Comparing effectiveness of sacrospinous hysteropexy to vaginal hysterectomy with sacrospinous ligament fixation.

IMPORTANCE

Limited data exists comparing the effectiveness of sacrospinous hysteropexy to vaginal hysterectomy with sacrospinous ligament fixation for uterovaginal prolapse.

OBJECTIVES

The primary objective of this study was to compare surgical failure rates between sacrospinous hysteropexy (SSHP) and vaginal hysterectomy with sacrospinous ligament fixation (VH + SSLF). Surgical failure was defined as either recurrent apical prolapse stage 2 or greater with bothersome bulge symptoms or repeat surgery performed for recurrent apical prolapse. The secondary objectives included time to surgical failure, recurrent anterior and posterior wall prolapse at or beyond the hymen, estimated blood loss, operative time, and intraoperative complications.

STUDY

DESIGN

This was a retrospective cohort study comparing women who underwent SSHP or VH + SSLF for stage 2 uterovaginal prolapse or greater between November 2016 and October 2023 at a single institution.

RESULTS

One hundred and forty-eight participants were included (78 SSHP and 70 VH + SSLF). Median follow up time was 15 months for both groups. SSHP and VH + SSLF had failure rates of 9% and 12.9% respectively, p = 0.45. SSHP had significantly lower estimated blood loss (150 mL vs 200 mL, p < 0.001) and shorter operative time (94 min vs 157 min, p < 0.001). Time to surgical failure, recurrent anterior and posterior wall prolapse, and intraoperative complications were not significantly different between the two groups.

CONCLUSIONS

Sacrospinous hysteropexy and vaginal hysterectomy with sacrospinous ligament fixation may have similar surgical failure rates.