Laparoscopic Shull Technique for Uterine Prolapse and Risk of Recurrences: A Retrospective Comparison with Vaginal Hysterectomy.

INTRODUCTION AND HYPOTHESIS

The objective was to compare the vaginal and laparoscopic approaches with natural tissue vaginal repair of pelvic organ prolapse (POP) in terms of recurrence rate and complete remission rate (CRR) of symptoms.

MATERIALS AND METHODS

This retrospective cohort study analyzed women who underwent hysterectomy for uterine prolapse at two Italian hospitals between October 2021 and March 2023. Group A included 89 patients who received vaginal hysterectomy and colposuspension (VCH), whereas group B included 58 patients who underwent laparoscopic hysterectomy followed by laparoscopic colposuspension sec Shull (LPSS).

RESULTS

The study included 147 patients with comparable baseline characteristics regarding menopausal age and body mass index. Concerning preoperative data, it is worth mentioning that group A had a higher proportion of patients with more than two previous deliveries and, overall, more severe prolapse stages. Concerning postoperative results, the patients undergoing laparoscopic surgery had longer operation times than group A. Moreover, group B had a higher recurrence rate after surgery (5.6% vs 13%, p = 0.057). Kaplan-Meier analysis indicated a lower rate of prolapse-free patients over time in group B. Cox regression showed a higher hazard ratio for recurrence in the LCSS group than in the VCH group. Complete remission rates for urinary symptoms varied, with group B showing higher CRR for stress incontinence (33% vs 71%, p < 0.001).

CONCLUSION

Both VCH and LCSS are effective for POP treatment, with VCH showing better outcomes in terms of symptom remission and shorter operation times. At the same time, LCSS had better CRR for stress incontinence but a higher recurrence rate. Further high-quality prospective studies are needed to confirm these findings and determine the best surgical approach for POP.