BACKGROUND AND PURPOSE:

• There is lack of high level evidence regarding best approach to repair vaginal vault prolapse following hysterectomy
• Malika et al. (Female Pelvic Medicine & Reconstructive Surgery, 2017) compared vaginal, open and robotic surgical approaches for the management of posthysterectomy vaginal vault prolapse

METHODS:

• Questionnaire-based retrospective study
• Patients who had undergone surgery for posthysterectomy apical vaginal prolapse
• Three techniques compared
  • Mayo-McCall culdoplasty (MMC)
  • Open abdominal sacrocolpopexy (ASC)
  • Robotic sacrocolpopexy (RSC)
• Baseline characteristics and perioperative outcomes were abstracted from electronic health records
• Validated questionnaires were used to do cross sectional data for current pelvic floor symptoms
• Survival free of retreatment was estimated with Kaplan-Meier method

RESULTS:

• 337 people completed at least a validated or abbreviated questionnaire
• Overall, there were no differences when comparing long-term posttreatment symptoms and quality of life among the 3 groups but some domain differences
• Urogenital Distress: MMC group had a greater median score (more distress) than patients who had undergone ASC (20.8 vs 8.3, P=0.02)
• Colorectal-Anal Distress: MMC had a greater median Colorectal-Anal Distress score (18.8 vs 12.5, P=0.04) compared to RSC
  • Otherwise, there were no significant differences in the long-term posttreatment symptoms and quality of life between these 2 procedures
• There was no significant difference in 5-year survival free of retreatment for MMC (94.0%) versus RSC (95.5%) and ASC (94.8%) versus RSC (92.1%)
• However, patients who had MMC were more likely to have retreatment than patients who had ASC during the first 10 years
  • 10-year survival free of retreatment: 81.1% vs 95.4%; hazard ratio, 3.68 (95% CI 1.51–8.98)
• Authors recommend long-term follow up under the AUGS Registry

CONCLUSION:

• Symptom relief and retreatment rates were comparable between procedures
• ASC has greater durability compared to MMC

Learn More – Primary Sources:

Symptom Relief and Retreatment After Vaginal, Open, or Robotic Surgery for Apical Vaginal Prolapse

Related ObG Topics:

Comparing the Use of Mesh Against Standard Repair for Prolapse

Cystourethroscopy – Did I Cut, Twist, Suture, Burn, or Make a Hole in It?

Recognition, Evaluation and Treatment of Vaginal Cuff Separation

Preemptive Analgesia to Control Postop Hysterectomy Pain: The SGS Clinical Guidelines