Clinical outcomes in women undergoing laparoscopic hysteropexy: A systematic review

Abstract

Objectives: To systematically review the current evidence on the anatomic and functional outcomes in women undergoing laparoscopic hysteropexy.

Study design: An electronic database search was undertaken (2000-2016). Keywords were: "laparoscopy", "hysteropexy", "cervicopexy", "uterine suspension", "uterosacral plication". References of identified studies as well as abstracts from conferences were considered. We restricted the search to humans, female patients and currently used surgical procedures. Studies with ≥5 cases in English language and published in 2000 or later, were included. After the initial yield, studies were selected following title screening, abstract and full text scrutiny.

Results: A total of 17 studies were deemed suitable for inclusion in the review. A total of 770 patients in 17 studies received the intervention being studied (laparoscopic hysteropexy) and were assessed post-operatively with pooled success rates of 85.32% (95%CI: ±2.5). Laparoscopic suture hysteropexy has pooled success of 70.5% (95%CI:±5.33) whereas the pooled success of the suspension to the sacral promontory using mesh or tape is 92% (95%CI: ±2.53). One small study on suspension to the anterior abdominal wall (28 cases) and one to the pectineal ligament (18 cases) have shown 96.4% (95%CI:±6.9) and 94.5% (95%CI:±10.53) objective success rates respectively.

Conclusion: Laparoscopic hysteropexy was associated with good anatomic cure rates of greater than 90% in majority of the studies. There was an improvement in symptoms, and good subjective cure rates in 73%-100% of the patients. Reoperation rates were low in most studies ranging from around 0%-28%. Complications rates were generally low. Laparoscopic hysteropexy is a feasible alternative for women needing surgical correction of uterovaginal prolapse and who desire conservation of the uterus.

Keywords: Cervicopexy; Hysteropexy; Laparoscopy; Uterine suspension; Uterosacral plication.