Laparoscopic mesh sacr ocolpopexy versus lateral vaginal vault suspension in prevention of post hysterectomy vault prolapse: a randomized trial

Abstract

Objective To compare laparoscopic mesh sacrocolpopexy (LSC) and laparoscopic lateral suspension (LLS) for preventing post hysterectomy vault prolapse. Methods This randomized trial included 40 women who were scheduled for a hysterectomy. The patients were randomly assigned to two groups in a 1:1 ratio: group I underwent LSC immediately after hysterectomy and group II (n=20) underwent LLS immediately after hysterectomy. Results Postoperative pelvic organ prolapse quantification measurements (anterior vaginal points anterior vaginal wall points A and posterior vaginal wall points B, vaginal apex point C, and posterior vaginal points anterior prolapse and posterior prolapse) were significantly better in the LSC group, with a lower rate of postoperative vault prolapse beyond the introitus (P=0.047). Both groups showed similar estimated blood loss, urinary tract infection, wound infection, and urinary retention rates. However, LSC was associated with significantly higher postoperative pain scores at 24 hours and 48 hours and a longer hospital stay (P<0.05). Conclusion Although LSC demonstrated more favorable anatomical outcomes and a lower incidence of postoperative vault prolapse beyond the introitus than LLS, these findings should be interpreted with caution because of the limited sample size. Both procedures showed comparable safety profiles, although the LSC was associated with greater postoperative pain and longer hospitalization times. Given the study’s exploratory design, small cohort, and short follow-up period, further large-scale multicenter studies are needed to confirm these preliminary observations and to better inform clinical practice regarding the optimal surgical approach for preventing post hysterectomy vault prolapse.