Digital Presentation AGES XXVIII Annual Scientific Meeting 2018

Prolapse Management: From the Top or the Bottom? Recurrence of pelvic organ prolapse at 12 months following vaginal or laparoscopic hysterectomy (5558)

Keryn Harlow 1 , John Short 1 2
  1. Canterbury District Health Board, Christchurch, CANTERBURY, New Zealand
  2. Oxford Women's Health, Christchurch, CANTERBURY, New Zealand

Background

Traditional management for symptomatic uterine prolapse has been vaginal hysterectomy. Recent years have seen an increase in the popularity of total laparoscopic hysterectomy. This retrospective observational study compared the rate of recurrent prolapse in women undergoing laparoscopic versus vaginal hysterectomy.

Method

Women undergoing vaginal or laparoscopic hysterectomy for symptomatic prolapse during 2016 were included in the study. Cases were recruited from a public gynaecology department and a private gynaecology practice. Electronic patient records for all women included in the study were reviewed. The primary outcome assessed was repeat surgery for prolapse. Referrals and reviews for prolapse and complications from the initial hysterectomy were also assessed. Notes were reviewed for a minimum of 12 months following hysterectomy.

Results

51 women had vaginal hysterectomy compared to 45 laparoscopic hysterectomy.

There was no difference in the rate of representation with symptomatic prolapse in each group. 17.6% (9/51) represented with symptomatic prolapse in the vaginal hysterectomy group vs 17.7% (8/45) in the laparoscopic group.

In the laparoscopic group the rate of recurrent surgery for apical prolapse was 4.4% (2/45) compared to 5.9% (3/51) in the vaginal group.

The rate of recurrent surgery for anterior compartment prolapse was 4.4% (2/45) in the laparoscopic group vs 3.9% (2/51) in the vaginal group and 2.2% (1/45) vs 3.9% (2/51) for posterior compartment prolapse respectively.

Complication rate was higher in the laparoscopic group with 38% (17/45) experiencing a complication, 9% (4/45) major. This compared to a complication rate of 14% (7/51) in the vaginal group, 4% (2/51) major.

Discussion

Mode of hysterectomy does not appear to alter the recurrence rate of pelvic organ prolapse. The rate of recurrent apical and posterior compartment prolapse was less in the laparoscopic group however the rate of recurrent anterior compartment prolapse was marginally higher. Due to the retrospective nature of this study it was not possible to compare the baseline demographics and presentation of prolapse in the two groups. An objective measure of prolapse prior to hysterectomy and at follow up would provide further information.

The higher complication rate reported in the laparoscopic group could be due to higher reporting rates from the women treated by a private gynaecologist compared to women treated in the public hospital, who primarily receive follow up from their GP.

Further investigation is required with a large, prospective study including an objective measure of prolapse.

  1. 1. Dallenbach P, Kaelin-Gambirasio I, Dubuisson J-B, Boulvain M, “Risk factors for pelvic organ prolapse repair after hysterectomy,” Obstet Gynecol 2007;110:625-32
  2. 2. Forsgren C, Lundholm C, Johansson AL, Cnattinguis S, Zetterstrom J, Altman D, “Vaginal hysterectomy and risk of pelvic organ prolapse and stress urinary incontinence surgery,” Int Urogynecol J 2012;23(1):43-8
  3. 3. Nieboer TE, Johnson N, Lethaby A, Tavender E, Curr E, Garry R, van Voorst S, Mol BWJ, Kluivers KB, “Surgical approach to hysterectomy for benign gynaecological disease (Review),” Cochrane Database of Systematic Reviews 2009;3
  • Have you presented oral, video or DCS at an AGES meeting before?: Yes
  • Are you a trainee and if so at what level?: 4
  • Are you a subspecialists or AGES member?: Yes