title: Ligament shortening compared to vaginal colpopexy at the time of hysterectomy for pelvic organ prolapse.
abstract: OBJECTIVE
  The performance of a colpopexy at the time of hysterectomy for pelvic organ prolapse is a potential indicator of surgical quality. However, vaginal colpopexy has not been directly compared with the classic technique of ligament shortening and reattachment. We sought to test the null hypothesis that there is no difference in prolapse recurrence between the techniques.
  
  
  METHODS
  We performed a retrospective chart review of 330 vaginal hysterectomies performed for prolapse, comparing symptomatic and/or anatomic recurrence rates between patients having a vaginal colpopexy (uterosacral ligament suspension or sacrospinous ligament suspension) and those having ligament shortening and reattachment. Clinically relevant variables significantly associated with recurrence in a univariate analysis were used to create a multivariable logistic regression model to predict recurrence.
  
  
  RESULTS
  With a mean follow-up of 20 months, there was no significant difference between symptomatic and/or anatomic recurrence rates: 19.4 % of patients (41 of 211) having colpopexy vs. 11.8 % of patients (14 of 119) having ligament shortening (p = 0.07). Baseline prolapse stage was higher in patients having colpopexy (median 3, IQR 2 - 5) than in those having ligament shortening (median 2, IQR 1 - 3; p ≤ 0.0001). In the multivariable logistic regression analysis, the procedure performed was not associated with recurrence (OR 1.57, 95 % CI 0.79 - 3.12). A baseline prolapse of 4 cm or greater was associated with recurrence (OR 2.63, 95 % CI 1.32 - 5.22), as was the time since hysterectomy (OR 1.02 per month, 95 % CI 1.01 - 1.04).
  
  
  CONCLUSIONS
  When compared with vaginal colpopexy, selective use of the ligament shortening technique at the time of vaginal hysterectomy was associated with similar rates of prolapse recurrence. Preoperative prolapse size was the factor most strongly associated with recurrence.
authors.affiliation: University of Michigan Female Pelvic Medicine and Reconstructive Surgery, Ann Arbor, MI, USA. pfairchi@gmail.com.|Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Urogynecology, Magee-Womens Hospital of UPMC, 300 Halket Street, Suite 2324, Pittsburgh, PA, 15213, USA. pfairchi@gmail.com.
authors.forename: Pamela S
authors.initials: PS
authors.lastname: Fairchild
authors.affiliation: University of Michigan Female Pelvic Medicine and Reconstructive Surgery, Ann Arbor, MI, USA.
authors.forename: Neil S
authors.initials: NS
authors.lastname: Kamdar
authors.affiliation: University of Michigan Female Pelvic Medicine and Reconstructive Surgery, Ann Arbor, MI, USA.
authors.forename: Emily R
authors.initials: ER
authors.lastname: Rosen
authors.affiliation: University of Michigan Female Pelvic Medicine and Reconstructive Surgery, Ann Arbor, MI, USA.
authors.forename: Carolyn W
authors.initials: CW
authors.lastname: Swenson
authors.affiliation: University of Michigan Female Pelvic Medicine and Reconstructive Surgery, Ann Arbor, MI, USA.
authors.forename: Dee E
authors.initials: DE
authors.lastname: Fenner
authors.affiliation: University of Michigan Female Pelvic Medicine and Reconstructive Surgery, Ann Arbor, MI, USA.
authors.forename: John O
authors.initials: JO
authors.lastname: DeLancey
authors.affiliation: University of Michigan Female Pelvic Medicine and Reconstructive Surgery, Ann Arbor, MI, USA.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Morgan
mesh_terms: D000368:Aged; D003127:Colposcopy / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods*; D008022:Ligaments / Q000601:surgery*; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D012447:Sacrum / Q000601:surgery; D016896:Treatment Outcome; D014599:Uterus / Q000601:surgery
keywords: Apical support; Colpopexy; Hysterectomy for prolapse; Recurrence