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LAPAROSCOPIC SUTURE HYSTEROPEXY FOR UTERINE PROLAPSE

From the Urogynaecology Unit, Royal Women’s and Mercy Hospital, Melbourne, Australia.

Address reprint requests to: Christopher F. Maher, FRANZCOG Wesley Urogynaecology Unit, Suite 86 Level 4 Sandford Jackson Building 30 Chasely Street Auchenflower, Queensland 4066 Australia E-mail: chrismaher{at}urogynaecology.com.au

Objective: Vaginal hysterectomy remains the accepted surgical treatment for women with uterine prolapse. The Manchester repair is favored in women wishing uterine preservation. Vaginal hysterectomy alone fails to address the pathologic cause of the uterine prolapse. The Manchester repair has a high failure rate and may cause difficulty sampling the cervix and uterus in the future. The laparoscopic suture hysteropexy offers physiologic repair of uterine prolapse.

Method: At the laparoscopic suture hysteropexy, the pouch of Douglas is closed and the uterosacral ligaments are plicated and reattached to the cervix.

Results: Forty-three women with symptomatic uterine prolapse were prospectively evaluated and underwent laparoscopic suture hysteropexy with a mean follow-up of 12 ± 7 months (range 6–32). The mean operating time for the laparoscopic suture hysteropexy alone was 42 ± 15 minutes (range 22–121), and the mean blood loss was less than 50 mL. On review, 35 women (81%) had no symptoms of prolapse and 34 (79%) had no objective evidence of uterine prolapse. Two women subsequently completed term pregnancies and were without prolapse. Both underwent elective cesarean delivery.

Conclusion: The laparoscopic suture hysteropexy is effective and safe in the management of symptomatic uterine prolapse. The result is physiologically correct, without disfiguring the cervix. This may be an appropriate procedure for women with uterine prolapse wishing uterine preservation.