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Traditional McCall culdoplasty compared to a modified McCall technique with double ligament suspension: anatomical
Silvia Parisi1, Antonia Novelli2,3, Elena Olearo1
1Department of Obstetrics and Gynecology, "Regina Montis Regalis" Hospital, ASLCN1, Via San Rocchetto 99, cap 12084, Mondovì, CN, Italy.
Introduction And Hypothesis:
This study compared anatomical and clinical outcomes of traditional McCall culdoplasty versus a modified McCall technique with double ligament suspension (DLS).
Methods:
This retrospective study presents outcomes of 68 patients who underwent vaginal hysterectomy and vaginal suspension for apical prolapse ≥ stage II according to the POP-Q score system, at, between January 2016 and February 2018. In 34 women vaginal cuff suspension was obtained with traditional McCall culdoplasty (McCall group), while in 34 women we performed a modified McCall, which consists of a double ligament suspension (DLS group), suspending the vaginal cuff to uterosacral ligaments and also to adnexal peduncles. Primary outcome was prolapse recurrence ≥ stage II according to the POP-Q system. Fisher's, Mann-Whitney U and Student's t tests were used for statistical analysis.
Results:
There were no statistical differences among patients' preoperative characteristics, operative time, blood loss or postoperative complications. Follow-up mean duration was 23.2 ± 6.7 and 22.4 ± 8.7 months in the McCall and DLS group, respectively. Prolapse recurrence occurred in 11 (32.3%) women in the McCall group versus 2 (5.9%) women in the DLS group (p < 0.05): among them, 2 patients (5.9%) in the McCall group and 1 (2.9%) in the DLS group required further treatment. Total vaginal length was 6.1 ± 0.9 cm in the McCall group versus 6.9 ± 0.7 cm in the DLS group (p < 0.001). No statistical difference in quality of life assessment was observed.
Conclusions:
DLS group patients had better anatomical outcomes and lower recurrence rates than McCall group patients, without increasing operative time or complications. A prospective study with more cases is needed to confirm our data.
