Sacrospinous Ligament Vault Suspension

Abstract Introduction and hypothesis Sacrocolpopexy and sacrospinous ligament fixation (SSLF) have been used for the restoration of apical support. Studies comparing sacrocolpopexy and SSLF have reported conflicting results. We aim to assess the current evidence regarding efficiency and the complications of sacrocolpopexy compared with SSLF. Methods We searched PubMed, Embase, and Cochrane Library and performed a systematic review meta-analysis to assess the two surgical approaches. Results 5Five randomized controlled trials, 8 retrospective studies, and 2 prospective studies including 4,120 cases were identified. Compared with abdominal sacrocolpopexy (ASC), SSLF was associated with a lower success rate (88.32% and 91.45%; OR 0.52; 95% CI 0.29–0.95; p = 0.03), higher recurrence (11.58% and 8.32%; OR 1.97; 95% CI 1.04–3.46; p = 0.04), and dyspareunia rate (14.36% and 4.67%; OR 3.10; 95% CI 1.28–7.50; p = 0.01). Patients in this group may benefit from shorter operative time (weighted mean difference −25.08 min; 95% CI −42.29 to −7.88; p = 0.004), lower hemorrhage rate (0.85% and 2.58%; OR 0.45; 95% CI 0.25–0.85; p = 0.009), wound infection rate (3.30% and 5.76%; OR 0.55; 95% CI 0.39–0.77; p = 0.0005), and fewer gastrointestinal complications (1.33% and 6.19%; OR 0.33; 95% CI 0.15–0.76; p = 0.009). Conclusion Both sacrocolpopexy and SSLF offer an efficient alternative to the restoration of apical support. When anatomical durability and sexual function is a priority, ASC may be the preferred option. When considering factors of mesh erosion, operative time, gastrointestinal complications, hemorrhage, and wound infections, SSLF may be the better option.

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Efficacy of a standardized technique of trans-vaginal entry into the peritoneal cavity for post-hysterectomy vaginal vault suspension

International Urogynecology Journal ◽

10.1007/s00192-008-0642-7 ◽

2008 ◽

Vol 19 (10) ◽

pp. 1393-1398 ◽

Cited By ~ 4

Author(s):

Amy J. Park ◽

Beri Ridgeway ◽

A. Marcus Gustilo-Ashby ◽

Marie Fidela R. Paraiso ◽

Mark D. Walters ◽

...

Keyword(s):

Peritoneal Cavity ◽

Vaginal Vault ◽

Vaginal Vault Suspension ◽

Vault Suspension

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Sacrospinous ligament fixation for eversion of the vagina

American Journal of Obstetrics and Gynecology ◽

10.1016/0002-9378(88)90088-9 ◽

1988 ◽

Vol 158 (4) ◽

pp. 872-881 ◽

Cited By ~ 212

Author(s):

George W. Morley ◽

John O.L. DeLancey

Keyword(s):

Sacrospinous Ligament ◽

Sacrospinous Ligament Fixation

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Symptoms of voiding dysfunction and other coexisting pelvic floor dysfunctions: the impact of transvaginal, mesh-augmented sacrospinous ligament fixation

International Urogynecology Journal ◽

10.1007/s00192-020-04649-y ◽

2021 ◽

Author(s):

Maren Himmler ◽

Martin Kohl ◽

Aidana Rakhimbayeva ◽

Magdalena Witczak ◽

Alexander Yassouridis ◽

...

Keyword(s):

Pelvic Floor ◽

Voiding Dysfunction ◽

Transvaginal Mesh ◽

Sacrospinous Ligament ◽

Sacrospinous Ligament Fixation ◽

The Impact

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Utilization and perioperative outcomes of robotic vaginal vault suspension compared to abdominal or vaginal approaches for pelvic organ prolapse

Canadian Urological Association Journal ◽

10.5489/cuaj.1858 ◽

2014 ◽

Vol 8 (3-4) ◽

pp. 100 ◽

Cited By ~ 6

Author(s):

Akshay Sood ◽

Hanhan Li ◽

Jesse Sammon ◽

Florian Roghmann ◽

Michael Ehlert ◽

...

Keyword(s):

Pelvic Organ Prolapse ◽

Length Of Stay ◽

Intraoperative Complications ◽

Pelvic Organ ◽

Vaginal Vault ◽

Hospital Charges ◽

Perioperative Outcomes ◽

Vaginal Vault Suspension ◽

Prolonged Length ◽

Vault Suspension

Objectives: Robot-assisted vaginal vault suspension (RAVVS) for pelvic organ prolapse (POP) represents a minimally-invasive alternative to abdominal sacrocolpopexy. We measured perioperative outcomes and utilization rates of RAVVS.Methods: RAVVS (n = 2381) and open VVS (OVVS, n = 11080) data were extracted from the 2009-2010 Nationwide Inpatient Sample. Propensity score-matched analysis compared patients undergoing RAVVS or OVVS for complications, mortality, prolonged length-of-stay, and elevated hospital charges.Results: Use of RAVVS for POP increased from 2009 to 2010 (16.3% to 19.2%). Patients undergoing RAVVS were more likely to be white (77.2% vs. 69.6%), to carry private insurance (52.8% vs. 46.0%) and to have fewer comorbidities (Charlson Comorbidity Index [CCI] ≥1 = 17.5% vs. 26.6%). They were more likely to undergo surgery at urban (98.2% vs. 93.7%) and academic centres (75.7% vs. 56.7%). Patients undergoing RAVVS were less likely to receive a blood-transfusion (0.7% vs. 1.8%, p < 0.001) or experience prolonged length-of-stay (9.3% vs. 25.1%, p < 0.001). They had more intraoperative complications (6.0% vs. 4.2%, p < 0.001), and higher median hospital charges ($32 402 vs. $24 136, p < 0.001). Overall postoperative complications were equivalent (17.9%, p = 1.0), though there were differences in wound (0.4% vs. 1.3%, p < 0.001), genitourinary (4.9% vs. 6.5%, p = 0.009), and surgical (6.6% vs. 4.9%, p = 0.007) complications.Conclusions: The increasing use of RAVVS from 2009 to 2010 suggests a growth in the adoption of robotics to manage POP. We show that RAVVS is associated with decreased length of stay, fewer blood transfusions, as well as lower postoperative wound, genitourinary and vascular complications. The benefits of RAVVS are mitigated by higher hospital charges and higher rates of intraoperative complications.

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