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Unilateral Anterior Sacrospinous Ligament Hysteropexy: a Single-Center Experience

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Abstract

The objective was to present our experience with unilateral sacrospinous ligament hysteropexy performed through an anterior vaginal incision. This is a retrospective cohort study identifying women who underwent unilateral sacrospinous hysteropexy (CPT code 57282) performed through an anterior vaginal wall incision at the University of Rochester between January 2013 and October 2017. Exclusions included follow-up < 6 months, graft augmentation, bilateral sacrospinous ligament suspension, and a posterior approach. Data were compared using a t test, Wilcoxon rank sum test, Chi-square test, or Fisher’s exact test as appropriate; p < 0.05 was considered statistically significant. The cohort (n = 59) consists predominantly of Caucasian (93%), nonsmoking (54%), post-menopausal women (92%), and women with private insurance (59%). Median baseline values were age 63 years (range, 43–80 years), body mass index 26.8 kg/m2 (range, 18.9–43.1 kg/m2), and stage 3 prolapse (range, 2–3). The median operative time was 80 min (IQR 67, 94.5 min) and estimated blood loss 50 mL (IQR 25, 50 mL). Most women (81%) were discharged home on the day of surgery. Subjective recurrence, in any compartment, was 25.4% (n = 15). The recurrence rate was greatest at 44% during the first year (2013), reflecting a learning curve. In years after, recurrence rates averaged 17%. Recurrence was not associated with the surgeon, subject characteristics, obstetric history, or operative factors. Unilateral anterior sacrospinous hysteropexy is an efficient procedure with few complications. It provides a convenient approach for uterus-preservation pelvic organ prolapse repair with a recurrence comparable to anterior sacrospinous ligament vaginal vault suspension.

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Abbreviations

(SSLH):

Sacrospinous ligament hysteropexy

(UVP):

uterovaginal prolapse

(US):

United States

(BMI):

body mass index

(EBL):

estimated blood loss

(mins):

minutes

(IQR):

intra-quartile range

(MME):

morphine milligram equivalents

(CI):

confidence interval

(EMR):

electronic medical record

(POPQ):

Pelvic Organ Prolapse Quantification

(PACU):

post-anesthesia care unit

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Acknowledgments

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Funding

No external funding.

Author information

Authors and Affiliations

  1. Department of Obstetrics & Gynecology, School of Medicine & Dentistry, University of Rochester, 601 Elmwood Avenue, PO Box 668, Rochester, NY, 14642, USA

    Derrick J Sanderson & Gunhilde M Buchsbaum

  2. School of Medicine & Dentistry, University of Rochester, 601 Elmwood Avenue, Rochester, NY, USA

    Jubin Matloubieh

Authors
  1. Derrick J Sanderson
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  3. Gunhilde M Buchsbaum
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Contributions

DJ Sanderson: protocol/project development, data collection/analysis, manuscript writing/editing.

J Matloubieh: data collection, manuscript writing/editing.

GM Buchsbaum: protocol/project development, manuscript writing/editing.

Corresponding author

Correspondence to Derrick J Sanderson.

Ethics declarations

Conflict of Interest

DJ Sanderson: Consultant with InterPRO Urology. J Maloubieh and GM Buchsbaum have no conflicts of interest to disclose.

Ethical Approval

All research activities performed in this retrospective analysis were in accordance with ethical standards.

Informed Consent

This research was conducted under waived informed consent due, approved by the University of Rochester Research Subjects Review Board, Rochester, NY.

Conference Presentation

Initial results were presented at the Society of Gynecologic Surgeons (SGS) Annual Meeting, Tucson, Arizona, USA, March 31–April 3, 2019.

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This article is part of the Topical Collection on Surgery

Brief Summary

Unilateral anterior sacrospinous ligament hysteropexy is a novel technique that is well tolerated with few complications and provides a convenient approach for a single-incision multi-compartment repair of uterovaginal prolapse.

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Sanderson, D.J., Matloubieh, J. & Buchsbaum, G.M. Unilateral Anterior Sacrospinous Ligament Hysteropexy: a Single-Center Experience. SN Compr. Clin. Med. 2, 948–955 (2020). https://doi.org/10.1007/s42399-020-00327-8

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