Traditional McCall culdoplasty compared to a modified McCall technique with double ligament suspension: anatomical and c
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ORIGINAL ARTICLE
Traditional McCall culdoplasty compared to a modified McCall technique with double ligament suspension: anatomical and clinical outcomes Silvia Parisi 1 & Antonia Novelli 1,2 & Elena Olearo 1 & Alessandro Basile 1 & Andrea Puppo 1,3 Received: 23 April 2020 / Accepted: 17 June 2020 # The International Urogynecological Association 2020
Abstract Introduction and hypothesis This study compared anatomical and clinical outcomes of traditional McCall culdoplasty versus a modified McCall technique with double ligament suspension (DLS). Methods This retrospective study presents outcomes of 68 patients who underwent vaginal hysterectomy and vaginal suspension for apical prolapse ≥ stage II according to the POP-Q score system, at, between January 2016 and February 2018. In 34 women vaginal cuff suspension was obtained with traditional McCall culdoplasty (McCall group), while in 34 women we performed a modified McCall, which consists of a double ligament suspension (DLS group), suspending the vaginal cuff to uterosacral ligaments and also to adnexal peduncles. Primary outcome was prolapse recurrence ≥ stage II according to the POP-Q system. Fisher’s, Mann-Whitney U and Student’s t tests were used for statistical analysis. Results There were no statistical differences among patients’ preoperative characteristics, operative time, blood loss or postoperative complications. Follow-up mean duration was 23.2 ± 6.7 and 22.4 ± 8.7 months in the McCall and DLS group, respectively. Prolapse recurrence occurred in 11 (32.3%) women in the McCall group versus 2 (5.9%) women in the DLS group (p < 0.05): among them, 2 patients (5.9%) in the McCall group and 1 (2.9%) in the DLS group required further treatment. Total vaginal length was 6.1 ± 0.9 cm in the McCall group versus 6.9 ± 0.7 cm in the DLS group (p < 0.001). No statistical difference in quality of life assessment was observed. Conclusions DLS group patients had better anatomical outcomes and lower recurrence rates than McCall group patients, without increasing operative time or complications. A prospective study with more cases is needed to confirm our data. Keywords McCall culdoplasty . Native tissue repair . Prolapse recurrence . Vaginal suspension
Introduction Pelvic organ prolapse (POP) is defined as the descent of the vaginal walls, uterus or cuff [1]. It is a common clinical condition affecting 50% of parous women > 50 years of age [2].
* Antonia Novelli [email protected] 1
Department of Obstetrics and Gynecology, “Regina Montis Regalis” Hospital, ASLCN1, Via San Rocchetto 99, cap 12084, Mondovì, CN, Italy
2
Division of Gynecology Oncology, Department of Women and Child Health, Catholic University of the Sacred Heart, Rome, Italy
3
Clinic of Obstetrics and Gynecology, Ospedale Santa Croce e Carle, Cuneo, Italy
Pelvic floor dysfunction leads to surgery for 11% of women in their lifetime [3, 4]. Approximately 30% of these women will require a second surgery [5]. Due to absence of evidence, the surgical strategy for uterine prolapse repair varies
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