Study between Laparoscopic Uterosacral Ligament Suspension versus Sacrospinous Ligament Fixation for Apical Prolapse

Abstract

The aim of the present investigation is to study relation between Laparoscopic Uterosacral Ligament Suspension (L-USLS) versus Sacrospinous Ligament Fixation (SSLF) for Apical Prolapse. A retrospective study was performed on 45 consecutive patients who underwent L-USLS or SSLF. All surgeries were performed at a teritary medical center, an academic hospital system. All patients were evaluated in the clinic by an attending physicianpreoperatively. They were assessed for Pelvic Organ Prolapse Quantification (POP-Q) Stage. Patients were evaluated for occult stress urinary incontinence at the discretion of their physician. Leading edge information was translated to POP-Q Stage. Demographic, surgical and medical history, intraoperative course, postoperative complications, and postoperative follow-up data were collected from the electronic medical record. There was one cystotomy in both the L-USLS and SSLF cohorts, and one bowel injury in the SSLF cohort. All were recognized intraoperatively and repaired without postoperative sequelae. One patient in the SSLF cohort was taken back to the OR due to bleeding at the vaginal cuff that was identified in the postoperative care unit. One patient in the L-USLS group experienced a small bowel obstruction which required bowel resection. This patient had a complex surgical history with resulting dense abdominal adhesions. There were two readmissions in each group; two for pneumonia, one for enterocolitis, and one for vaginal bleeding which did not require any intervention. In conclusion, there was not a statistically significant difference in perioperative complications between L-USLS and SSLF. Given these unattainable sample sizes, the out- comes of this study are likely clinically similar.

Keywords:  Laparoscopic Uterosacral Ligament Suspension, Sacrospinous Ligament Fixation, Apical Prolapse, Surgical repairs, Vaginal apical prolapse