Objectives: McCall culdoplasty is a commonly performed procedure for pelvic organ prolapse surgical repair; despite its good efficacy, however, anterior prolapse recurrence frequently occurs. The aim of our study was to verify whether fixation of utero-sacral ligaments (USLs) to anterior vaginal wall during a modified McCall culdoplasty (MMC) could reduce the rate of anterior recurrence of prolapse. Study design: This was a retrospective study on women submitted to MMC after vaginal hysterectomy and anterior colporraphy for prolapse repair. Patients undergoing concurrent anterior fixation of USLs (AF) were compared to cases treated with MMC alone, evaluating potential differences in anatomic result of prolapse repair at 12 months, rate of anterior recurrence over time, operative data and post-operative morbidity. Results: Women undergoing MMC with AF (n = 45), compared with patients treated with MMC alone (n = 77), showed better results in terms of anatomic support in the anterior compartment at 12 months, assessed by means of POP-Q system parameters Aa (-1.8 cm vs −1.2 cm, p 0.0025) and Ba (-2.0 cm vs −1.3 cm, p 0.00015), and a lower rate of anterior recurrence (11.1% vs 29.9%, p 0.025); the other parameters of prolapse anatomic staging did not differ significantly, nor did operative data or post-operative morbidity. Follow up confirmed a longer disease-free survival over time for women treated with MMC with AF (p 0.028) Conclusions: Fixation of USLs to anterior vaginal wall at time of post-hysterectomy MMC appears to improve anatomic outcomes of the procedure reducing the risk of anterior prolapse, without implying a reduced safety, nor a greater surgical complexity.

Fixation of uterosacral ligaments to anterior vaginal wall during modified McCall culdoplasty after vaginal hysterectomy

Mancarella M.;Testa F.;Novara L.;Biglia N.
;
2022-01-01

Abstract

Objectives: McCall culdoplasty is a commonly performed procedure for pelvic organ prolapse surgical repair; despite its good efficacy, however, anterior prolapse recurrence frequently occurs. The aim of our study was to verify whether fixation of utero-sacral ligaments (USLs) to anterior vaginal wall during a modified McCall culdoplasty (MMC) could reduce the rate of anterior recurrence of prolapse. Study design: This was a retrospective study on women submitted to MMC after vaginal hysterectomy and anterior colporraphy for prolapse repair. Patients undergoing concurrent anterior fixation of USLs (AF) were compared to cases treated with MMC alone, evaluating potential differences in anatomic result of prolapse repair at 12 months, rate of anterior recurrence over time, operative data and post-operative morbidity. Results: Women undergoing MMC with AF (n = 45), compared with patients treated with MMC alone (n = 77), showed better results in terms of anatomic support in the anterior compartment at 12 months, assessed by means of POP-Q system parameters Aa (-1.8 cm vs −1.2 cm, p 0.0025) and Ba (-2.0 cm vs −1.3 cm, p 0.00015), and a lower rate of anterior recurrence (11.1% vs 29.9%, p 0.025); the other parameters of prolapse anatomic staging did not differ significantly, nor did operative data or post-operative morbidity. Follow up confirmed a longer disease-free survival over time for women treated with MMC with AF (p 0.028) Conclusions: Fixation of USLs to anterior vaginal wall at time of post-hysterectomy MMC appears to improve anatomic outcomes of the procedure reducing the risk of anterior prolapse, without implying a reduced safety, nor a greater surgical complexity.
2022
270
221
226
Anterior colporraphy; Anterior recurrence; McCall culdoplasty; Pelvic organ prolapse surgery; Uterosacral ligaments; Vaginal hysterectomy; Female; Humans; Ligaments; Retrospective Studies; Treatment Outcome; Hysterectomy, Vaginal; Pelvic Organ Prolapse
Mancarella M.; Testa F.; Chiado Piat F.; Novara L.; Biglia N.; Sgro L.G.
File in questo prodotto:
File Dimensione Formato  
Fixation to uterosacral ligaments to anterior vaginal wall during modified McCall culdoplasty after vaginal hysterectomy.pdf

Accesso riservato

Descrizione: Articolo principale
Tipo di file: PDF EDITORIALE
Dimensione 537.62 kB
Formato Adobe PDF
537.62 kB Adobe PDF   Visualizza/Apri   Richiedi una copia

I documenti in IRIS sono protetti da copyright e tutti i diritti sono riservati, salvo diversa indicazione.

Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/2318/1858479
Citazioni
  • ???jsp.display-item.citation.pmc??? 1
  • Scopus 1
  • ???jsp.display-item.citation.isi??? 1
social impact