Abdominal Sacral Hysteropexy

Cvach, Kristina; Geoffrion, Roxana; Cundiff, Geoffrey W.

doi:10.1097/spv.0b013e3182673772

Cited by 19 publications

(7 citation statements)

References 14 publications

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“…There was no evidence of publication bias with the Egger test for reoperation for POP recurrence (P5.521) (Appendix 5, http://links.lww.com/ AOG/C307). A meta-analysis found an increased risk of mesh exposure with hysterectomy and sacrocolpopexy compared with sacrohysteropexy (open 66,70 or laparoscopic 74 ) at 1.6-4.25 years (7.5% vs 0%; RR 9.74, 95% CI 1.26-75.21; I 2 0%; three studies, one excluded from meta-analysis; n5197) (low). 66,70,74 Other comparisons and results for hysterectomy and suspensions compared with hysteropexy are in Appendix 6 (http://links.…”

Section: Resultsmentioning

confidence: 99%

Surgical Management of Symptomatic Apical Pelvic Organ Prolapse

Larouche

Belzile

Geoffrion

2021

Obstetrics &Amp; Gynecology

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OBJECTIVE: To systematically review objective and subjective success and complications of apical suspensions for symptomatic uterine or vaginal vault pelvic organ prolapse (POP). DATA SOURCES: MEDLINE, CENTRAL, ClinicalTrials.gov, and EMBASE (2002–2019) were searched using multiple terms for apical POP surgeries, including comparative studies in French and English. METHODS OF STUDY SELECTION: From 2,665 records, we included randomized controlled trials and comparative studies of interventions with or without hysterectomy, including abdominal apical reconstruction through open, laparoscopic, or robotic approaches and vaginal apical reconstructions. Repairs using transvaginal mesh, off-the-market products, procedures without apical suspension, and follow-up less than 6 months were excluded. TABULATION, INTEGRATION, AND RESULTS: Relative risk (RR) was used to estimate the effect of surgical procedure on each outcome. For each outcome and comparison, a meta-analysis was conducted to pool the RRs when possible. Meta-regression and bias tests were performed when appropriate. The GRADE (Grades for Recommendation, Assessment, Development and Evaluation) system for quality rating and PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) reporting were used. Sixty-two articles were included in the review (N=22,792) and 50 studies in the meta-analyses. There was heterogeneity in study quality, techniques used, and outcomes reported. Median follow-up was 1–5 years. Vaginal suspensions showed higher risk of overall and apical anatomic recurrence compared with sacrocolpopexy (RR 1.82, 95% CI 1.22–2.74 and RR 2.70, 95% CI 1.33–5.50) (moderate), whereas minimally invasive sacrocolpopexy showed less overall and posterior anatomic recurrence compared with open sacrocolpopexy (RR 0.59, 95% CI 0.47–0.75 and RR 0.59, 95% CI 0.44–0.80, respectively) (low). Different vaginal approaches, and hysterectomy and suspension compared with hysteropexy had similar anatomic success. Subjective POP recurrence, reintervention for POP recurrence and complications were similar between most procedures. CONCLUSION: Despite variations in anatomic outcomes, subjective outcomes and complications were similar for apical POP procedures at 1–5 years. Standardization of outcome reporting and comparative studies with longer follow-up are urgently needed. SYSTEMATIC REVIEW REGISTRATION: PROSPERO, CRD42019133869.

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Section: Resultsmentioning

confidence: 99%

Surgical Management of Symptomatic Apical Pelvic Organ Prolapse

Larouche

Belzile

Geoffrion

2021

Obstetrics &Amp; Gynecology

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“…25,26 Ridgeway 18 concluded that the advantages of the uterine-sparing POP procedure include shorter operative time, reduced blood loss, quicker recovery, fertility preservation, avoidance of unnecessary hysterectomy and minimization of surgical risks, maintenance of pelvic stability and sexual satisfaction, and diminished risk of mesh exposure. 15,20,[27][28][29][30] Other disadvantages include subsequent hysterectomy might be difficult, the ongoing risk for cervical or endometrial neoplasm, and the need of longterm surveillance for gynecological cancers. 18 Additionally, a recent meta-analysis 15 analyzed nine non-RCT studies comparing mesh sacrohysteropexy with hysterectomy plus mesh sacrocolpopexy via either an open abdominal or laparoscopic approach.…”

Section: Discussionmentioning

confidence: 99%

“…However, minimally invasive sacrocolpopexy had a significant outcome in overall objective recurrence (pooled risk ratio [RR], 0.59; 95% CI, 0.47-0.75) and objective posterior recurrence (pooled RR, 0.59; 95% CI, 0.44-0.80) than open abdominal sacrocolpopexy. 4 Furthermore, among the minimally invasive sacrocolpopexy procedures, Chang et al 20 and Yang et al 38 also conducted systematic reviews and meta-analyses to study the effectiveness and outcomes of sacrocolpopexy using a laparoscopic or robotic approach. They found that robotic sacrocolpopexy was associated with significantly less blood loss, lower conversion rate, similar perioperative complications, and postoperative symptoms, as well as comparable anatomical outcomes and objective recurrence at a median of 6 to 12 months postoperative follow-up.…”

Section: Discussionmentioning

confidence: 99%

“…J Chin Med Assoc ratio [OR], 0.16; 95% CI, 0.03-0.97). 15,18 Therefore, when possible, sacrohysteropexy [19][20][21] without hysterectomy is a suitable alternative to sacrocolpopexy for apical prolapse repair. There are limited data on the effectiveness of robot-assisted sacrohysteropexy (RASH) with uterine preservation compared with different prolapse surgeries.…”

Section: Introductionmentioning

confidence: 99%

“…15–17 As an increasing number of women have been requesting uterine preservation over the years, uterine preservation may be associated with a lower risk of mesh exposure (odds ratio [OR], 0.16; 95% CI, 0.03–0.97). 15,18 Therefore, when possible, sacrohysteropexy 19–21 without hysterectomy is a suitable alternative to sacrocolpopexy for apical prolapse repair. There are limited data on the effectiveness of robot-assisted sacrohysteropexy (RASH) with uterine preservation compared with different prolapse surgeries.…”

Section: Introductionmentioning

confidence: 99%

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Robot-assisted sacrohysteropexy vs. robot-assisted sacrocolpopexy in women with primary advanced apical prolapse: A retrospective cohort study

Chan

Chen

Shih

et al. 2023

Journal of the Chinese Medical Association

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Background: This study aimed to evaluate the anatomic and clinical outcomes of robot-assisted sacrohysteropexy (RASH) against robot-assisted sacrocolpopexy (RASC) for the treatment of primary advanced apical prolapse. Methods: We conducted a retrospective cohort study of all robot-assisted pelvic organ prolapse surgeries for primary advanced apical prolapse (stage ≥II) between January 2011 and May 2021 at an academic tertiary hospital. Surgical outcomes and pelvic organ function were evaluated using the Pelvic Organ Prolapse Quantitative (POP-Q) stage and validated questionnaires (POPDI-6) during preoperative and postoperative 12-month follow-up evaluations. All data were obtained from electronic medical records. Results: A total of 2368 women underwent surgery for apical prolapse repair, and 18 women underwent either RASH (n = 11) or RASC (n = 7). Compared to the RASC group, the RASH group was significantly younger, premenopausal, and less parous. Preoperative prolapse stage, operative time, estimated blood loss, and hospitalization length was comparable between the groups. No intraoperative complications were observed. All women had a median follow-up duration of 24 months (range: 12-108 months). During the 12-month follow-up period, women in the RASH group reported higher satisfaction with the surgery than those in the RASC group (100% vs. 71.4%, p = 0.137). The mesh exposure rate was significantly higher in the RASC group (3/7, 42.9%) than in the RASH group (0/11, 0%) (p = 0.043), which was found at 12 to 36 months postoperatively and was successfully managed with vaginal estrogen cream. In the RASH group, one woman required reoperation with anterior colporrhaphy for recurrent anterior prolapse at 60 months postoperatively. The apical success rate was 100% at one year postoperatively, without apical recurrence in either group during the follow-up period. Conclusion: RASH represents an effective and feasible option for the surgical treatment of advanced primary apical prolapse in women who desire uterine preservation and have a significantly lower risk of mesh erosion than RASC.

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Cervical elongation following sacrospinous hysteropexy: a case series

2013

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In recent years, pelvic floor surgeons have increasingly repaired pelvic organ prolapse around an intact uterus. Uterine conservation and hysteropexy have been driven by patient preference, less risk of mesh erosion, shorter operative time, and decreased blood loss and postoperative pain. We present a case series of patients with cervical elongation after vaginal sacrospinous hysteropexy using polypropylene mesh arms, a novel technique developed by the senior author. We defined cervical elongation as greater than or equal to a two-fold increase in cervical length compared with preoperative measurements. Of the 8 patients who underwent this procedure, 5 (62.5 %) had cervical elongation during the first year postoperatively. In the most severe case, the cervix extended to 4 cm beyond the hymenal ring. Most of the patients were mildly symptomatic and chose expectant management. The cases are reviewed in detail. A brief literature review on cervical elongation is presented.

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Abdominal Sacral Hysteropexy

Abstract: The ASH offers advantages and disadvantages that warrant further investigation with a prospective study.

Cited by 19 publications

References 14 publications

Surgical Management of Symptomatic Apical Pelvic Organ Prolapse

Surgical Management of Symptomatic Apical Pelvic Organ Prolapse

Robot-assisted sacrohysteropexy vs. robot-assisted sacrocolpopexy in women with primary advanced apical prolapse: A retrospective cohort study

Cervical elongation following sacrospinous hysteropexy: a case series

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