EMPLOYEMENT OF EITHER A HIGH McCALL UTEROSACRAL SUSPENSION OR SACROSPINOUS FIXATION AT THE TIME OF VAGINAL HYSTERECTOMY: A PERI-OPERATIVE APPRAISAL

C. Medina, M.D.

   Objective: To compare intra-operative and post-operative morbidity associated with two commonly utilized procedure (high McCall (HMC) and sacrospinous fixation (SSF)) to suspend the vaginal cuff at the time of hysterectomy.

   Materials and Methods: Retrospective study analyzing 57 consecutive patients having either a HMC (n=30) or SSF (n=27).  All patients were operated at Jackson Memorial Hospital for uterine prolapse and other additional pathologies.  Clinical and hospital records were reviewed, recorded peri-operative outcome measures included any intra-operative or post-operative complication, BMI, EBL, and hospital stay.  Quantitative variables were evaluated using the unpaired t-test and qualitative variables were analyzed utilizing the chi-square.

   Results: There was no statistical significance in intra-operative complications between the two groups, [x²(1) = 0.002, p = 0.96], 8 (27%) intra-operative complications in the HMC group (5 EBL > 600 ml, 2 ureteral obstructions and 1 bladder perforation) and 8 (30%) in the SSF group (6 EBL > 600 ml, 1 bladder perforation and 1 retained sponge necessitating a mini-lap for removal). Both immediate and delayed post-operative complications were encountered in nearly equal frequency between the two groups, 6 (20%) patients in the HMC group and 5 (19%) in the SSF group, [x²(1) = 0.038, p=0.85].  There was no difference in either EBL or hospital stay between both groups, [t(1) p = 0.62] and [t(1) p = 0.42] respectively. 

  Conclusions:  While the frequency of peri-operative complications were similar for both groups, the ones associated with the high McCall suspension were more significant, thus reaffirming the need for cystoscopy whenever performing this procedure.

   Key Words: High McCall, sacrospinous fixation, ureteral obstruction