Research Article| Volume 116, ISSUE 1, P79-84, September 10, 2004

Laparoscopic burch colposuspension: comparison of effectiveness of extraperitoneal and transperitoneal techniques


      Objective: To compare the effectiveness of two different laparoscopic colposuspension procedures: extraperitoneal approach using mesh fixed with tacks, and transperitoneal approach using sutures. Study design: We conducted a retrospective study of all patients (n=64) who had undergone two different techniques of laparoscopic Burch colposuspension without additional surgeries over a 6-year period. Thirty-six women underwent laparoscopic transperitoneal colposuspension with using nonabsorbable sutures (group A), whereas 28 women underwent laparoscopic extraperitoneal colposuspension with using mesh and preperitoneal balloon dissection technique (group B). Cure rate was assessed by simple cystometry with a cough stress test in the standing position. Both groups were compared with regard to cure rates, operative time, length of hospital stay, complications, estimated blood loss, and total hospital charges. Results: The mean times to follow-up were 25.7 months in the group A and 27.3 months in the group B (P=0.082). At last follow-up, 33 of 36 (91.7%) patients in the group A and 23 of 28 (82.1%) patients in the group B were continent (P=0.22). The other results were as follows for group A and B, respectively: average duration of surgery, 58.1 compared with 46.8 min (P=0.001); average hospital stay, 2.05 compared with 1.57 days (P=0.02); the intraoperative complication rate, 8.3% compared with 7.1% (P=0.62). The total hospital charges for the group B were found significantly higher (US$ 2234 versus US$ 1348, P=0.001). Conclusion: Although we found higher cure rates in laparoscopic colposuspension with the transperitoneal approach using sutures than the extraperitoneal approach using mesh fixed with tacks, there was no statistically significant difference between the two procedures. In comparison with extraperitoneal mesh technique, lower cost is the superiority of the transperitoneal suture technique.


      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      1. Fantl J, Newman D, Colling J. Urinary incontinence in adults: acute and chronic management. Clinical Practice Guidelines, no. 2, 1996 Update. Rockville, MD: US Department of Health and Human Services, Public Health Service, Agency for Health Care Policy and Research. AHCPR Publication No. 96-0682. March 1996.

        • Burch J.C
        Urethrovaginal fixation to Cooper’s ligament for the correction of stress incontinence, cystocele, and prolapse.
        Am. J. Obstet. Gynecol. 1961; 88: 281-290
        • Jarvis G.J
        Surgery for genuine stress incontinence.
        Br. J. Obstet. Gynaecol. 1994; 101: 371-374
        • Kiilhoma P
        • Makinen J
        • Chancellor M.B
        • Pitkanen Y
        • Hirvonen T
        Modified Burch colposuspension for stress urinary incontinence in females.
        Surg. Gynecol. Obstet. 1993; 176: 111-115
        • Bergman A
        • Elia G
        Three surgical procedures for genuine stress incontinence: five year follow-up of a prospective randomized study.
        Am. J. Obstet. Gynecol. 1995; 173: 66-71
        • Bergman A
        • Ballard C.A
        • Koonings P.P
        Comparison of three different surgical procedures for genuine stress urinary incontinence: prospective randomized study.
        Am. J. Obstet. Gynecol. 1989; 160: 1102-1106
        • Vancaillie T.G
        • Schuessler W
        Laparoscopic bladder neck suspension.
        J. Laparoendosc. Surg. 1991; 1: 169-173
        • Miklos J.R
        • Kohli N
        • Moore R.D
        Laparoscopic management of urinary incontinence.
        Curr. Opin. Obstet. Gynecol. 2001; 13: 411-417
        • Saidi M.H
        • Sadler R.K
        • Saidi J.A
        Extraperitoneal laparoscopic colposuspension for genuine stress urinary incontinence.
        J. Am. Assoc. Gynecol. Laparosc. 1998; 5: 247-252
        • Ou C.S
        • Rowbotham R
        Five year follow-up of laparoscopic bladder neck suspension using synthetic mesh and surgical staples.
        J. Laparoendosc. Adv. Surg. Tech. A. 1999; 9: 249-252
        • Lyons T.L
        Minimally invasive retropubic urethropexy: the Nolan-Lyons modification to the Burch procedure.
        Gynecol. Endosc. 1994; 3: 40-52
        • Hannah S.L
        • Chin A.L
        Laparoscopic retropubic urethropexy.
        J. Am. Assoc. Gynecol. Laparosc. 1996; 4: 47-52
        • Kiilhoma P
        • Haarala M
        • Polvi H
        • Makinen J
        • Chancellor M.B
        Suturless colposuspension with fibrin sealant.
        Tech. Urol. 1995; 1: 81-83
        • Karram M.M
        • Bhatia N.N
        The Q–tip test: standardization of the technique and its interpretation in women with urinary incontinence.
        Obstet. Gynecol. 1988; 6: 807-811
        • Baden W
        • Walker T.A
        Physical diagnosis in the evaluation of vaginal relaxation.
        Clin. Obstet. Gynecol. 1972; 15: 1055-1061
        • Tanagho E
        Colpocystouretropexy, the way we do it.
        J. Urol. 1976; 116: 751-753
        • Karabacak O
        • Taner M.Z
        • Tiras M.B
        • Kaya A
        • Guner H
        • Yildirim M
        An extraperitoneal Burch procedure: a case report.
        J. Laparoendosc. Surg. 1996; 1: 65-68
        • Liu C.Y
        Laparoscopic retropubic colposuspension. A review of 58 cases.
        J. Reprod. Med. 1993; 38: 526-530
        • Tamussino K.F
        • Zivkovic F
        • Pieber D
        • Moser F
        • Haas J
        • Ralph G
        Five-year results after anti-incontinence operations.
        Am. J. Obstet. Gynecol. 1999; 181: 1347-1352
        • Ross J.V
        Laparoscopic Burch repair compared to laparotomy Burch for cure of urinary stress incontinence.
        Int. Urogynecol. J. 1995; 6: 323-328
        • Paraiso M.F
        • Falcone T
        • Walters M.D
        Laparoscopic surgery for genuine stress incontinence.
        Int. Urogynecol. J. Pelvic Floor Dysfunct. 1999; 10: 237-247
        • Lose G
        Laparoscopic Burch colposuspension.
        Acta Obstet. Gynecol. Scand. Suppl. 1998; 168: 29-33
        • Miannay E
        • Cosson M
        • Lanvin D
        • Querleu D
        • Crepin G
        Comparison of open retropubic and laparoscopic colposuspension for treatment of stress urinary incontinence.
        Eur. J. Obstet. Gynaecol. Reprod. Biol. 1998; 79: 159-166
        • Polascik T.J
        • Moore R.G
        • Rosenberg M.T
        • Kavoussi L.R
        Comparison of laparoscopic and open retropubic urethropexy for treatment of stress urinary incontinence.
        Urology. 1995; 45: 647-652
        • Vancaillie T.G
        Laparoscopic colposuspension and pelvic floor repair.
        Curr. Opin. Obstet. Gynecol. 1997; 9: 244-246
        • Saidi M.H
        • Gallagher M.S
        • Skop I.P
        • Saidi J.A
        • Sadler R.K
        • Diaz K.C
        Extraperitoneal laparoscopic colposuspension: short-term cure rate, complications, and duration of hospital stay in comparison with Burch colposuspension.
        Obstet. Gynecol. 1998; 92: 619-621
        • Zullo F
        • Palomba S
        • Piccione F
        • Morelli M
        • Arduino B
        • Mastrantonio P
        Laparoscopic Burch colposuspension: a randomized controlled trial comparing two transperitoneal surgical techniques.
        Obstet. Gynecol. 2001; 98: 783-788
        • Amaye-Obu F.A
        • Drutz H.P
        Surgical management of recurrent stress urinary incontinence: a 12 year experience.
        Am. J. Obstet. Gynecol. 1999; 181: 1296-1307
        • Drouin J
        • Tessier J
        • Bertrand P.E
        • Schick E
        Burch colposuspension: long-term results and review of published reports.
        Urology. 1999; 54: 808-814
        • Cardozo L.D
        • Stanton S.L
        • Williams J.E
        Detrusor instability following surgery for genuine stress incontinence.
        Br. J. Urol. 1979; 51: 204-207
        • Sand P.K
        • Bowen L.W
        • Ostergard D.R
        • Brubaker L
        • Panganiban R
        The effect of retropubic urethropexy on detrusor instability.
        Obstet. Gynecol. 1988; 71: 818-822
        • Von Theobald P
        • Levy G
        Laparoscopic preperitoneal colposuspension for stress incontinence in women.
        Surg. Endosc. 1995; 9: 1189-1192
        • Blander D.S
        • Carpiniello V.L
        • Harryhill J.F
        • Malloy T.R
        • Rovner E.S
        Extraperitoneal laparoscopic urethropexy with Marlex mesh.
        Urology. 1999; 53: 985-989
        • Ross J
        Two techniques of laparoscopic Burch repair for stress incontinence: a prospective, randomized study.
        J. Am. Assoc. Gynecol. Laparosc. 1996; 3: 351-357