Long-Term Risk of Reoperation After Vaginal Vault Suspension by Surgical Technique: A Nationwide Cohort Study

Objective: To compare reoperation rates for recurrent vaginal vault prolapse among six surgical suspension procedures and to assess compartment-specific reoperation rates. Design: Nationwide cohort study with 3–14 years of follow-up. Setting: The Danish Urogynecological Database (DugaBase) and medical records. Population: Women with prior hysterectomy undergoing primary vaginal vault prolapse surgery between 1 January 2010 and 31 December 2020 using sacrocolpopexy (SCP), laparoscopic or ipsilateral uterosacral ligament suspension (LUSLS, IUSLS), vaginal extraperitoneal uterosacral ligament suspension (VEULS), sacrospinous ligament fixation (SSLF), or SSLF with graft. Methods: Identification by NOMESCO codes and chart review. Reoperations only for recurrent prolapse recorded through December 31, 2023. Cox regression estimated adjusted hazard ratios (aHR), adjusting for demographics, comorbidities, prior anterior/posterior prolapse surgery, prolapse stage, concomitant surgery and surgeon experience. Main Outcome Measures: Overall and compartment-specific reoperation rates by surgical technique. Results: Among 1374 women, no procedure was superior across compartments. SSLF was associated with the highest overall reoperation rate (30.7%; aHR 2.14, 95% CI, 1.26–3.62). SCP had the lowest apical reoperation rate (1.3%), whereas SSLF had the highest (23.1%; aHR 42.7, 95% CI, 5.7–317.5 compared to SCP). Anterior reoperation risk was lower after IUSLS (aHR 0.46, 95% CI, 0.21–0.99) and VEULS (aHR 0.09, 95% CI, 0.01–0.71), while posterior risk was lower after IUSLS (aHR 0.30, 95% CI, 0.12–0.77), SSLF (aHR 0.30, 95% CI, 0.11–0.87) and SSLF with graft (aHR 0.09, 95% CI, 0.01–0.79). Conclusion: Long-term reoperation risk varies by surgical technique, with SCP providing the most durable apical support and SSLF showing higher recurrence.