Routine Pelvic Support Procedures for Laparoscopic Vaginal Hysterectomies
Prophylactic pelvic support procedures were performed with laparoscopic-assisted vaginal hysterectomies (LAVH) in 91 women to see if the frequency of future pelvic vault prolapse could be reduced. The patients were divided into two groups. In group 1, 43 women were treated with simple LAVH using a suture bipolar technique. In group 2, 48 women had LAVH and prophylactic modified culdoplasties for vault support. Indications for hysterectomy were routine, excluding only patients with significant pelvic relaxation. The work-up included quality of life questionnaire, pelvic ultrasound, standing vault examination, and cough stress test. The study design required follow-up at 6 weeks and 1 year. At 6 weeks all patients were asymptomatic. At 1 year, in group 1, 6 of 40 women had findings of pelvic prolapse and 3 had mild stress incontinence. In group 2, two patients had positive findings and one had stress incontinence. The occurrence rates of 15% and 4% are not statistically significant. It might well represent a trend of increased pelvic prolapse in women who do not have adequate concomitant pelvic support procedures. It will be necessary to follow these patients for 5 years to prove or disprove this concept.
Ross
JW
Center Reproductive Medicine and Laparoscopic Surgery, 254 San Jose Street, Salinas, CA 93901.