Colpocleisis with or without hysterectomy. A systematic review and meta-analysis

Area of Science:

• Gynecology
• Surgical Outcomes
• Pelvic Floor Disorders

Background:

• Pelvic organ prolapse (POP) is a prevalent condition in women, frequently necessitating surgical treatment.
• Colpocleisis is an established obliterative procedure, particularly for frail women with advanced POP.
• The necessity of combining colpocleisis with hysterectomy is a subject of ongoing clinical debate.

Purpose of the Study:

• To compare the perioperative outcomes of colpocleisis performed with versus without concomitant hysterectomy.
• To evaluate the impact of hysterectomy addition on surgical duration, blood loss, and postoperative complications in POP patients undergoing colpocleisis.

Main Methods:

• A systematic review and meta-analysis adhering to PRISMA guidelines.
• Searched databases including PubMed, Scopus, and Google Scholar up to January 2025.
• Included comparative studies on colpocleisis with and without hysterectomy, analyzing operative time, blood loss, complications, transfusion rates, and hospital stay.

Main Results:

• Analysis of four retrospective studies involving 1,423 patients (370 with hysterectomy, 1,043 without).
• Hysterectomy was associated with significantly longer operative time (MD: -27.79 min; p=0.01) and increased blood loss (MD: -17.78 ml; p=0.001).
• No significant differences were observed in complication rates (OR: 0.95; p=0.83), transfusion rates (OR: 0.77; p=0.65), or hospital stay (MD: -0.16 days; p=0.55).

Conclusions:

• Colpocleisis combined with hysterectomy extends surgical time and increases blood loss but does not elevate complication rates or hospital stay.
• While hysterectomy may prevent future uterine pathology, its added surgical risks are minimal.
• Individualized, patient-centered decision-making is essential when considering hysterectomy alongside colpocleisis.