Sacrospinous colpopexy versus McCall’s culdoplasty during vaginal hysterectomy in stage 3 and 4 prolapse for prevention of vault prolapse

S. S. Gulati; Samta Gupta; Neha Khan; Shelly Agarwal; Naima Afreen; Megha Ranjan

doi:10.18203/2320-1770.ijrcog20212675

Authors

S. S. Gulati School of Medical Science and Research, Sharda University Greater Noida, Uttar Pradesh, India
Samta Gupta School of Medical Science and Research, Sharda University Greater Noida, Uttar Pradesh, India
Neha Khan School of Medical Science and Research, Sharda University Greater Noida, Uttar Pradesh, India
Shelly Agarwal School of Medical Science and Research, Sharda University Greater Noida, Uttar Pradesh, India
Naima Afreen School of Medical Science and Research, Sharda University Greater Noida, Uttar Pradesh, India
Megha Ranjan School of Medical Science and Research, Sharda University Greater Noida, Uttar Pradesh, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20212675

Keywords:

Pelvic organ prolapse, Vaginal hysterectomy, McCall Culdoplasty, Sacrospinous ligament fixation

Abstract

Background: Pelvic organ prolapse is a common condition seen in women due to weakening of support of pelvic organs. Different surgical procedures have been adopted for suspension of vaginal vault during vaginal hysterectomy to restore vault to near normal anatomic position as preventive measures for vault prolapse. The aim of study was to compare the efficacy of the McCall’s culdoplasty and sacrospinous ligament colpopexy in stage 3 and 4 prolapse (POP-Q).

Methods: This prospective study comprised 100 women presenting with stage 3 and 4 prolapse (POP-Q). They were divided into two equal groups of 50 each. The patients were randomized to undergo McCall’s culdoplasty (Group A) or sacrospinous ligament fixation (Group B) with vaginal hysterectomy based on note contained in an envelope comparative analysis was done, and patients were evaluated for intra-operative difficulties and immediate (48 hours) post-operative complications using SPSS-version 23 for statistical analysis. The patients were followed up at one month and one year to evaluate symptomatically and objectively.

Results: In group A, patients with 3-degree prolapse 1 woman had hemorrhage and 1 woman had bladder injury intraoperatively. Whereas in group B, 5 women had hemorrhage and 1 woman had rectal injury intraoperatively. All complications were dealt successfully. No other major intra- and post-operative complications occurred.

Conclusions: Vaginal hysterectomy with sacrospinous colpopexy resulted in better outcomes after surgery. Hence, it was concluded that unilateral or bilateral SSLF may be added to vaginal hysterectomy in patients of stage 3 or 4 prolapse.

Metrics

Metrics Loading ...

References

Rooney K, Kenton K, Mueller ER, FitzGerald MP, Brubaker L. Advanced anterior vaginal wall prolapse is highly correlated with apical prolapse. Am J Obstet Gynecol. 2006;195(6):1837-40.

Barber MD, Maher C. Apical prolapse. Int Urogyn Ecol J. 2013;24(11):1815-33.

Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P, Ulmsten U et al. Standardization. Subcommittee of the International Continence Society. The standardization of terminology of lower urinary tract function: report from the standardization subcommittee of the international continence society. Neurourol Urodyn. 2002;21:167-8.

Sedera L. Surgery in prolapse of a blind-end vagina. Geburtshilfe Frauenheilkd. 1958;18:824-8.

Randall CL, Nichols DH. Surgical treatment of vaginal inversion. Obstet Gynecol. 1971;38:327-32.

Holley RL, Varner RE, Gleason BP, Apffel LA, Scott S. Recurrent pelvic support defects after sacrospinous ligament fixation for vaginal vault prolapse. J Am Coll Surg. 1995;180: 444-8.

Sze EH, Karram MM. Transvaginal repair of vault prolapse: a review. Obstet Gynecol. 1997;89:466-75.

Toozs-Hobson P, Boos K, Cardozo L. Management of vaginal vault prolapse. Br J Obstet Gynaecol. 1998;105:13-7.

Cruikshank SH, Muniz M. Outcomes study: a comparison of cure rates in 695 patients undergoing sacrospinous ligament fixation alone and with other site-specific procedure 16-year study. Am J Obstet Gynecol. 2003;188:1509-15.

Ling-Hong Tseng, Ilene Chen, Shuenn-Dyh Chang, Chyi-Long Lee. Modern role of sacrospinous ligament fixation for pelvic organ prolapse surgery A systemic review. Taiwanese J Obstetr Gynecol. 2013;52:311-7.

Ağaçayak E, Tunç SY, İçen MS, Başaranoğlu S, Fındık FM, Sak S et al. Should we add unilateral sacrospinous ligament fixation to vaginal hysterectomy in management of stage 3 and stage 4 pelvic organ prolapse? Turk J Obstet Gynecol. 2015;12:144-50.

Gupta P. Transvaginal sacrospinous ligament fixation technique, as part of the vaginal repair procedure for massive uterovaginal (Pelvic Organ Prolapse stage III and stage IV and vault prolapse. Iran J Med sci. 2015;40:1.

Hefni M, El-Toukhy T, Bhaumik J, Katsimanis E. Sacrospinous cervicocolpopexy with uterine conservation for uterovaginal prolapse in elderly women: an evolving concept. Am J Obstet Gynecol. 2003;188:645-50.

Guner H, Noyan V, Tiras MB, Yildiz A, Yildirim M. Transvaginal sacrospinous colpopexy for marked uterovaginal and vault prolapse. Int J Gynecol Obstet. 2001;74:165-70.

Colombo M, Milani R. Sacrospinous ligament fixation and modified McCall culdoplasty during vaginal hysterectomy for advanced uterovaginal prolapse. Am J Obstet Gynecol. 1998;179:13-20.

Gayathri KB, Gurumurthy R, Bhargav PRK, Rapoor S, Devi VN. Sacrospinous fixation for prevention and treatment of vault prolapse: institutional experience from South India. Int J Reprod Contracept Obstet Gynecol. 2014;3(2):380-4.

Smilen SW, Saini J, Wallach SJ, Porges RF. The risk of cystocele after sacrospinous ligament fixation. Am J Obstet Gynecol. 1998;179:1465-71.

Shull BL, Capen CV, Riggs MW, Kuehl TJ. Preoperative and postoperative analysis of site-specific pelvic support defects in 81 women treated with sacrospinous ligament suspension and pelvic reconstruction. Am J Obstet Gynecol. 1992;166:1764-8.

RCOG/BSUG Joint Guideline. Green-top Guideline No. 46 Post-Hysterectomy Vaginal Vault Prolapse. 2015.