Laparoscopic Uterosacral Ligament Suspension versus Sacrospinous Ligament Fixation for Apical Prolapse: Perioperative Outcomes

Abstract Background: Pelvic organ prolapse can be repaired vaginally or laparoscopically. Studies comparing vaginal repair with sacrospinous ligament fixation (SSLF) or uterosacral ligament suspension (V-USLS) have found no difference in functional or adverse outcomes. Laparoscopic USLS (L-USLS) is becoming a popular treatment for pelvic organ prolapse because it has a low rate of ureteral compromise. To date, no studies have compared perioperative outcomes between L-USLS and SSLF. The objective of this study is to compare the rates of perioperative complications (intraoperative and postoperative complications) between these two methods.Methods: This was a retrospective chart review of 243 consecutive patients who underwent L-USLS or SSLF at one institution between 3/2017 and 8/2019 for apical pelvic organ prolapse. Descriptive data was analyzed as appropriate with student t-tests and Chi Square. Univariable Logistic Regression analysis was performed to assess predictors of perioperative complications.Results: Preoperative Pelvic Organ Prolapse Quantification Stage (POP-Q) was similar between the two cohorts (p=0.23). After adjusting for confounding factors, L-USLS was associated with a longer operative time (118 vs 142 min, p <0.01) and shorter length of hospitalization (0.68 vs 1.06 days, p <0.01). The estimated blood loss between the procedures was not statistically significant after adjusting for confounding factors. There was no difference in perioperative complication rates between L-USLS and SSLF (5% vs 7%, p = 0.55). No clinical risk factors were significantly associated with perioperative complications.Conclusion: We did not find a difference in complications between L-USLS and SSLF.