Hiatal area is related to symptoms of prolapse. This study aimed at evaluating the hiatal area after surgical repair of pelvic organ prolapse (POP) and the factors affecting it.

This is a preliminary analysis of a prospective study. Women had perineal ultrasound (US) in a standard way before surgical treatment for POP. US volumes at rest, during maximum Valsalva and pelvic floor contraction (PFMC) were stored. Generally, for women who had uterine prolapse would receive vaginal hysterectomy and pelvic floor repair (VHPFR). Women who had stage III uterine prolapse would receive concomitant anterior vaginal mesh repair and sacrospinous fixation (SSLF) if their aged was older (>65 years) and sexually inactive. If they were sexually active, they would receive concomitant laparoscopic sacrocolpopexy. If women opted not for mesh repair, they would receive SSLF. If they had vaginal vault prolapse, vaginal mesh repair or laparoscopic sacrocolpopexy would be performed according to their age and sexual status. They were followed up at 3 months, and then annually. Perineal US were performed in the same way. Offline analysis was performed to study the hiatal area and levator ani muscle (LAM) avulsion in standard way in this study.

78 women, mean age of 70.9±7.3 years, were included. In all, 53% and 47% had stage II and III/IV POP, respectively. Among them, 44 (56.4%), 4 (5.1%), 12 (15.3%), 6 (7.7%) had VHPFR, VHPFR+SSLF, VHPFR+anterior vaginal mesh±SSLF and VHPFR+laparoscopic sacrocolpopexy, respectively. Twelve (15.3%) had history of hysterectomy and received vaginal mesh repair or sacrocolpopexy. The mean follow-up duration was 26±23 months. 

28% of women were found to have LAM avulsion. Women with LAM avulsion or stage III POP had significantly larger hiatal area before surgery (table 1). Hiatal areas were significantly reduced after the operation (table 2). There was a tendency of, but not statistical significant, more reduction of hiatal area for women with stage III/IV POP when compared with stage II POP. Women who received mesh repair had more reduction in hiatal area but this did not reach statistical significance (table 3). In women with LAM avulsion, there was significantly more reduction in hiatal area after mesh repair when compared to those without the avulsion (table 4).

Women who had LAM avulsion or more advanced stage of POP had larger hiatal area. Hiatal areas were significantly reduced after surgical repair of POP. More reductions were found after mesh repair. However, this only reached statistical significant in the group with LAM avulsion, but not in those without LAM avulsion.

Hiatal areas were significantly reduced after surgical repair of POP. More reductions were found after mesh repair in women with LAM avulsion. A larger study is needed to confirm the findings.