 1.42–7.17; I2 = 39%; P = 0.005). No differences were found regarding intraoperative and postoperative complications, sexual dysfunction, and stress urinary incontinence rate after surgery. Hysteropexy showed shorter operative time and shorter hospital length with a pool mean difference of 27.37 min (95% CI 18.04–32.71; I2 = 0%; P < 0.001) and 0.7 days (95% CI 0.24–1.17; I2 = 75%; P = 0.003), respectively. Concurrent hysterectomy was not associated with a higher rate of mesh‐related complications (P = 0.53). No major differences were found regarding recurrence and reoperation rate (P = 0.10 and P = 0.93, respectively).ConclusionsLTH/LSCH with LSC has better objective and subjective outcomes in pelvic organ prolapse surgery than LSH alone, especially for apical and anterior compartments, and is not associated with higher postoperative sexual dysfunction and mesh‐related complications. Adequate preoperative counseling is highly recommended in patients who desire uterine preservation.PROSPERO Registration NumberCRD42024537270.