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

Pelvic organ prolapse (POP) is a common condition among women, often requiring surgical intervention. Colpocleisis is a well-established obliterative procedure especially for frail women with advanced POP. However, the need for concomitant vaginal hysterectomy remains debated. We aim to compare the perioperative outcomes of patients who had colpocleisis with and without hysterectomy.

A systematic review and meta-analysis was performed following PRISMA guidelines. PubMed, Scopus, and Google Scholar were searched up to January 2025. Comparative studies assessing perioperative outcomes of colpocleisis with and without hysterectomy were included. Primary outcomes were operative time, estimated blood loss, and postoperative complications. Secondary outcomes included blood transfusion rates and hospital stay.

Four retrospective studies with 1.423 patients were analyzed (370 colpocleisis with hysterectomy versus 1.043 colpocleisis alone). Hysterectomy was associated with longer operative time (MD: -27.79 min; p = 0.01) and increased amounts of estimated blood loss (MD: -17.78 ml; p = 0.001). However, complication rates (OR: 0.95; p = 0.83), transfusion rates (OR: 0.77; p = 0.65), and hospital stay (MD: -0.16 days; p = 0.55) were comparable.

Colpocleisis with hysterectomy prolongs surgery and increases blood loss without affecting complication rates or hospital stay. The addition of hysterectomy to colpocleisis may prevent future uterine pathology while its added surgical risks are considered minimal. However, individualized patient-based decision-making remains crucial.