Vermeulen CKM, Schuurman B, Coolen ALWM, Meijs-Hermanns PR, van Leijsen SAL, Veen J, Bongers MY. The effectiveness and safety of laparoscopic uterosacral ligament suspension: A systematic review and meta-analysis.
BJOG 2023;
130:1568-1578. [PMID:
37271736 DOI:
10.1111/1471-0528.17565]
[Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 05/10/2023] [Accepted: 05/19/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND
Laparoscopic uterosacral ligament suspension (LUSLS) is a technique to correct apical pelvic organ prolapse (POP) by shortening the uterosacral ligaments with sutures.
OBJECTIVE
A systematic review with meta-analysis of the effectiveness and safety of LUSLS as treatment for apical POP.
SEARCH STRATEGY
PubMed and Cochrane search using 'pelvic organ prolapse', 'laparoscopy' and 'uterosacral', including synonyms.
SELECTION CRITERIA
All articles in English presenting outcome of an original series of women with LUSLS as treatment of apical POP. Case reports were excluded.
DATA COLLECTION AND ANALYSIS
Study enrollment was performed by two reviewers. Our primary outcome measures were objective and subjective effectiveness of the procedure. Secondary outcome measures regarded complications and recurrence. Bias was assessed with the Newcastle Ottawa Scale.
MAIN RESULTS
Of 138 hits, 13 studies were included with 933 LUSLS patients. The average follow-up was 22 months. All were nonrandomised cohort studies. The pooled anatomic success rate is 90% for all LUSLS procedures (95% confidence interval [CI] 83.3-95.5). LUSLS with hysterectomy resulted in an anatomic success rate of 96.6% (95% CI 87.5-100) and LUSLS with uterus preservation 83.4% (95% CI 67.7-94.6). The pooled subjective cure rate was 90.5% (95% CI 81.9-96.5). The rate of major complications was 1%.
CONCLUSIONS
Laparoscopic uterosacral ligament suspension (with or without uterus preservation) seems to be an effective and safe treatment for women with apical POP, but long-term prospective trials and randomised controlled trials are necessary to confirm these findings.
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