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Vaginal intraperitoneal versus extraperitoneal uterosacral ligament vault suspensions: a comparison of a standard and novel approach

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Abstract

Introduction and hypothesis

Uterosacral ligament suspension surgery is commonly utilized to correct post-hysterectomy vaginal vault prolapse (VVP). Vaginal intraperitoneal uterosacral vault suspension (IUSVS) is a viable option, but intraperitoneal access can be challenging. An alternative approach is an extraperitoneal uterosacral vault suspension (EUSVS). The aim of our study was to compare surgical outcomes of IUSVS and EUSVS in patients with post-hysterectomy VVP.

Methods

Retrospective cohort study of women who underwent treatment of post-hysterectomy VVP with an IUSVS and EUSVS from May 2016 to January 2019 at our institution. The primary outcome was surgical success that was assessed by a composite outcome for surgical failure, defined as ANY of the following: (1) apical descent > 1/3 of the TVL or anterior or posterior vaginal wall beyond the hymen, (2) retreatment of prolapse, or (3) bothersome vaginal bulge symptoms with a positive response to either of two questions on the PFDI questionnaire. Secondary outcomes included EBL, operative time, duration of hospitalization, and perioperative complications. Two-sample t-tests and chi-square tests were used for the bivariate analysis.

Results

Eighty patients were included (36 IUSVS and 44 EUSVS) with a mean follow-up of 7 months. For our primary outcome, there was no difference in surgical success (IUSVS group 72.22% vs. EUSVS group 81.82%, p = 0.307). Operative time, duration of hospitalization, and EBL were significantly less in the EUSVS group than in the IUSVS group.

Conclusions

EUSVS demonstrated similar short-term success compared to IUSVS for post-hysterectomy VVP, with shorter operative time, EBL, and length of stay.

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Authors and Affiliations

  1. Division of Urogynecology, Department of Obstetrics and Gynecology, Houston Methodist Hospital, 6550 Fannin Street, Smith Tower Suite 901.31, Houston, TX, 77030, USA

    Danny Mounir, Fiona M. Lindo, Danielle D. Antosh & Tristi W. Muir

  2. Texas A&M University Health Science Center College of Medicine, College Station, TX, USA

    Nyla O. Vasquez-Tran

Authors
  1. Danny Mounir
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  2. Nyla O. Vasquez-Tran
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  3. Fiona M. Lindo
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  4. Danielle D. Antosh
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  5. Tristi W. Muir
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Contributions

D Mounir: Protocol/project development, Data collection/analysis, Manuscript writing/editing.

N Vasquez-Tran: Data collection.

FM Lindo: Protocol/project development, Manuscript editing.

DD Antosh: Protocol/project development, Data analysis, Manuscript editing.

TW Muir: Protocol/project development, Manuscript writing/editing.

Corresponding author

Correspondence to Danny Mounir.

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An abstract of this study was presented as a non-oral poster at the Society of Gynecologic Surgeons 46th Annual Scientific Meeting, a virtual event, held July 9–12, 2020.

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Mounir, D., Vasquez-Tran, N.O., Lindo, F.M. et al. Vaginal intraperitoneal versus extraperitoneal uterosacral ligament vault suspensions: a comparison of a standard and novel approach. Int Urogynecol J 32, 913–918 (2021). https://doi.org/10.1007/s00192-020-04462-7

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  • DOI: https://doi.org/10.1007/s00192-020-04462-7

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