Laparoscopic sacrocolpopexy with concurrent hysterectomy or uterine preservation: A metanalysis and systematic review

Veronica Tius; Martina Arcieri; Cristina Taliento; Giulia Pellecchia; Giampiero Capobianco; Tommaso Simoncini; Giovanni Panico; Daniela Caramazza; Giuseppe Campagna; Lorenza Driul; Giovanni Scambia; Alfredo Ercoli; Stefano Restaino; Giuseppe Vizzielli

doi:10.1002/ijgo.15891

Laparoscopic sacrocolpopexy with concurrent hysterectomy or uterine preservation: A metanalysis and systematic review

Int J Gynaecol Obstet. 2024 Sep 26. doi: 10.1002/ijgo.15891. Online ahead of print.

Authors

Veronica Tius¹, Martina Arcieri², Cristina Taliento^{3

4}, Giulia Pellecchia¹, Giampiero Capobianco⁵, Tommaso Simoncini⁶, Giovanni Panico⁷, Daniela Caramazza⁸, Giuseppe Campagna⁸, Lorenza Driul^{1

2}, Giovanni Scambia⁹, Alfredo Ercoli¹⁰, Stefano Restaino^{2

11}, Giuseppe Vizzielli^{1

2}

Affiliations

¹ Medical Area Department (DAME), in Department of Medicine (DMED), University of Udine, Udine, Italy.
² Clinic of Obstetrics and Gynecology, "S. Maria della Misericordia" University Hospital, Azienda Sanitaria Universitaria Friuli Centrale (ASUFC), Udine, Italy.
³ Department of Medical Sciences, Institute of Obstetrics and Gynecology, University of Ferrara, Ferrara, Italy.
⁴ Department of Development and Regeneration-Woman and Child, KU Leuven, Leuven, Belgium.
⁵ Department of Clinical and Experimental Medicine, Gynecologic and Obstetric Clinic, University of Sassari, Sassari, Italy.
⁶ Division of Obstetrics and Gynecology, Department of Clinical and Experimental Medicine, University of Pisa, Pisa, Italy.
⁷ Department of Woman and Child's Health and Public Health, Division of Urogynecology and Reconstructive Surgery of Pelvic Floor, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
⁸ Precision Gynecological Surgery Unit, Dipartimento Centro di Eccellenza Donna e Bambino Nascente, Fatebenefratelli Gemelli Isola Tiberina, Rome, Italy.
⁹ Department of Woman and Child's Health and Public Health, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
¹⁰ Department of Human Pathology in Adult and Childhood "G. Barresi", Unit of Gynecology and Obstetrics, University of Messina, Messina, Italy.
¹¹ PhD School in Biomedical Sciences, Gender Medicine, Child and Women Health, University of Sassari, Sassari, Italy.

PMID: 39324500
DOI: 10.1002/ijgo.15891

Abstract

Background: Literature is lacking strong evidence about comparisons of efficacy and quality of life-related outcomes between laparoscopic total and/or supracervical hysterectomy (LTH/LSCH) with laparoscopic sacrocolpopexy (LSC) and minimally invasive sacrohysteropexy (LSH).

Objective: To summarize and compare available data on this topic providing a useful clinical tool in the treatment decision process.

Search strategy: We performed a systematic research of PubMed (MEDLINE), Web of Science, and Gooogle Scholar.

Selection criteria: We included studies that compared at least one efficacy outcome (objective or subjective outcome) between LTH/LSCH with LSC and LSH. Data on surgery-related morbidities were also extracted where available.

Data collection and analysis: A random-effect meta-analysis was conducted reporting pooled mean differences and odds ratios (OR) between groups using Review Manager V.7.9.0.

Main results: We included a total of nine observational studies. LTH/LSCH with LSH was associated with a significantly higher objective success (apical compartment OR 7.95; 95% confidence interval [CI] 2.23-28.33; I² = 0%; P = 0.001; anterior compartment OR 2.23; 95% CI 1.26-4.30; I² = 12%; P = 0.007) and subjective success (OR 3.19; 95% CI 1.42-7.17; I² = 39%; P = 0.005). No differences were found regarding intraoperative and postoperative complications, sexual dysfunction, and stress urinary incontinence rate after surgery. Hysteropexy showed shorter operative time and shorter hospital length with a pool mean difference of 27.37 min (95% CI 18.04-32.71; I² = 0%; P < 0.001) and 0.7 days (95% CI 0.24-1.17; I² = 75%; P = 0.003), respectively. Concurrent hysterectomy was not associated with a higher rate of mesh-related complications (P = 0.53). No major differences were found regarding recurrence and reoperation rate (P = 0.10 and P = 0.93, respectively).

Conclusions: LTH/LSCH with LSC has better objective and subjective outcomes in pelvic organ prolapse surgery than LSH alone, especially for apical and anterior compartments, and is not associated with higher postoperative sexual dysfunction and mesh-related complications. Adequate preoperative counseling is highly recommended in patients who desire uterine preservation.

Prospero registration number: CRD42024537270.

Keywords: hysterectomy; hysteropexy; laparoscopy; minimally invasive surgery; pelvic organ prolapse; sacrocolpopexy; uterine preservation.

Publication types

Review