Abdominal colposacropexy and sacrospinous ligament suspension for severe uterovaginal prolapse: A comparison

A randomized prospective study was undertaken to compare the results of abdominal colposacropexy and sacrospinous ligament fixation in correcting severe uterovaginal prolapse. Between 1991 and 1996, 138 women with uterine prolapse or vaginal vault eversion greater than stage III (ICS grading system) were enrolled. Seventy-two women were treated with unilateral sacrospinous ligament suspension, and 66 underwent abdominal colposacral suspension. Optimal surgical effectiveness was defined as no protrusion of vaginal wall greater than stage II. One hundred eighteen patients (abdominal approach 52, vaginal approach 66) were followed up for a mean period of 2.1 years (range 1-5.2 years). These two groups were comparable in age, weight, parity, and rate of prior pelvic surgery. Four in the abdominal group and seven in the vaginal group incurred complications that necessitated further surgical corrections. The vaginal group had more intraoperative blood loss, a shorter operative time, longer indwelling catheterization, and dyspareunia as well as longer hospital stay. The optimal surgical effectiveness in the vaginal group was 80.3% (53/66), and that in the abdominal group was 94.2% (49/52). These results revealed a statistically significant difference (p = 0.029). In view of the significant difference in optimal surgical effectiveness and other parameters, abdominal colposacropexy achieved better results in correcting severe pelvic organ prolapse than did sacrospinous ligament suspension.