Complications After Vaginal Vault Suspension: A Nationwide Cohort Study Comparing Six Apical Procedures

Area of Science:

• Urogynecology
• Pelvic Reconstructive Surgery
• Surgical Outcomes Research

Background:

• Vaginal vault prolapse is a common condition following hysterectomy.
• Several surgical procedures exist for vaginal vault prolapse repair.
• Comparing complication profiles is crucial for optimal patient management.

Purpose of the Study:

• To compare complication profiles of six surgical procedures for vaginal vault prolapse in women with prior hysterectomy.
• To identify the safest and most effective surgical approach based on complication rates.

Main Methods:

• Nationwide cohort study with 3-14 years' follow-up.
• Included 1374 women undergoing primary vaginal vault suspension: sacrocolpopexy (SCP), laparoscopic uterosacral ligament suspension (LUSLS), ipsilateral uterosacral ligament suspension (IUSLS), vaginal extraperitoneal uterosacral ligament suspension (VEULS), sacrospinous ligament fixation (SSLF), and SSLF with graft.
• Complications within 30 days were classified by Clavien-Dindo; Cox regression adjusted for demographics.

Main Results:

• SSLF demonstrated the lowest intraoperative and severe Clavien-Dindo ≥ III complication rates.
• Mesh exposure was 12.0% for SCP and 12.2% for SSLF with graft.
• IUSLS had higher rates of catheter use and UTIs; SSLF was linked to increased hematoma and pain; SCP had more de novo incontinence and subsequent SUI surgery.

Conclusions:

• Complication profiles varied significantly among the six surgical procedures.
• SSLF was associated with a lower risk of severe complications.
• Mesh-based repairs showed comparable mesh exposure rates, supporting individualized surgical decision-making.