Surgical Outcomes of Laparoscopic High Uterosacral Vaginal Vault Suspension for Apical Prolapse Repair
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Abstract
Objectives: To evaluate surgical outcomes of laparoscopic high uterosacral ligament suspension (HUSLS) for apical prolapse repair in terms of success rates, perioperative complications, and the ability to perform concomitant bilateral salpingectomy/salpingo-oophorectomy.
Methods: This is a retrospective study of women diagnosed with stage II-IV uterovaginal prolapse who had undergone laparoscopic HUSLS for apical prolapse repair at Department of Obstetrics and Gynecology, Phramongkutklao Hospital between January 2017 and September 2020. Patients’ baseline characteristics, clinical presentation, pre- and post-operative prolapse stage and location, pre- and post-operative POP-Q measurements, perioperative complications, and feasibility of opportunistic salpingectomy/salpingo-oophorectomy were collected and analyzed.
Results: Of 40 patients enrolled, mean age was 62.33±7.49 years, whereas mean body mass index was 24.7±3.2 kg/m2. Most were postmenopausal (92.5%) and presented with bulge symptom (97.5%). Thirty-five (87.5%) patients were diagnosed with advanced stage prolapse. All underwent hysterectomy prior to laparoscopic HUSLS. Additional procedures comprised anterior colporrhaphy (42.5%), posterior colporrhaphy (70%), perineorrhaphy (50%), and midurethral sling (5%). Bilateral salpingo-oophorectomy was performed in all patients. Mean operative time for all procedures was 3.1±0.8 hours, whereas median blood loss was 50 milliliters. No major perioperative complications, including ureteric injury, were encountered. High anatomical success of 90% was achieved at 12-month F/U with significant improvement in all POP-Q measurements, except PB and TVL. Of 4 patients with recurrent prolapse, 3 later underwent total colpocleisis, whereas 1 required anterior vaginal mesh repair.
Conclusion: Laparoscopic HUSLS is a safe and effective procedure for apical prolapse repair without major perioperative complications when performed in the hands of experts.
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