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Anatomical Outcome and Patient Satisfaction After Laparoscopic Uterosacral Ligament Hysteropexy for Anterior and Apical Prolapse

Haj Yahya, Rani, MD; Chill, Henry H., MD; Herzberg, Shmuel, MD; Asfour, Alaa, MD; Lesser, Steven, MD; Shveiky, David, MD

Female Pelvic Medicine & Reconstructive Surgery: September/October 2018 - Volume 24 - Issue 5 - p 352–355
doi: 10.1097/SPV.0000000000000446
Original Articles

Objectives The aim of this study was to determine anatomical and clinical cure, as well as patient satisfaction in uterine-preserving laparoscopic uterosacral ligament suspension (LUSLS) in women with anterior and apical prolapse.

Methods This was a retrospective cohort study including all women who underwent LUSLS for anterior and apical prolapse between January 2012 and December 2015 at a tertiary-care university hospital. All women had LUSLS hysteropexy and anterior colporrhaphy. Pre- and postoperative pelvic organ prolapse quantification (POP-Q) measurements were taken. Prolapse symptoms were queried via standardized history. Patient satisfaction was measured by the Patient Global Impression of Improvement (PGI-I).

Results Fifty-three women underwent the procedure during the study period. Follow-up data were available for 48 women. The mean preoperative POP-Q Ba point was 2.7 ± 1.6 and C point was −0.8 ± 2.8. At a mean follow-up of 17.5 ± 16.0 months with a median of 12 months (range, 1–54 months), there was a significant improvement of POP-Q points Ba, C, and Bp (P < 0.001 for all comparisons). Anatomical cure, defined as no prolapse of any POP-Q point at or below 1 cm above the hymen (−1), was 85.4%. Clinical cure, defined as a composite outcome of no prolapse outside the hymen, C point above total vaginal length/2, no prolapse symptoms, and no need for further treatment, was 95.8%. At a mean of 22.2 ± 12.4 months postoperatively, patient satisfaction was high, with 95.5% stating their condition was very much better (PGI-I-A) or much better (PGI-I-B).

Conclusion Laparoscopic uterosacral ligament suspension is a valid uterine-preserving option for women with anterior and apical prolapse, with high anatomical and clinical cure rates and patient satisfaction.

From the Department of Obstetrics and Gynecology, Hadassah Medical Center, Ein-Kerem, Jerusalem, Israel.

Correspondence: Henry H. Chill, MD, Department of Obstetrics and Gynecology, Hadassah, Hebrew University Medical Center, Ein Kerem, PO Box 12000, Jerusalem 91120, Israel. E-mail: henchill@gmail.com.

Rani Haj Yahya and Henry H. Chill contributed equally to this work.

The authors have declared they have no conflicts of interest.

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