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Ginekologia i Położnictwo medical project
ISSN 1896-3315 e-ISSN 1898-0759

Comparison between abdominal sacral hysteropexy and vaginal sacrospinous hysteropexy for management of women with apical uterine descent : A randomized clinical trial


Abstract

Author(s): Ihab Gomaa, Mohammad NasrAl Deen, Tamer Farouk Borg, Mahmoud Ghaleb, Asmaa Ragab* and Basem Aly Islam

Aim: Regarding surgical treatment of uterine prolapse, sacral colpopexy has been reported to show low risk of recurrence. Previous studies paid less attention to functional outcomes, peri-operative  problems and surgical lengths of stay. We here attempted to determine which    is clinically better, abdominal sacral hysteropexy (ASH) vs. vaginal sacrospinous hysteropexy (SSF) in women with apical prolapse.

Methods: Patients consisted of 72 women with apical uterine descent stage II or more according to POP-Q, who were treated in Ain Shams University Maternity Hospital. These patients were randomly divided into two groups; ASH (n=37) vs. SSF (35). Operative time, peri-operative complications, and length of stay were compared. Follow up visits at 4 weeks, 3 months, 6 months and 1 year were scheduled. We assessed recurrent or de novo prolapse, urinary incontinence, need for re- operation, the sexual function, and the quality of life.

Results: The two groups showed similar background. ASH, compared with SSF, showed the followings; 1) less frequent recurrence, 2) less frequent re-surgery at 1 year, 3) less frequent presence of symptoms at 1 year, 4) longer operative time, more blood loss, and longer hospital stay, 4) more frequent minor complications.

Conclusion: ASH, compared with SSF, showed a lower rate of recurrence, but with significantly larger amount of intra-operative blood loss, postoperative pyrexia, and hospital stay. We must consider this merit/demerit of ASH when we choose the procedure.