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Sacrospinous fixation with mesh: Hysteropexy vs Colpopexy
IUGA Academy. Sandor C. Jun 30, 2018; 212998; 287 Topic: Pelvic Organ Prolapse
Carola Sandor
Carola Sandor

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287

Sacrospinous fixation with Mesh: Hysteropexy vs Colpopexy

Ubertazzi, E1; Fonseca, C1;Sandor, C1; Vendramini, A1; Pavan, L1

1: Hospital Italiano Buenos Aires

Introduction: Vaginal hysterectomy is the most common treatment to correct uterine prolapse without scientific evidence to support it, so, hysterectomies in patients with prolapse are still controversial.1 Currently, there is a growing tendency towards performing sacrospinous hysteropexy, traditional or with mesh, as these procedures are less invasive and have fewer complications.2

The comparison of these two techniques in search of lower recurrence and complication rates is subject to ongoing reviews.3

Objective: The main objective is to assess the recurrence rate of apical prolapse between hysteropexy vs colpopexy in the sacrospinous ligament with mesh. Secondary objectives were to assess postoperative complications

Methods: A retrospective cohort study including patients who underwent sacrospinous fixation with mesh between June 2011 to May 2017 in the urogynecology section.

Patients with apical prolapse greater than or equal to stage II of POPq classification were included and divided into two groups: hysteropexy or colpopexy, the latter included vaginal vault prolapse and vaginal hysterectomy+colpopexy. Patients with a follow up shorter than 6 months were excluded.

Recurrence was defined as: presence of vaginal lump symptoms and/or point C >? for total vaginal length and/or retreatment (new surgery or pessary use). Perioperative complications were assessed using the Dindo-Clavien classification. The data were obtained from a specific database and from electronic clinical records.

Results: The study included 260 patients (216 with hysteropexies and 44 with colpopexies). Demographic variables were similar for both groups, except for the number of previous vaginal births, history of prolapse surgery, and stage III-IV preoperative prolapse. Table 1.

Prolapse stages in both groups were: Stage II 11.3%(5) and 33.3%(72), Stage III 43.2%(19) and 45.5%(94), Stage IV 45.5%(20) and 23.2%(50) in the colpopexy and hysteropexy groups respectively. The median follow up time for both groups was 12.5 months (IR 7-23 and 7-27 respectively), p=0.7498.

The recurrence rate was 10.19% (22/216) for hysteropexy, and 4.55% (2/44) for colpopexy, p=0.390. Hysteropexy showed a HR of 2.82 (95% CI 0.65-12.15, p=0.322) for apical prolapse recurrence. When adjusting this value by vaginal births, apical stage III or IV, and history of prolapse surgery, the adjusted HR was 3.47 (95% CI 0.76-18.72), p = 0.106. Figure 1.

Surgical time was greater in the colpopexy group, 127 min (SD 45.16) vs. 96.8 min (SD 28.75), p=0.0001.

No differences were found between hysteropexy and colpopexy perioperative complications (24.5% vs. 15.9%, p= 0.216), or in the classification-based Dindo analysis. Table 2, Table3.

Conclusions: There was no difference in the apical prolapse recurrence rate between both groups. Complications were not significantly different between hysteropexy and colpopexy.

We think that vaginal mesh hysteropexy is a favorable option for the treatment of uterine prolapse, since it requires less surgical time without increasing morbidity and surgical complications

References

  1. International Urogynecology Journal. 2017; 28(9):1285–94.
  2. British Medical Journal 2015; 351:h3717.
  3. Clinical Obstetrics and Gynecology. 2017:60(2): 312-323.



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Work supported by industry: no.

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