The resurrection of sacrospinous fixation: unilateral apical sling hysteropexy

Evaluation of the effectiveness of laparoscopic pectopexy in advanced stage apical prolapse

OBJECTIVE

We aimed to investigate the effectiveness of the laparoscopic pectopexy procedure in women who want to preserve their uterus for stage III or IV apical prolapse.

STUDY DESIGN

132 women who underwent laparoscopic pectopexy due to stage III or IV apical pelvic organ prolapse (POP) were included in this study. Demographic data of the patients, duration of surgery, blood loss, hospitalisation, intraoperative and postoperative complications, recurrence rate were searched from the hospital file archive. Pelvic organ prolapse quantification (POP-Q) system was used at postoperative control visits. The patients' quality of life was evaluated by comparing the results of the pelvic organ quality of life (P-QOL) questionnaire which they filled out at the preoperative and 6th months later.

RESULTS

The patients' mean age was 60(52-66)years. The average duration of the surgery was 110(90-150) minutes. Average blood loss was 150(75-220) ml. No intraoperative or postoperative complications were noted. The average hospitalisation was 2(1-3) days. The average follow-up period was 19 (13-26) months. Apical prolapse recurrence was observed in 3 (2.2 %) patients and laparoscopic sacrohysteropexy was performed. There was a significant improvement in the POP-Q scores of the patients in the postoperative period (p < 0.0001). A significant improvement was detected in the P-QOL total score and all each paramaters after surgery (p < 0.0001).

CONCLUSION

Laparoscopic pectopexy seems to be a reliable and efficient method for patients in advanced stages apical prolapse whom wants to preservation of the uterus.With all the advantages of minimally invasive surgery, it increases the patients' quality of life.

The influence of simultaneous posterior colporrhaphy and perineoplasty on the efficiency and safety of mesh-augmented sacrospinal fixation (apical sling) in advanced POP repair

BACKGROUND

Pelvic organ prolapse (POP) is one of the most common pathologies of the pelvic floor, and it can be found among 40-60% of women who have given birth. Correction of the defect of the DeLancey level II without reconstruction of the apical defect is doomed to failure. Also, in the structure of pelvic floor defects, there is often an incompetency of the perineal body, as a consequence of traumatic delivery. Perineoplasty is considered to be the main method of correction for perineal body incompetency. However, it is worth mentioning that there are no randomized trials, which estimate the influence of simultaneous correction of the perineal body on the effectiveness of transvaginal apical fixation.

METHODS

It is planned to include 310 patients in this trial. Patients who met the inclusion/exclusion criteria will be randomized into 2 groups: 1st group-patients who will undergo mesh-augmented sacrospinal fixation with anterior and posterior colporrhaphy without perineoplasty, 2nd group-patients who will undergo mesh-augmented sacrospinal fixation with anterior and posterior colporrhaphy and perineoplasty. Patients will be called to an appointment 6, 12, and 24 months after discharge.

DISCUSSION

The aim of this trial is to evaluate the efficiency and safety of simultaneous perineoplasty on the clinical and anatomical efficacy of mesh-augmented sacrospinal fixation in advanced pelvic organ prolapse repair. Based on previous studies, it was difficult to estimate and comprehend whether colpoperinoplasty actually reduces the risk of prolapse recurrence.

TRIAL REGISTRATION

NCT05422209. Registered on 18 May 2022.

Anterior bilateral sacrospinous ligament fixation with concomitant anterior native tissue repair: a pilot study

INTRODUCTION AND HYPOTHESIS

Anterior bilateral sacrospinous ligament fixation (ABSSLF) was first described in 2000 but only evaluated in a limited number of studies. However, due to the FDA's ban on transvaginal mesh, interest in this technique has re-emerged. The SSLF procedure is known for its inherent high risk for anterior compartment failure; hence, in our center we started performing a preemptive concomitant anterior repair with the intention to reduce such risk. The aim of this study was to review the feasibility and clinical outcomes of this innovative technique.

METHODS

We performed a retrospective cohort study of all the women who had an ABSSLF and a concomitant anterior native tissue repair between May 2019 and July 2020 in a tertiary hospital in France. Our primary endpoint was surgical feasibility, while as secondary endpoints we wanted to explore the perioperative morbidities and clinical outcomes associated with this technique.

RESULTS

A total of 50 women were operated on in the studied period. The median follow-up time was 10 [8.5] months. It was feasible to perform the combined ABSSLF and concomitant anterior native tissue repair in all cases. The most frequent perioperative complications reported were urinary tract infection (14%) and difficulty in resuming voiding (16%). Anatomical and functional results were improved. The rate of anterior compartment recurrence was 37%.

CONCLUSIONS

ABSSLF with a concomitant anterior native tissue repair is feasible and relatively safe for treating anterior and apical pelvic prolapse. However, anterior compartment failure rate is still a limitation. Further larger studies with long-term anatomical and functional results comparing this technique to alternative transvaginal surgical approaches are needed.

The Vaginal Patch Plastron Associated to the Anterior Sacrospinous Ligament Fixation for the Treatment of Advanced Anterior Vaginal Wall Prolapse

Background: this study aims to compare the efficacy and safety of vaginal patch plastron (VPP) associated to anterior sacrospinous ligament fixation (SSLF-A) with SSLF-A associated or not to the anterior colporrhaphy (AC) for cystocele treatment. Methods: single-center retrospective study in women with cystocele ≥ III stage submitted to surgery. The primary outcome was to compare objective and subjective cystocele relapse and reoperation rate at follow-up > 6 months. The secondary outcome was to describe peri- and postoperative complications and risk factors for cystocele objective relapse. Results: 75 women were submitted to SSLF-A and 61 women to VPP. VPP objective and subjective relapse (6.5%, 4/61 and 1.1%, 1/61) were lower than SSLF-A (26.7%, 20/75 and 20%, 15/75; p = 0.002 and p = 0.001, respectively). SSLF-A had a higher reintervention rate, but not significantly (6.6%, 5/75 vs. 0%, 0/61; p = 0.06). Previous hysterectomy was a risk factor (HR 4; 1.3−12.1) while VPP was protective factor (HR 0.2; 0.1−0.9) for cystocele anatomical relapse. Postoperative buttock pain was more prevalent in VPP (57.4%, 35/75 vs. 34.7%, 26/61; p = 0.01). Conclusions: VPP is effective and safe for advanced cystocele treatment, with lower objective and subjective relapse rates in comparison to isolated SSLF-A or associated with the AC.

Bilateral Sacrospinous Hysteropexy Versus Bilateral Sacrospinous Ligament Fixation with Vaginal Hysterectomy for Apical Uterovaginal Prolapse

Purpose

The aim of this retrospective study was to compare the anatomical and functional outcomes between bilateral sacrospinous hysteropexy (BSHP) and bilateral sacrospinous ligament fixation with vaginal hysterectomy (BSLF/VH) in women with apical-predominant uterovaginal prolapse.

Methods

Clinical data from patients with symptomatic Pelvic Organ Prolapse-Quantification (POP-Q) stage 2 or higher uterovaginal prolapse who underwent either BSHP (48 patients) or BSLF/VH (69 patients) between January 2014 and December 2018 were reviewed retrospectively. The primary outcome was the subjective satisfaction rate evaluated by Patient Global Impression of Improvement, and the secondary outcomes included objective anatomical success rates, impact on disease-specific quality of life evaluated by the Pelvic Organ Prolapse/Urinary Incontinence Sexual Questionnaire-12, Pelvic Floor Distress Inventory-Short Form 20, and Pelvic Floor Impact Questionnaire 7, and surgical complications.

Results

After a median follow-up of 35 months (range, 25–58 months), all patients in both groups demonstrated significant postoperative improvements in anatomical and functional outcomes (P<0.001). There were no significant differences in postoperative subjective and objective results, sexual satisfaction outcomes, or disease-specific quality of life between the BSHP and BSLF/VH groups, and similar incidence rates of intraoperative and postoperative complications were also recorded.

Conclusions

The uterus-sparing BSHP procedure yielded noninferior anatomical and functional outcomes compared to the BSLF/VH procedure and could be adopted as an alternative to conventional hysterectomy-based native-tissue repair modalities for symptomatic apical-predominant uterovaginal prolapse.

Sacrospinous ligament fixation vs uterosacral ligaments suspension for pelvic organ prolapse: a systematic review and meta-analysis

OBJECTIVE

To compare the effectiveness and safety of sacrospinous ligament fixation (SSLF) and uterosacral ligaments suspension (ULS) for surgical correction of pelvic organ prolapse (POP).

METHODS

Comparative studies were identified in PubMed, EMBASE, MEDLINE, Cochrane library, Medicine and clinicaltrials.gov databases. Randomized controlled trials, prospective and retrospective cohort studies were included. Primary outcomes were collected including anatomical success rate (Defined as anterior or posterior vaginal wall beyond the hymen), surgical success rate, recurrence and total complication rate, while secondary outcomes were specific complications rates. Data were analyzed using Revman (Version 5.4).

RESULTS

After searching databases and removing the duplicate studies, a total of 57 articles had entered the screening stage. Finally, nine moderate and high quality studies (4 randomized controlled trials and 5 retrospective studies) with 4516 participants were included. For primary outcomes, there was no statistical difference between the two groups regarding surgical success rate (RR=1.00; 95% CI: 0.91-1.01; I²= 0%; P=0.98), anatomical success (RR=0.90; 95% CI: 0.78-1.05; I²= 61%; P=0.19), recurrence rate (RR=1.26; 95% CI: 0.85-1.87; I²= 75%; P=0.24) and total complication rate (RR=1.07; 95% CI: 0.89-1.28; I²= 33%; P=0.47). Subgroup analysis regarding different follow-up times (1,2 and 5 years) and stages (Stage 2 and stage 3-4) found similar results in primary outcomes.

CONCLUSIONS

In conclusion, SSLF and ULS have the same efficacy and safety for patients. However, SSLF seems to have lower complication rates of vaginal granulation tissue and urethral injury and is gradually favored by surgeons because of its short operation time and simple operation. We still need more high-quality research, especially in terms of the incidence of complications.

Sacrospinous ligament fixation: medium and long-term anatomical results, functional and quality of life results

BACKGROUND

To evaluate the medium and long-term anatomical results of sacrospinous ligament fixation (SLF) and its impact on quality of life (QoL).

METHODS

We conducted a retrospective and observational single centre study. Fifty-nine patients were interviewed using the Pelvic Floor Distress Inventory and Pelvic Floor Impact Questionnaire and underwent physical examination using POP-Q several years after SLF. Primary outcome was the comparison of anatomic results of SLF at medium-term (group 1: 1-5 years after surgery) and long-term (group 2: more than 5 years after surgery). The secondary outcome was QoL evaluation.

RESULTS

The overall recurrence and complication rates were respectively 22% and 10%, with no significant differences between groups 1 and 2. The recurrence rate was similar in both groups [twelve (35%) in group 1 and nine (20%) in group 2, p = 0.09]. Two patients (12%) in the recurrence and none in the no recurrence group had clinical symptoms (p = 0.08). Two patients (12%) in the recurrence and one patient (2%) in the no-recurrence group had a significant impact on their quality of life (p = 0.12).

CONCLUSION

This study showed sustainable anatomic and functional results of SLF in medium and long-term analysis with overall low morbidity.

Comparison of two natural tissue repair-based surgical techniques; sacrospinous fixation and uterosacral ligament suspension for pelvic organ prolapse treatment

INTRODUCTION AND PURPOSE

The present study aims to compare the effectiveness and perioperative results of the natural tissue repair-based treatments sacrospinous fixation (SSF) and uterosacral ligament suspension (USLS) based on the preoperative Pelvic Organ Prolapse Quantification system (POP-Q).

MATERIALS AND METHODS

Medical records of patients with stage ≥2 uterine prolapse between January 2011 and December 2016 were retrospectively examined. Preoperative POP-Q stages, demographic characteristics, perioperative results, and recurrence ratios in mid-term follow-up for patients were compared.

RESULTS

Overall, 235 patients were determined according to our study's inclusion criteria. A total of 155 patients underwent vaginal hysterectomy and USLS (VH/USLS), whereas 80 patients underwent vaginal hysterectomy and SSF (VH/SSF). There were no significant differences between groups in terms of body mass index (BMI), age, and parity as well as cardiovascular disease and diabetes mellitus. There was no significant difference in terms of anatomical success and clinical success rates in the postoperative follow-up period between both groups. (p = 0.588 and 0.692, respectively). However, the assessment of results based on preoperative stages of patients revealed that recurrence and anatomical failure were higher in the stage 4 group (p < 0.001).

CONCLUSION

Our findings indicate that the main determinant factor in evaluating recurrence rates is preoperative POP-Q staging of the patient. Recurrence rates significantly increase with disease stage. Consistent with studies that do not report a clear superiority for USLS or SSF, we observed no significant differences between both procedures in terms of recurrence. The effectiveness of these procedures is similar. We believe that prospective, long-term follow-up studies with larger populations are required to accurately identify preoperative risk factors and compare them with mesh techniques.