Comparison of laparoscopic high and vaginal uterosacral ligament suspension in the management of apical prolapse

Abstract

Objective: Currently, the usage of uterosacral ligament suspension (USLS) procedures for apical prolapse is increasing. However, studies comparing the symptomatic outcomes of USLS procedures are lacking. We aimed to compare the anatomical and symptomatic outcomes between laparoscopic high USLS and vaginal USLS. Materials and Methods: This retrospective case control study was conducted with patients who had undergone laparoscopic high USLS and vaginal USLS procedures performed at a university hospital from 2015 to 2020. The operative characteristics, POP-Q stages, Pelvic Floor Distress Inventory-20 (PFDI-20) and Patient Global Impression of Improvement (PGI-I) scores of both laparoscopic high USLS and vaginal USLS cases were compared. Results: There were 35 laparoscopic high USLS and 37 vaginal USLS procedures with a follow-up of 12 months. The complications, operation time, length of hospital stay, POP-Q stages, PFDI-20 and PGI-I scores were similar between the groups (p>0.05). Conclusion: Those patients with apical prolapse who had undergone laparoscopic high USLS had similar anatomical success and patient satisfaction rates compared to the vaginal procedure. When making a surgical plan for apical prolapse patients, it is appropriate to decide based on the patient’s request, patient’s gynecological history, the experience of the surgeon, and the equipment of the operating room.