Comparison of effectiveness of vaginal and abdominal routes in treating severe uterovaginal or vault prolapse

CCM Ng, WHC Han
Correspondence: Dr Christopher Ng Chee Mun, drchrisng@hotmail.com

ABSTRACT
Introduction This study compares the efficacy of abdominal and vaginal routes in correcting severe uterovaginal or vault prolapses by examining their primary surgical outcomes.
Methods A retrospective study was conducted on operations performed from March 1998 to December 2001. The classifications of uterovaginal prolapse and vault prolapse were based on the Halfway system. It involved 177 women with at least grade 4 uterovaginal prolapse or grade 3 vault prolapse, and had undergone vaginal sacrospinous ligament fixation or abdominal sacrocolpopexy. The subjects were divided into two groups: 113 women who had an abdominal sacrocolpopexy and 64 women who had a vaginal sacrospinous ligament fixation. The primary surgical outcome measures was classified as cured, improved or failure according to our definition at their last follow-up.
Results The abdominal sacrocolpopexy group had significantly greater intra-operative blood loss, operating time, haematuria, longer postoperative catheterisation and hospitalisation. Vaginal sacrospinous ligament fixation had more suture erosion. 95.6 percent of women with abdominal sacrocolpopexy were cured compared to 79.7 percent with vaginal sacrospinous ligament fixation. Five (4.4 percent) patients in the abdominal sacrocolpopexy group and six (9.4 percent) in the vaginal sacrospinous ligament fixation group defaulted their six-month follow-up with a mean follow-up of 18.1 months (range 0.9-48.1 months) and 13.2 months (range 1.1-29.1 months), respectively.
Conclusion Abdominal sacrocolpopexy is more effective in correcting severe uterovaginal or vault prolapses but it is associated with higher intra- and post-operative morbidity compared to vaginal sacrospinous ligament fixation. Vaginal sacrospinous ligament fixation is preferred in patients with medical disorders.

Keywords: abdominal sacrocolpopexy, uterovaginal prolapse, vaginal sacrospinous ligament fixation, vault prolapse
Singapore Med J 2004; 45(10): 475-481