Minimally Invasive Total Versus Supracervical Hysterectomy With Sacrocolpopexy

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IMPORTANCE: Limited data exist comparing total laparoscopic hysterectomy (TLH) versus laparoscopic supracervical hysterectomy (LSCH) at the time of minimally invasive sacrocolpopexy for uterovaginal prolapse. OBJECTIVES: The objective of this study was to compare TLH versus LSCH at the time of minimally invasive sacrocolpopexy for uterovaginal prolapse, hypothesizing that LSCH would demonstrate a higher proportion of recurrent prolapse, but a lower proportion of mesh exposures. STUDY DESIGN: This was a retrospective, secondary analysis comparing a prospective cohort of patients undergoing TLH sacrocolpopexy versus a retrospective cohort of patients who had undergone LSCH sacrocolpopexy. Our primary outcome was composite anatomic pelvic organ prolapse recurrence (prolapse beyond hymen, apical descent > half vaginal length, retreatment). Secondary outcomes included vaginal mesh exposures. RESULTS: There were 733 procedures: 184 (25.1%) TLH sacrocolpopexy and 549 (74.9%) LSCH sacrocolpopexy. Median follow-up was longer in the TLH cohort (369 [IQR 354-386] vs 190 [IQR 63-362] days, P < 0.01). There was no difference in composite prolapse recurrence between groups on bivariable analysis (3.3% vs 4.7%, P = 0.40). However, multivariable logistic regression demonstrated that TLH sacrocolpopexy had lower odds of composite pelvic organ prolapse recurrence than LSCH sacrocolpopexy (OR 0.21, 95% CI 0.05-0.82, P = 0.02). Among procedures with lightweight mesh types, TLH demonstrated a higher proportion of mesh exposures compared to LSCH (10 [5.4%] vs 4 [1.1%], P < 0.01); however, this was not significant after controlling for confounders (OR 4.51, 95% CI 0.88-39.25, P = 0.08). There were no differences in retreatment or reoperation. CONCLUSION: For the treatment of uterovaginal prolapse, both TLH and LSCH are acceptable methods of concomitant hysterectomy at the time of minimally invasive sacrocolpopexy, albeit with likely different risk profiles.

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