Ginekologia i Poloznictwo
ISSN 1896-3315 e-ISSN 1898-0759

Investigation of the effect of uterosacral ligament plication ın preventing cuff prolapse

Belma Gözde Özdemir^1*, Meltem Aydoğdu², Betül Dik1, Görkem Aktaş¹, Leyla Huseynli³, Günay Safarova¹, Ahmet Bilgi¹, Mustafa Gazi Uçar¹ and Çetin Çelik^{1 *}Correspondence: Belma Gözde Özdemir, Department of Gynecology and Obstetrics, Faculty of Medicine, Selçuk University, Turkey,

Received: 20-Jun-2025, Manuscript No. gpmp-25-167764; Editor assigned: 23-Jun-2025, Pre QC No. P-167764; Reviewed: 15-Jul-2025, QC No. Q-167764; Revised: 23-Jul-2025 Published: 29-Aug-2025

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Introduction

Hysterectomy is a gynecological surgical procedure performed for benign or malignant reasons. Technique diversity enriches surgery. Interlocking continue suture is used as the classical cuff closure method. While the rate of apical prolapse in normal women is 2%, the frequency of apical prolapse after hysterectomy is 3.2% [1]. One study found that hysterectomy in nulliparous women, regardless of type, may cause approximately 60% more prolapse [2]. In order to prevent this situation, various modifications have been made in vaginal or abdominal hysterectomies. The risk factors here are the weakness of the pelvic tissues due to old age due to the older patient population, the loss of the main elements of the ligaments and collagen tissue and the hypoestrogenic environment, slow wound healing, a history of pelvic prolapse, and scar tissue formation due to surgery [3,4].

The main support tissue in prophylactic methods is the uterosacral ligament. Head fixation or plication (USLP) of the uterosacral ligament (USL) is important at this point. The length to be taken is determined according to whether the ligament is atrophic or not and the mobility of the cuff [5]. USLP can be applied both abdominally and vaginally [6].

We aimed to determine the need for surgery due to cuff prolapse in the short and long term in patients who underwent total abdominal hysterectomy.

Material and Methods

A retrospective study ,all cases that underwent total abdominal hysterectomy for benign or malignant reasons between 2010 and 2024 were evaluated in our clinic. Among these, patients who developed cuff prolapse and underwent surgery for this reason were identified. Patients who underwent USLP and those who did not were categorized. We examined patient records over a 14-year period. In the next process, we grouped the patients who were operated on and those who were not due to cuff prolapse. Patients who had no previous history of prolapse or surgery and no collagen tissue disease were included in the study.

Statistical Analysis

The data was analyzed through the Statistical Package for the Social Sciences (SPSS) 26.0 Statistics Package Program. Data regarding the person performing the hysterectomy and the status of Cuff prolapse are given as numbers and percentages. Chi-Square test was used to examine the relationship between the person performing the hysterectomy and the rates of vaginal cuff prolapse. In the entire study, significance levels were determined by taking into account the values of 0.05 and 0.01.

Results

The total number of patients who underwent hysterectomy was 2033, the number of patients who underwent USLP was 832, and the cuff was closed with continuous locking in 1201 patients. In the study, it was observed that 59.1 percent of women who underwent hysterectomy did not undergo USLP and 40.9 percent underwent USLP. When looking at the status of vaginal cuff prolapse, it was seen that 99.2 percent of women did not have prolapse, and only 0.8 percent had prolapse. When USLP was performed in hysterectomy, vaginal cuff prolapse was not observed in 99.8% of the operations, while prolapse was detected in only 0.2% (2 of 832). In operations without USLP, prolapse was not observed in 98.8% of the cases, while prolapse occurred in 1.2% of the patients (15 of 1201). According to these data, there was a statistically significant difference in the rates of vaginal cuff prolapse between the two groups (p<0.05). The incidence of cuff prolapse is higher when the USLP technique is not added (Tab. 1.). We considered a demographically homogeneous group.

Tab. 1. Relationship between USLP and cuff prolapse.

Discussion

In our study, we found that patients who underwent USLP had fewer surgical interventions due to cuff prolapse in the long term. We use a style in which two separate number 1 polyglactin sutures are held at the cuff corners, and the uterosacral ligaments are taken sequentially and sewn to the cuff. We close the cuff fully. We do not use subtotal hysterectomy to prevent prolapse.

In our study, we evaluated only abdominal hysterectomies. In one study, the type of hysterectomy was not found to be associated with a difference in the recurrence, degree or subsequent treatment of prolapse. This can create a liberal area for us when choosing the type of surgery [7].

In our cases, we used number 1 polyglactin suture. In this study, two layers of different suture materials were used. We refrained from using non-dissolvable sutures because we thought they might cause erosion. Technically, two different suture techniques were used in vaginal surgery [8].

The incidence of vaginal prolapse after hysterectomy was significantly higher in women who had multiple vaginal births, had a difficult birth, had post-hysterectomy complications, did heavy physical labor, had neurological disease, had a hysterectomy for pelvic organ prolapse, and/or had a family history of pelvic organ prolapse [9]. These risk factors remind us of the importance of patient-based prolapse counseling.

The patient can be informed about the type of surgery to be performed and sexual status and existing prolapse should be questioned in the anamnesis. In a study, the adequacy of collagen tissue was emphasized and no separate risk factor was considered for vaginal hysterectomy [10].

In our study, risk factors for USL applied abdominally were evaluated as age and weakness in collagen tissue. In a study examining USL suspension applied after vaginal hysterectomy, it was mentioned that body mass index, smoking and Pelvic Organ Prolapse Ba point were a risk for failure [11].

In a study conducted on cadavers, it was thought that cuff corner angled suture could prevent apical prolapse [12]. In fact, it is the same logic as our technique, but our work seems more advantageous rather than supporting two corners without connection to each other.

Conclusion

Individually examining the short and long-term results of each surgery is a surgical art. In order to prevent cuff plapse, the techniques used when closing the cuff are important. A practical and easily applicable technique. Preventive techniques should be evaluated in terms of patients' quality of life and additional morbidities, especially in the long term. In addition to the technique, prophylactic estrogen-containing local products can also be applied.

Conflict of Interest

No conflict of interest.

Acknowledgment

All necessary permissions and ethics committee approvals are available.

Complies with Helsinki Decleration rules.

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