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LAVH superior to TVH when concomitant salpingo-oophorectomy is intended in prolapse hysterectomy: a comparative cohort study

  • Anke R. Mothes
  • Anja Schlachetzki
  • Kristin Nicolaus
  • Julia Vorwergk
  • Thomas Lehmann
  • Marc P. Radosa
  • Henning K. Mothes
  • Ingo B. Runnebaum
General Gynecology
  • 18 Downloads

Abstract

Purpose

This comparative cohort study evaluated the influence of surgical route for prolapse hysterectomy (vaginal or laparoscopically assisted) on the achievement of intended elective salpingo-oophorectomy, which was a procedural goal planned with the patient before primary vaginal native-tissue prolapse surgery.

Methods

Consecutive patients who underwent total vaginal hysterectomy (TVH; n = 163) or laparoscopically assisted vaginal hysterectomy (LAVH; n = 144) and vaginal native-tissue repair for pelvic organ prolapse at Jena University Hospital were enrolled.

Results

Peri- and postoperative parameters, including Clavien–Dindo (CD) classification of surgical complications, were compared between groups using Student’s t test, Fisher’s exact test, and multivariable regression. Patient characteristics were similar, except that grade IV prolapse was more common in the LAVH group (p < 0.001). The following parameters differed between the TVH and LAVH groups: concomitant salpingectomy (1.2% vs. 34%) and salpingo-oophorectomy (45% vs. 66%), non-performance of intended salpingo-oophorectomy (36% vs. 0% OR 0.006, 95% CI < 0.001–0.083), adhesiolysis (0% vs. 44%), CD II–III complications (51% vs. 14.6% p < 0.001), operating time (153 ± 61 vs. 142 ± 27 min), and postoperative in-patient days (9.02 ± 4.9 vs. 4.99 ± 0.96; all p < 0.001).

Conclusions

LAVH enabled the safe performance of planned concomitant salpingo-oophorectomy in all cases. To achieve the procedural goal in such cases, laparoscopic assistance in prolapse hysterectomy should be considered.

Keywords

Elective concomitant salpingo-oophorectomy Salpingectomy Vaginal hysterectomy Laparoscopically assisted vaginal hysterectomy Failure of intended surgery Clavien–Dindo classification 

Abbreviations

BMI

Body mass index

CD

Clavien–Dindo

IUGA

International Urogynecological Association

LAVH

Laparoscopically assisted vaginal hysterectomy

POP

Pelvic organ prolapse

TVH

Total vaginal hysterectomy

Notes

Author contributions

ARM: protocol/project development, data collection and data management, patient recruitment, responsible surgeon, and manuscript writing/editing. AS: patient recruitment, data collection, and data management. KN: data collection and management. JV: data collection and management. TL: statistics and data management. MPR: responsible surgeon and data management. HKM: project development and data management, and editing of manuscript. IBR: patient recruitment, responsible surgeon, and editing of manuscript.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interests.

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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Anke R. Mothes
    • 1
  • Anja Schlachetzki
    • 1
  • Kristin Nicolaus
    • 1
  • Julia Vorwergk
    • 1
  • Thomas Lehmann
    • 2
  • Marc P. Radosa
    • 1
  • Henning K. Mothes
    • 3
  • Ingo B. Runnebaum
    • 1
  1. 1.Department of Gynecology and Reproductive Medicine, University Women’s Hospital JenaJena University Hospital, Friedrich-Schiller-University JenaJenaGermany
  2. 2.Institute of Medical Statistics, Informatics and Documentation, University HospitalFriedrich-Schiller-University JenaJenaGermany
  3. 3.Department of General, Visceral and Vascular Surgery, Jena University HospitalFriedrich-Schiller-University JenaJenaGermany

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