[Application of transvaginal sacrospinous colpopexy in the treatment of pelvic organs prolapse]

Capio slim suture capturing device for transvaginal apical pelvic organ prolapse

OBJECTIVE

Pelvic organ prolapse is an extremely common condition, with approximately 12% of women requiring surgical correction over their lifetime. This is the first study comparing standard technique with Capio device with a prolonged follow-up. The aim of this study was to describe a standardization technique and its efficacy to treat vaginal vault prolapse based on Capio device to sacrospinous ligament (SSL) suspension in comparison to the well-known and described "Capio-free" standard technique (ST).

MATERIALS AND METHODS

From January 2016 to January 2022, we retrospectively evaluated 163 women undergoing surgery to treat apical vaginal prolapse with ST and/or Capio technique (CT) at two high-volume centers.

RESULTS

ST mean operative time resulted to be longer in comparison to the CT (98 ± 22.6 m vs 86 ± 17.4 m, p < 0.001). Mean intraoperative bleeding, hospital stay, and indwelling catheter resulted to be comparable between the two groups (all p > 0.05).

CONCLUSION

The CT used to treat women with vaginal vault prolapse was effective, secure, easy to perform, and associated with low risks of bleeding, perineal pain, vessel injuries and recurrent prolapse. The shorter operative time observed in surgery performed with Capio device, could suggest an implementation of such technique due to the overlapping complications, prolapse recurrence and postoperative quality of life.

The sacrospinous ligament: conveniently effective or effectively convenient?

The sacrospinous ligament has been used for over 50 years as a convenient structure for treating vaginal vault and more recently, uterine prolapse. The procedure has evolved over the years and its efficacy has been hotly debated with invariable comparisons made to abdominal sacral colpopexy. Mesh surgery has introduced a newer dimension to the debate. This review is an attempt to clarify the anatomy, reflect on various techniques and offer a critique on the current 'status' of the sacrospinous ligament.

[How to manage multicompartment pelvic organe prolapse?]

Repair of pelvic organ prolapse by vaginal route may use native tissues or meshes, which have been in extensive use over the last decades. Traditional surgery, and particularly sacrospinous fixation, has been proven to be effective with long term follow-up with well-known specific risks that could be avoided by skilled surgeons on condition that he observes basic vaginal surgery rules. This surgery is still recommended as first choice in patients over 70 years old with high-grade prolapse. Nevertheless recurrence rate after high-grade cystocele repair using native tissues as been reported between 30 and 50% depending on the technique used. Mesh repair and particularly the use of mesh kits is a valid option in case of prolapse with cystocele behind the hymen, specifically in case of paravaginal defect. Meshes use is licit in patients with prolapse recurrence as well. In contrast, spread use of transvaginal meshes in young patients with grade 3 or 4 prolapse whom tissues have a poor quality, has to be considered very carefully because of the lack of knowledge about long term results and sexual outcome.