Sacrocolpopexy: Surgical Technique, Outcomes, and Complications

Takacs, Elizabeth B.; Kreder, Karl J.

doi:10.1007/s11934-016-0643-x

Cited by 35 publications

(24 citation statements)

References 48 publications

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“…Certain items, such as preoperative counseling and postoperative analgesia, are more specific to the procedure and could benefit from studies in patients undergoing ASC. Experts in the field of pelvic organ prolapse surgery agree that patient education improves outcomes after surgery 6 ; however, there are no studies to support this claim. Cross‐sectional studies have found that women are either not adequately informed or had a deficiency in their understanding of ASC during their preoperative discussion, 48,49 but the impact on their recovery is not known.…”

Section: Discussionmentioning

confidence: 99%

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A systematic review of best practices for the perioperative management of abdominal sacrocolpopexy

Nemirovsky

Herbert

Gorman

et al. 2020

Neurourology and Urodynamics

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Purpose Enhanced recovery after surgery (ERAS) pathways have been shown to reduce surgical morbidity and length of stay across various procedures. Our objective was to systematically evaluate the literature for best practices of ERAS elements in abdominal sacrocolpopexy (ASC), to determine if there is sufficient evidence to create best practice guidelines for this procedure. Materials and Methods Following the preferred reporting items for systematic review and meta‐analysis (PRISMA) statement, we performed a review using Pubmed, Embase, and Cochrane Library. Eligible articles contained ERAS components and postoperative outcomes of ASC published in English since 1997. Thirty‐five full‐text articles were selected for final qualitative analysis. Results Poor functional status before ASC was associated with a longer length of hospital stay. Laparoscopic ASC was associated with a shorter postoperative hospital stay, with no difference between laparoscopic and robotic approaches. Epidural analgesia in addition to spinal anesthesia lowered levels of pain throughout the postoperative stay in laparoscopic ASC. A multimodal bowel regimen shortened time to first bowel movement compared to a single agent regimen. Removing a Foley catheter may lead to sooner first spontaneous void but may result in higher rates of urinary retention and urinary tract infection. Studies investigating preoperative bowel preparation, preanesthesia medication, and multidose antimicrobial prophylaxis did not show significant benefit. Conclusions Best practices for ASC can be developed based on current findings from the literature and extrapolation of evidence from other surgeries where ASC‐specific elements are missing, with the ability to modify the pathways as new data become available.

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Section: Discussionmentioning

confidence: 99%

“…Abdominal sacrocolpopexy (ASC) is considered the “gold‐standard” for the treatment of apical pelvic organ prolapse 6 . The procedure traditionally is performed open, but with the adoption of laparoscopic and robotic techniques, the proportion of minimally invasive ASC has been steadily increasing 7 .…”

Section: Introductionmentioning

confidence: 99%

A systematic review of best practices for the perioperative management of abdominal sacrocolpopexy

Nemirovsky

Herbert

Gorman

et al. 2020

Neurourology and Urodynamics

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“…For patients with apical prolapse, sacral ligament suspension, sacrospinous ligament xation, and sacrocolpopexy (SCP) are the rst-line choices. SCP has long been regarded as the gold standard for the treatment of POP [20] . SCP is also an effective option for primary anterior compartment prolapse repair [21] .…”

Section: Discussionmentioning

confidence: 99%

A modified technique for paravaginal repair for the treatment of anterior vaginal prolapse and cystocele: a retrospective study

Huang¹,

Lv²,

Li³

et al. 2020

Preprint

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Background We aimed to determine the efficacy and safety of a modified protocol for paravaginal repair for treating symptomatic paravaginal defect cystocele. Methods This study was an observational case series of 98 consecutive female patients, referred to our hospital between June 2014 and May 2018, with symptomatic grade II to IV paravaginal defects and cystocele. Our modified technique for paravaginal repair is based on the conventional protocol but incorporates reverse bridge repair and the cross-stitching of bilateral sutures. The curative effect of this new technique was evaluated subjectively and objectively during postoperative follow-up. Results All operations were successful. Patients were followed up for 12 to 48 months, until June 2019; the mean follow-up period was 32.4 months. Three months after surgery (98 cases), the subjective cure rate was 100%; in each case, the top of the vagina lay above the level of the sciatic spine. The objective cure rate was 100%. The objective cure rate was 94.9% (93 cases) twelve months after surgery (98 cases), 91.0% (61 cases) twenty-four months after surgery (71 cases), and 76.2% (16 cases) forty-eight months after surgery (21 cases). Four cases required a second round of surgery; three of these cases were treated with sacrocolpopexy, and one case was treated with sacrospinous ligament fixation. Conclusion Our modified technique for paravaginal repair was safe and effective for the treatment of anterior vaginal prolapse and cystocele, as confirmed by the results observed over a mean follow-up period of 32.4 months.

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“…Использование перманентных материалов в реконструкции тазового дна всегда сопровождается риском развития эрозий. Так, при самом популярном методе апикальной фиксации -сакрокольпопексии риск формирования экструзии сетчатого эндопротеза составляет 0-10 % [28]. В описанном нами способе унилатеральной сакроспинальной фиксации была значительно снижена материалоемкость имплантата (применяли ленту размером 1,5 × 20 см).…”

Section: Discussionunclassified

Unilateral apical sling: a new look at the sacrospinous fixation

et al. 2019

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Hypothesis/aims of study. Nowadays a sacrospinous ligament fixation is one of the most studied and popular methods of colpo- and hysteropexy. Despite the high effectiveness against apical compartment defect, this technique has a number of specific side effects: chronic pain syndrome, dyspareunia, and а high rate of postoperative cystocele de novo. This study aimed to evaluate the efficacy and safety of unilateral sacrospinous ligament fixation with use of a modern synthetic monofilament mesh combined with the original technique of pubocervical fascia reconstruction using subfascial colporrhaphy. Study design, materials and methods. This study involved 174 women suffering from anterior/apical prolapse. All patients were operated with the proposed method. Postoperative assessment was performed at 1, 6 and 12 months after surgery and included vaginal examination with evaluation of pelvic organ prolapse by standardized POP-Q system, uroflowmetry, bladder ultrasound with post-void residual urine volume measurement, and filling in validated questionnaires (PFDI-20, PFIQ-7, PISQ-12). Results. Mean operation time was 26 ± 7.8 min. No cases of damage to the bladder or intraoperative clinically significant bleeding were noted. During a postoperative period, most of the patients showed a significant improvement in POP-Q points while maintaining the total vaginal length. Within 12 months of follow-up, the recurrence was observed in 1 (0.7%) patient in the apical compartment and in 10 (6.8%) patients in the anterior compartment. It should be mentioned that only in 3 cases of cystocele recurrence did the vaginal wall descend beyond the hymen. There were no cases of mesh erosion and pelvic pain syndrome through 12 months postoperatively. In the postoperative period, an improvement in urination was observed in all women. Most of the patients after the treatment showed a significant improvement in the quality of life. Only one patient complained of dyspareunia de novo. According to the questionnaires, satisfaction with the result of treatment was 96.5%. Conclusion. A unilateral sacrospinous fixation using a synthetic mesh combined with pubocervical fascia reconstruction (subfascial colporrhaphy) provides a high efficiency, while significantly reducing the rate of complications related to the traditional sacrospinous fixation.

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Sacrocolpopexy: Surgical Technique, Outcomes, and Complications

Cited by 35 publications

References 48 publications

A systematic review of best practices for the perioperative management of abdominal sacrocolpopexy

A systematic review of best practices for the perioperative management of abdominal sacrocolpopexy

A modified technique for paravaginal repair for the treatment of anterior vaginal prolapse and cystocele: a retrospective study

Unilateral apical sling: a new look at the sacrospinous fixation

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