Should we add unilateral sacrospinous ligament fixation to vaginal hysterectomy in management of stage 3 and stage 4 pelvic organ prolapse?

Abstract

Objective:To compare ‘‘vaginal hysterectomy alone’’ with ‘‘vaginal hysterectomy with prophylactic unilateral sacrospinous ligament fixation’’ in terms of intraoperative complications and 1-year anatomic outcomes and symptoms in patients aged over 50 years who presented with stage 3 or 4 pelvic organ prolapse (POP).Materials and Methods:Thirty-five patients underwent vaginal hysterectomy alone and 32 patients underwent vaginal hysterectomy with unilateral sacrospinous ligament fixation because of benign pathology between January 2012, and June 2014, were retrospectively analyzed in this study. The patients’ demographic data and preoperative and intraoperative findings were obtained from the hospital records and noted. The patients were invited by phone to a follow-up visit to assess their 1-year anatomic outcomes and symptoms.Results:There was no significant demographic difference between the patients who underwent vaginal hysterectomy alone and those who had a vaginal hysterectomy with sacrospinous ligament fixation. Both length of operation and hospital stay were significantly longer in the patients who underwent vaginal hysterectomy with sacrospinous ligament fixation (p<0.001); intraoperative complications requiring blood transfusion were also significantly more frequent in these patients compared with the patients who underwent vaginal hysterectomy only (p=0.048). Recurrence of vaginal vault prolapse was significantly more frequent in the patients with vaginal hysterectomy alone compared with those who had both vaginal hysterectomy and sacrospinous ligament fixation (p=0.035).Conclusion:Unilateral sacrospinous ligament fixation might be added to vaginal hysterectomy in patients with stage 3 or 4 POP who are predicted to have long survival times. However, further studies with a larger sample size are needed in this area of research.

Sacrospinous colpopexy versus McCall’s culdoplasty during vaginal hysterectomy in stage 3 and 4 prolapse for prevention of vault prolapse

“…Our incidence was comparable to studies by Guner et al and Elif et al who reported 18% and 21.9% incidence of gluteal pain and nerve injury. 11,14 If the pain is severe or associated with paresthesia, reoperation and relocation of the suture more medially are often suggested but in our study the pain was transient and subsided within 7 to 30 days of surgery by analgesics and anti-inflammatory agents. 7 Colombo and Milani compared SLF with McCall culdoplasty and found that the latter yielded better results in terms of length of operation, blood loss as approaching the sacrospinous ligament requires additional tissue dissection which is not the case in McCall culdoplasty.…”

“…Elif et al reported a similar incidence of 18.8%. 11 However, incidence reported by Gupta et al and Hefani et al was 1.9% and 1.8% respectively. 12,13 Statistically significant complication that was noted post operatively within one week of surgery was gluteal pain, which was more common in the SSLF group-7 (16.28%).…”

Outcome of sacrospinous ligament fixation with conventional instruments in the treatment of Stage 3-4 vaginal vault prolapse

“…It has been also shown that unilateral SSLF prophylactic to vaginal hysterectomy may reduce the recurrence rates in patients with stage3-4 POP 31 . In our study, although there was a significant difference between the unilateral and bilateral SSLF in terms of the operation time and amount of bleeding, these complications did not cause any additional morbidity.…”

The effect of sacrospinous ligament fixation during vaginal hysterectomy on postoperative de novo stress incontinence occurrence: a prospective study with 2-year follow-up

“…Correction of apical prolapse is especially important in POP surgery to prevent future vaginal cuff prolapse [24]. Uterosacral ligament suspension, SSLF, abdominal open and laparoscopic sacral colpopexy are mainly utilized surgical procedures to support the vaginal apex [11,18]. Each of these procedures carries their own benefits and risks.…”

“…In patients with POP in whom a VAH is planned, the addition of sacrospinous ligament fixation (SSLF) procedure might decrease the rate of postoperative vaginal cuff prolapse [12,13]. However, the addition of this procedure might also increase the operative time and the risk of perioperative complications [14][15][16][17][18]. The purpose of the present study was to determine the risk of de novo SUI occurrence in women who were treated with SSLF in addition to VAH and colporrhaphy anterior-posterior (VAH + CAP) over a follow-up period of 24 months.…”