Laparoscopic sacrocolpopexy with concurrent hysterectomy or uterine preservation: A metanalysis and systematic review.

Abstract

<h4>Background</h4>Literature is lacking strong evidence about comparisons of efficacy and quality of life-related outcomes between laparoscopic total and/or supracervical hysterectomy (LTH/LSCH) with laparoscopic sacrocolpopexy (LSC) and minimally invasive sacrohysteropexy (LSH).<h4>Objective</h4>To summarize and compare available data on this topic providing a useful clinical tool in the treatment decision process.<h4>Search strategy</h4>We performed a systematic research of PubMed (MEDLINE), Web of Science, and Gooogle Scholar.<h4>Selection criteria</h4>We included studies that compared at least one efficacy outcome (objective or subjective outcome) between LTH/LSCH with LSC and LSH. Data on surgery-related morbidities were also extracted where available.<h4>Data collection and analysis</h4>A random-effect meta-analysis was conducted reporting pooled mean differences and odds ratios (OR) between groups using Review Manager V.7.9.0.<h4>Main results</h4>We included a total of nine observational studies. LTH/LSCH with LSH was associated with a significantly higher objective success (apical compartment OR 7.95; 95% confidence interval [CI] 2.23-28.33; I² = 0%; P = 0.001; anterior compartment OR 2.23; 95% CI 1.26-4.30; I² = 12%; P = 0.007) and subjective success (OR 3.19; 95% CI 1.42-7.17; I² = 39%; P = 0.005). No differences were found regarding intraoperative and postoperative complications, sexual dysfunction, and stress urinary incontinence rate after surgery. Hysteropexy showed shorter operative time and shorter hospital length with a pool mean difference of 27.37 min (95% CI 18.04-32.71; I² = 0%; P < 0.001) and 0.7 days (95% CI 0.24-1.17; I² = 75%; P = 0.003), respectively. Concurrent hysterectomy was not associated with a higher rate of mesh-related complications (P = 0.53). No major differences were found regarding recurrence and reoperation rate (P = 0.10 and P = 0.93, respectively).<h4>Conclusions</h4>LTH/LSCH with LSC has better objective and subjective outcomes in pelvic organ prolapse surgery than LSH alone, especially for apical and anterior compartments, and is not associated with higher postoperative sexual dysfunction and mesh-related complications. Adequate preoperative counseling is highly recommended in patients who desire uterine preservation.<h4>Prospero registration number</h4>CRD42024537270.