title: Pectineal Ligament Hysteropexy for Uterine Prolapse in Premenopausal Women by Open and Laparoscopic Approach in Indian Urban and Rural Centers.
abstract: OBJECTIVE
  The aim of this study was to evaluate (a) the surgical outcomes of pectineal ligament hysteropexy (PLH) for uterine prolapse by laparotomy and (b) the feasibility and safety of the procedure by laparoscopic route.
  
  
  METHODS
  This is a retrospective consecutive case series of women who underwent PLH from January 1998 to December 2011. The prolapsed uterus was suspended with polyester tape to pectineal ligament on either side through a Cherney incision or laparoscopically at 3 urban and 3 rural hospitals in India.
  
  
  RESULTS
  In 194 women who underwent PLH (176 open and 18 laparoscopic), there were no intraoperative complications. The mean follow-up was 6.5 years (range, 0.5-12 years) for open method and 1 year (range, 0.5-2 years) for laparoscopic approach. There were 46 births in 40 women after the procedure including 32 vaginal and 14 cesarean deliveries. Overall, 10 women (5.1%) had uterine prolapse recurrence; 7 of these occurred after vaginal delivery. One woman had tape erosion into the bladder because of pelvic tuberculosis. At follow-up, 12 women developed cystocele, and 7 women developed portio vaginalis elongation. There were no postoperative enteroceles. Overall reoperation rate was 14.9%. Laparoscopic PLH had minimal morbidity with no recurrence over 2 years.
  
  
  CONCLUSIONS
  Open PLH for uterine prolapse may be safely performed and gives durable support to the prolapsed uterus with low recurrence risk.
authors: From the *Department of Obstetrics and Gynecology, KEM Hospital; †Suyash Hospital, Walchandnagar; ‡Emerald Endoscopy Center, Pune; §Department of Obstetrics and Gynecology, Walawalkar Rural Hospital, Derwan, Ratnagiri; ║Kashti Rural Hospital, Pune; and ¶Department of Obstetrics and Gynecology, Dr Panjabrao Deshmukh Memorial Medical College, Amravati, Maharashtra, India.
authors: Vivek Madhusudan
authors: VM
authors: Joshi
authors: Suhas R
authors: SR
authors: Otiv
authors: Vasant B
authors: VB
authors: Dagade
authors: Mahindra
authors: M
authors: Borse
authors: Rabin N
authors: RN
authors: Majumder
authors: Maneesha
authors: M
authors: Shrivastava
authors: Ravindra
authors: R
authors: Shelmohkar
authors: Smita
authors: S
authors: Bijwe
mesh_terms: D000328:Adult; D052858:Cystocele / Q000473:pathology; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006780:Hospitals, Rural; D006786:Hospitals, Urban; D006801:Humans; D007194:India; D010535:Laparoscopy / Q000379:methods*; D008022:Ligaments / Q000601:surgery*; D017697:Premenopause; D012189:Retrospective Studies; D014596:Uterine Prolapse / Q000601:surgery*; D055815:Young Adult