Is ‘suspension plus plication’ of the uterosacral ligaments to the vaginal apex during hysterectomy a preventive measure for vaginal vault prolapse? A randomized trial

Objective: The purpose of this study is to investigate the effectiveness of ‘suspending+plicating’ of the uterosacral ligaments to the vaginal apex during transabdominal total hysterectomy as regards development of postoperative vaginal vault prolapse. Materials and methods: The study has been carried out on 60 women who have had total abdominal hysterectomy due to benign reasons between the dates of April 2013 and April 2014. The patients were randomly allocated either to ‘suspension + plication’ group (SP, Group 1) or ‘suspension’ group (S, Group 2). Pelvic Organ Prolapse Quantification (POP-Q) system was applied to all patients before and at 6th months after the surgeries. Preoperative and postoperative C point and transvaginal length (TVL) values were compared within and and between groups. Wilcoxon Signed Ranks test has been used for the statistical analysis of the data. P value was set at 0.05). The comparison between C points (preoperatively and at the 6th month follow up) showed statistically significant difference (p = 0.0002) in group 1, whereas no difference was found in group 2 regarding C point (p = 0.1433). However, the comparison between TVL measurements (preoperatively and at the 6th months follow up) showed no statistically significant difference in group 1 (p = 0.4539), but statistically significant difference was observed in group 2 concerning TVL measurements (p = 0.0001). Conclusion: The ‘suspension + plication’ of the uterosacral ligaments is prophylactic on vault prolapse in the short term.