From the Guidelines
A supracervical hysterectomy is recommended during sacrocolpopexy because it provides a stronger attachment point for the mesh or graft material, reducing the risk of mesh erosion and preserving vaginal length and axis. This approach offers several advantages, including improved incontinence and sexual response, as well as shorter, less-morbid surgery 1. The benefits of supracervical hysterectomy are outlined in Table 1 of the study by 1, which highlights the potential advantages of this procedure, including improved incontinence sexual response, less urinary issues, and less pelvic floor prolapse.
Some key points to consider when deciding on a supracervical hysterectomy during sacrocolpopexy include:
- The cervical stump serves as a sturdy anatomical structure for mesh fixation, potentially reducing the risk of mesh erosion into the vagina
- Preserving the cervix may help maintain normal vaginal length and axis, potentially resulting in better sexual function outcomes
- The supracervical approach is typically associated with shorter operative time, less blood loss, and lower risk of injury to surrounding structures like the ureters and bladder
- Patients who retain their cervix will need to continue cervical cancer screening according to standard guidelines, as noted in the study 1
It is essential to individualize this recommendation based on the patient's specific circumstances, including the absence of cervical pathology or risk factors for cervical disease, as the study 1 suggests that the decision should be left to the individual and her practitioner. For women with a history of abnormal Pap smears, cervical dysplasia, or other cervical pathology, a total hysterectomy may be more appropriate during sacrocolpopexy.
From the Research
Rationale for Supracervical Hysterectomy at Time of Sacrocolpopexy
- The decision to perform a supracervical hysterectomy at the time of sacrocolpopexy is based on several factors, including the potential benefits of reduced surgical and postoperative morbidity 2.
- Studies have shown that supracervical hysterectomy may be associated with better preservation of bladder and sexual function compared to total hysterectomy 2.
- A retrospective study comparing outcomes of laparoscopic sacrocolpopexy with concomitant supracervical hysterectomy or uterine preservation found that composite failure rates were similar between the two groups, with 10.7% for supracervical hysterectomy and 3.6% for preservation (p=0.87) 3.
- Another study found that reoperations for prolapse and mesh complications after sacrocolpopexy were similar between patients who underwent supracervical hysterectomy, total hysterectomy, or no hysterectomy 4.
Surgical Considerations
- Laparoscopic supracervical hysterectomy has been introduced as a minimally invasive alternative to traditional open supracervical hysterectomy, with potential advantages including reduced operative time and blood loss 5.
- A randomized clinical trial comparing different methods for cervical incision and uterine morcellation during laparoscopic sacral colpopexy found that the use of a bipolar laparoscopic loop and morcellator resulted in significantly shorter operative times and reduced blood loss 5.
- A multicenter retrospective cohort study comparing laparoscopic sacral hysteropexy and laparoscopic sacral colpopexy with concomitant supracervical hysterectomy found that both procedures were safe and effective, with similar anatomical and subjective success rates 6.
Patient Selection
- The decision to perform a supracervical hysterectomy at the time of sacrocolpopexy should be individualized based on patient factors, including the presence of abnormal uterine findings and patient preference 6.
- Patients who are strongly motivated to preserve the uterus in the absence of abnormal uterine findings may be offered laparoscopic sacral hysteropexy as an alternative to supracervical hysterectomy 6.