Clinician perspectives on hysterectomy versus uterine preservation in pelvic organ prolapse surgery : A systematic review and meta-analysis
© 2024 International Federation of Gynecology and Obstetrics..
BACKGROUND: Previous reviews on hysterectomy versus uterine-sparing surgery in pelvic organ prolapse (POP) repair did not consider that the open abdominal approach or transvaginal mesh use have been largely abandoned.
OBJECTIVES: To provide up-to-date evidence by examining only studies investigating techniques currently in use for POP repair.
SEARCH STRATEGY: MEDLINE and Embase databases were searched from inception to January 2023.
SELECTION CRITERIA: We included randomized and non-randomized studies comparing surgical procedures for POP with or without concomitant hysterectomy. Studies describing open abdominal approaches or transvaginal mesh implantation were excluded.
DATA COLLECTION AND ANALYSIS: A random effect meta-analysis was conducted on extracted data reporting pooled mean differences and odds ratios (OR) between groups with 95% confidence intervals (CI).
MAIN RESULTS: Thirty-eight studies were included. Hysterectomy and uterine-sparing procedures did not differ in reoperation rate (OR 0.93; 95% CI 0.74-1.17), intraoperative major (OR 1.34; 95% CI 0.79-2.26) and minor (OR 1.38; 95% CI 0.79-2.4) complications, postoperative major (OR 1.42; 95% CI 0.85-2.37) and minor (OR 1.18; 95% CI 0.9-1.53) complications, and objective (OR 1.38; 95% CI 0.92-2.07) or subjective (OR 1.23; 95% CI 0.8-1.88) success. Uterine preservation was associated with a shorter operative time (-22.7 min; 95% CI -16.92 to -28.51 min), shorter hospital stay (-0.35 days, 95% CI -0.04 to -0.65 days), and less blood loss (-61.7 mL; 95% CI -31.3 to -92.1 mL). When only studies using a laparoscopic approach for both arms were considered, no differences were observed in investigated outcomes between the two groups.
CONCLUSIONS: No major differences were observed in POP outcomes between procedures with and without concomitant hysterectomy. The decision to preserve or remove the uterus should be tailored on individual factors.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2024 |
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| Erschienen: |
2024 |
| Enthalten in: |
Zur Gesamtaufnahme - year:2024 |
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| Enthalten in: |
International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics - (2024) vom: 25. Jan. |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Porcari, Irene [VerfasserIn] |
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| Links: |
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| Themen: |
Hysteropexy |
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| Anmerkungen: |
Date Revised 25.01.2024 published: Print-Electronic Citation Status Publisher |
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| doi: |
10.1002/ijgo.15343 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM367602814 |
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| 041 | |a eng | ||
| 100 | 1 | |a Porcari, Irene |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Clinician perspectives on hysterectomy versus uterine preservation in pelvic organ prolapse surgery |b A systematic review and meta-analysis |
| 264 | 1 | |c 2024 | |
| 336 | |a Text |b txt |2 rdacontent | ||
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| 500 | |a Date Revised 25.01.2024 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status Publisher | ||
| 520 | |a © 2024 International Federation of Gynecology and Obstetrics. | ||
| 520 | |a BACKGROUND: Previous reviews on hysterectomy versus uterine-sparing surgery in pelvic organ prolapse (POP) repair did not consider that the open abdominal approach or transvaginal mesh use have been largely abandoned | ||
| 520 | |a OBJECTIVES: To provide up-to-date evidence by examining only studies investigating techniques currently in use for POP repair | ||
| 520 | |a SEARCH STRATEGY: MEDLINE and Embase databases were searched from inception to January 2023 | ||
| 520 | |a SELECTION CRITERIA: We included randomized and non-randomized studies comparing surgical procedures for POP with or without concomitant hysterectomy. Studies describing open abdominal approaches or transvaginal mesh implantation were excluded | ||
| 520 | |a DATA COLLECTION AND ANALYSIS: A random effect meta-analysis was conducted on extracted data reporting pooled mean differences and odds ratios (OR) between groups with 95% confidence intervals (CI) | ||
| 520 | |a MAIN RESULTS: Thirty-eight studies were included. Hysterectomy and uterine-sparing procedures did not differ in reoperation rate (OR 0.93; 95% CI 0.74-1.17), intraoperative major (OR 1.34; 95% CI 0.79-2.26) and minor (OR 1.38; 95% CI 0.79-2.4) complications, postoperative major (OR 1.42; 95% CI 0.85-2.37) and minor (OR 1.18; 95% CI 0.9-1.53) complications, and objective (OR 1.38; 95% CI 0.92-2.07) or subjective (OR 1.23; 95% CI 0.8-1.88) success. Uterine preservation was associated with a shorter operative time (-22.7 min; 95% CI -16.92 to -28.51 min), shorter hospital stay (-0.35 days, 95% CI -0.04 to -0.65 days), and less blood loss (-61.7 mL; 95% CI -31.3 to -92.1 mL). When only studies using a laparoscopic approach for both arms were considered, no differences were observed in investigated outcomes between the two groups | ||
| 520 | |a CONCLUSIONS: No major differences were observed in POP outcomes between procedures with and without concomitant hysterectomy. The decision to preserve or remove the uterus should be tailored on individual factors | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Review | |
| 650 | 4 | |a hysteropexy | |
| 650 | 4 | |a laparoscopic hysterectomy | |
| 650 | 4 | |a minimally invasive surgery | |
| 650 | 4 | |a sacral cervicopexy | |
| 650 | 4 | |a sacrocolpopexy | |
| 650 | 4 | |a sacrohysteropexy | |
| 650 | 4 | |a uterine prolapse | |
| 650 | 4 | |a vaginal hysterectomy | |
| 700 | 1 | |a Zorzato, Pier Carlo |e verfasserin |4 aut | |
| 700 | 1 | |a Bosco, Mariachiara |e verfasserin |4 aut | |
| 700 | 1 | |a Garzon, Simone |e verfasserin |4 aut | |
| 700 | 1 | |a Magni, Francesca |e verfasserin |4 aut | |
| 700 | 1 | |a Salvatore, Stefano |e verfasserin |4 aut | |
| 700 | 1 | |a Franchi, Massimo P |e verfasserin |4 aut | |
| 700 | 1 | |a Uccella, Stefano |e verfasserin |4 aut | |
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