Comparison of the Functional and Anatomical Outcomes of Abdominal Sacrocolpopexy and Vaginal Sacrospinous Ligament Suspension for the Treatment of Apical Prolapse

Objective. To evaluate efficacy in terms of vaginal capacity, coital function, and recurrence prevention of a new biological mesh of bovine pericardium (Tutomesh) in the repair of severe POP.Methods. Thirty cases of patients suffering from stage III uterine or apical prolapse undergone surgical repair by means of a modified sacrospinous ligament suspension combined with mesh attachment to both the cardinal ligaments, posterior and anterior colporrhaphy, and perineal body fixation. The mesh was replaced inside the pelvis with the goal of reconstructing the tridimensional fascial disposition of the structures sustaining the correct axis of vagina. Follow-up was done at 12 months with POPIQ analysis.Results. One total mesh failure occurred early after surgery due to marked deficiency of anatomy. Two cystoceles were observed at 12 months in two patients treated for apical prolapse where anterior repair was not performed. Two other patients developed a de novo SUI at 12 months. No reported abnormalities of coital function or dyspareunia were ever found after surgery.Conclusions. It is possible that the utilization of a tension-free and tridimensional placement of Tutomesh might favor a more physiologic reconstruction of the vaginal axis as compared with traditional sacrospinous ligament suspension.

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Vaginal Configuration on MRI after Abdominal Sacrocolpopexy and Sacrospinous Ligament Suspension

International Urogynecology Journal ◽

10.1007/s001920170016 ◽

2001 ◽

Vol 12 (6) ◽

pp. 375-380 ◽

Cited By ~ 35

Author(s):

E. H. M. Sze ◽

J. Meranus ◽

N. Kohli ◽

J. R. Miklos ◽

M. M. Karram

Keyword(s):

Sacrospinous Ligament ◽

Sacrospinous Ligament Suspension ◽

Abdominal Sacrocolpopexy

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Comparison of the effectiveness of sacrospinous ligament fixation and sacrocolpopexy: a meta-analysis

International Urogynecology Journal ◽

10.1007/s00192-021-04823-w ◽

2021 ◽

Author(s):

Wenju Zhang ◽

Willy Cecilia Cheon ◽

Li Zhang ◽

Xiaozhong Wang ◽

Yuzhen Wei ◽

...

Keyword(s):

Operative Time ◽

Meta Analysis ◽

Current Evidence ◽

Cochrane Library ◽

Surgical Approaches ◽

Sacrospinous Ligament ◽

Gastrointestinal Complications ◽

Sacrospinous Ligament Fixation ◽

Apical Support ◽

Abdominal Sacrocolpopexy

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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