Post-Hysterectomy Vaginal Length: Horizontal vs. Vertical Closure

Gaziosmanpasa Research and Education Hospital62 enrolled

Overview

This prospective clinical study aims to evaluate the impact of vaginal cuff closure orientation-horizontal versus vertical-on postoperative total vaginal length in patients undergoing vaginal hysterectomy combined with lateral suspension. By comparing anatomical outcomes between the two closure techniques, the study seeks to determine which method better preserves vaginal length, potentially influencing surgical preferences and postoperative quality of life.

This prospective clinical study is designed to evaluate the effect of vaginal cuff closure orientation-horizontal versus vertical-on postoperative total vaginal length in patients undergoing vaginal hysterectomy with lateral suspension. Vaginal length is a significant factor in pelvic floor support, sexual function, and patient satisfaction after pelvic organ prolapse surgeries. Eligible patients undergoing vaginal hysterectomy and lateral suspension for uterine prolapse will be randomly assigned to two groups based on the vaginal cuff closure technique: Group 1 (horizontal closure) and Group 2 (vertical closure). All surgeries will be performed by the same surgical team to minimize technique-related variability. Preoperative and postoperative total vaginal lengths will be measured via standardized pelvic examination and recorded. Secondary outcomes will include patient-reported symptoms (e.g., sensation of vaginal shortening, sexual function), surgical duration, intraoperative complications, and early postoperative outcomes. The study aims to provide evidence-based guidance on optimal vaginal cuff closure technique in uterovaginal prolapse surgery, with an emphasis on preserving vaginal length and improving postoperative quality of life.

Study Type

INTERVENTIONAL

Allocation

RANDOMIZED

Purpose

TREATMENT

Masking

NONE

Enrollment

Interventions

Horizontal Vaginal Cuff Closure TechniquePROCEDURE

In this arm, patients undergoing vaginal hysterectomy with lateral suspension will receive horizontal closure of the vaginal cuff. After removal of the uterus, the vaginal cuff is closed in a transverse (right-to-left) direction using standard absorbable sutures. The technique aims to maintain or optimize the anatomical axis and preserve vaginal length in the horizontal plane. The entire procedure is performed under general or regional anesthesia by an experienced surgical team.

Vertical Vaginal Cuff Closure TechniquePROCEDURE

In this arm, patients undergoing vaginal hysterectomy with lateral suspension will receive vertical closure of the vaginal cuff. After the uterus is removed, the vaginal cuff is closed in a cranio-caudal (top-to-bottom) orientation using absorbable sutures. This technique is hypothesized to better support apical structures and reduce tissue tension. Procedures are performed under general or regional anesthesia with standardized operative technique.

Eligibility

Sex: FEMALEMin age: 35 YearsMax age: 65 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Cases with vaginal hysterectomy and lateral suspension surgery due to stage 3-4 uterine prolapse Agree to participate in the study and sign the informed consent form Exclusion Criteria: * Cases that have previously undergone a different suspension surgery due to descent uteri (vaginal hysterectomy and sacrospinous ligament fixation surgery, vaginal hysterectomy and sacrocolopexy surgery, vaginal hysterectomy and high sacouterin plication surgery) Cases that have undergone vaginal hysterectomy due to malignancy Cases that have undergone radiotherapy due to malignancy (brachytherapy) Patients who are not suitable for surgical intervention due to severe vaginal atrophy. Patients who will not be able to comply with the follow-up process. Not accepting to participate in the study or not signing the informed consent form

Outcomes

Primary Outcomes

Pelvic Organ Prolapse Quantification (POP-Q) Score

POP-Q scores will be used to assess anatomical outcomes of the pelvic support structures before and after surgery. Standardized POP-Q measurements (Aa, Ba, C, D, Ap, Bp, gh, pb, tvl) will be recorded preoperatively, 3 and 6 months postoperatively by blinded examiners. The primary focus will be on point C (vaginal apex) and total vaginal length (TVL) for comparison between groups.

Time frame: Baseline, 3 and 6 months postoperatively

PISQ-12 Questionnaire Score

The Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) will be administered to sexually active patients preoperatively, 3 and 6 months postoperatively to assess sexual function and satisfaction. Changes in the total PISQ-12 score will be analyzed between the horizontal and vertical closure groups.