Document Detail


Is hysterectomy necessary for laparoscopic pelvic floor repair? A prospective study.
MedLine Citation:
PMID:  18971137     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
STUDY OBJECTIVE: To evaluate whether the addition of hysterectomy to laparoscopic pelvic floor repair has any impact on the short-term (perioperative) or long-term (prolapse outcome) effects of the surgery. DESIGN: A controlled prospective trial (Canadian Task Force classification II-1). SETTING: Private and public hospitals affiliated with a single institution. PATIENTS: A total of 64 patients with uterovaginal prolapse pelvic organ prolapse quantification system stage 2 to 4 had consent for laparoscopic pelvic floor repair from January 2005 through January 2006 (32 patients in each treatment arm). Patients self-selected to undergo hysterectomy in addition to their surgery. INTERVENTIONS: Patients were divided into group A (laparoscopic pelvic floor repair with hysterectomy) or group B (laparoscopic pelvic floor repair alone). All patients had laparoscopic pelvic floor repair in at least 1 compartment, whereas 52 patients had global pelvic floor prolapse requiring multicompartment repair. Burch colposuspension and/or additional vaginal procedures were performed at the discretion of the surgeon in each case. MEASUREMENTS AND MAIN RESULTS: Symptoms of prolapse and pelvic organ prolapse quantification system assessments were collected preoperatively, perioperatively, and at 6 weeks, 12 months, and 24 months postoperatively. Validated mental and physical health questionnaires (Short-Form Health Survey) were also completed at baseline, 6 weeks, and 12 months. No demographic differences occurred between the groups. Time of surgery was greater in group A (+35 minutes), as was estimated blood loss and inpatient stay, although the latter 2 results had no clinically significant impact. No difference between groups was detected in the rate of de novo postoperative symptoms. At 12 months, 4 (12.9%) patients in group A had recurrent prolapse as did 6 (21.4%) patients in group B. At 24 months these figures were 6 (22.2%) and 6 (21.4%), respectively. These differences were not statistically significant (p=.500 at 12 months and .746 at 24 months). In the group not having hysterectomy, 4 (14.3%) of 28 patients had cervical elongation or level-1 prolapse by the 12-month assessment. CONCLUSION: The addition of total laparoscopic hysterectomy to laparoscopic pelvic floor repair adds approximately 35 minutes to surgical time with no difference in the rate of perioperative or postoperative complications or prolapse outcome. Leaving the uterus in situ, however, is associated with a risk of cervical elongation potentially requiring further surgery. Laparoscopic pelvic floor repair is successful in 80% of patients at 2 years.
Authors:
David M B Rosen; Anshumala Shukla; Gregory M Cario; Mark A Carlton; Danny Chou
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of minimally invasive gynecology     Volume:  15     ISSN:  1553-4650     ISO Abbreviation:  -     Publication Date:    2008 Nov-Dec
Date Detail:
Created Date:  2008-10-30     Completed Date:  2009-02-19     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101235322     Medline TA:  J Minim Invasive Gynecol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  729-34     Citation Subset:  IM    
Affiliation:
Sydney Women's Endosurgery Centre, St. George Hospital, Sydney, Australia. dmbrosen@medemail.com.au
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MeSH Terms
Descriptor/Qualifier:
Fecal Incontinence / etiology
Female
Follow-Up Studies
Humans
Hysterectomy / methods,  statistics & numerical data*
Laparoscopy / statistics & numerical data*
Length of Stay
Pelvic Floor / surgery*
Prospective Studies
Urinary Incontinence / etiology
Uterine Prolapse / etiology*,  surgery*
Vagina / surgery*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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