Comparison of outcomes of laparoscopic sacrocolpopexy with concomitant supracervical hysterectomy or uterine preservation
Open accessAbstract
Introduction and hypothesis: Sacrocolpopexy was traditionally performed for post-hysterectomy prolapse or during concurrent hysterectomy. Sacrocolpopexy outcome with uterine preservation is poorly investigated. This study compared outcomes of laparoscopic sacrocolpopexy with concurrent supracervical hysterectomy or uterine preservation. Methods: This retrospective study compared data of patients with pelvic organ prolapse who underwent laparoscopic sacrocolpopexy with uterine preservation with the data of controls who underwent laparoscopic sacrocolpopexy with supracervical hysterectomy. We analyzed composite failure in uterine preservation versus concurrent supracervical hysterectomy (primary objective) and evaluated factors associated with the primary outcome of composite failure after laparoscopic sacrocolpopexy with preservation or supracervical hysterectomy (secondary objective). Composite failure was defined as subjective bulge symptoms, reoperation, or anatomical prolapse. Cox models indicated time to composite failure as an endpoint. Results: Of 274 patients, 232 underwent laparoscopic sacrocolpopexy with supracervical hysterectomy and 42 underwent laparoscopic uterine preservation. After propensity score matching (ratio: 2, for the laparoscopic sacrocolpopexy with supracervical hysterectomy group), 56 patients (24.1%) were in the supracervical hysterectomy group and 28 (66.7%) in the uterine preservation group. All patients underwent 24 months of follow-up. The composite failure rates were 10.7% for supracervical hysterectomy and 3.6% for preservation (p=0.87). The mean estimated blood loss was 10 ml (preservation, 10.0 ml [5.0–10.0] versus supracervical hysterectomy, 10.0 ml [10.0–15.0]; p=0.007). In the Cox proportional hazards model, higher preoperative body mass index and the point Ba increased composite failure risk. Conclusions: Although not statistically significant, composite failure in the two techniques is likely clinically meaningful.
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These findings are consistent with those of Sato et al. and align with meta-analytic data suggesting that increased blood loss associated with hysterectomy-based repair is primarily attributable to total rather than subtotal hysterectomy.
“These findings are consistent with those of Sato et al. [19] and align with meta-analytic data suggesting that increased blood loss associated with hysterectomy-based repair is primarily attributable to total rather than subtotal hysterectomy [17, 19, 25].”
From Perioperative complications of laparoscopic sacrohysteropexy versus sacrocolpopexy with subtotal hysterectomy for pelvic organ prolapse (2026) · cites this paper as [19]
Sato et al.’s Abstract Results report similar median estimated blood loss with uterine preservation and supracervical hysterectomy (10 mL in each group), and the Discussion describes the difference as not clinically significant. That is consistent with the limited claim about subtotal hysterectomy, but the study did not compare total with subtotal hysterectomy or establish which procedure primarily accounts for increased blood loss. (LLM, conf=0.86)
Experimental — accuracy not yet measuredThese findings contrast with previous observational studies that reported higher mesh exposure rates when total hysterectomy or vaginal mesh procedures were included.
“These findings contrast with previous observational studies that reported higher mesh exposure rates when total hysterectomy or vaginal mesh procedures were included [15–24, 29].”
From Perioperative complications of laparoscopic sacrohysteropexy versus sacrocolpopexy with subtotal hysterectomy for pelvic organ prolapse (2026) · cites this paper as [19]
The Methods and Results passages (page unavailable) describe laparoscopic sacrocolpopexy with uterine preservation or supracervical hysterectomy, not studies including total hysterectomy or vaginal mesh procedures. Searches for mesh exposure, erosion, and those procedures found no passage reporting the claimed higher exposure rates. (LLM, conf=0.74)
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“In contrast, Sato et al. [19] observe that older patients with significant comorbidities may benefit from uterine preservation due to shorter operative time, although this must be weighed against the risk of malignancy and the need for ongoing uterine surveillance.”
- Authors
- Sato, H., Otsuka, S., Abe, H., & Tsukada, S.
- Affiliations
- Kameda Medical Center (JP)
- Corresponding author
- Sato, Hirotaka
- Venue
- International Urogynecology Journal
- Published
- 2023-04-13
- Volume
- 34
- Issue
- 9
- Pages
- 2217-2224
- ISSN
- 0937-3462 (ISSN-L)
- 1433-3023
- PMC
- PMC10506926
- OpenAlex
- W4365442884
- Cited by
- 8
- References
- 28
- Citations by year
- 2026: 1 · 2025: 2 · 2024: 3 · 2023: 2
- FWCI
- 1.67
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Locations
- International Urogynecology Journal (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Gynecological conditions and treatments
- Keywords
- laparoscopic sacrocolpopexy, uterine preservation, subtotal hysterectomy, pelvic organ prolapse, composite failure, body mass index, blood loss
- MeSH terms
- Female, Humans, Hysterectomy, Laparoscopy, Retrospective Studies, Vagina, Treatment Outcome, Pelvic Organ Prolapse
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