Modern role of sacrospinous ligament fixation for pelvic organ prolapse surgery—A systemic review

Abstract

Pelvic organ prolapse (POP) is a common condition in women. Women with POP often experience pelvic discomfort, urinary and fecal problems, sexual dysfunction, and an overall decrease in their quality of life. Surgical treatment is a feasible option if conservative management fails. Various surgical techniques have been proposed to correct POP with or without the use of graft material. Owing to recent U.S. Food and Drug Administration warnings about mesh-related complications, sacrospinous ligament fixation (SSF), as a traditional vaginal procedure, may play an important role again. To answer this question and evaluate quantitatively the efficacy of SSF in POP, we conducted a systemic review of the available data about SSF and POP. Interventions had to include SSF as a point of attachment. To eliminate confounding bias and effect modification, at least one arm must include SSF without mesh or graft. All follow-up periods were allowed. Information on the following parameters was extracted and entered into a database: study design, type of intervention, number of patients, follow-up in months, cure rate, recurrence rate, intra/postoperative complications, and/or uni/bilateral, preventive/therapeutic, or concomitant procedures. Published papers from the years 1995 to 2011 were selected for analysis.

Medium-term outcomes of laparoscopic sacrocolpopexy or sacrohysteropexy versus vaginal sacrospinous ligament fixation for middle compartment prolapse

“…Abdominal sacrocolpopexy (ASC) has been typically regarded as a better procedure and is associated with a lower rate of vault prolapse recurrence and decreased dyspareunia . VSSLF, however, is a surgical procedure that has afforded advantages including a quicker and more cost‐effective treatment timeline since it was introduced …”

“…4 VSSLF, however, is a surgical procedure that has afforded advantages including a quicker and more cost-effective treatment timeline since it was introduced. 5,6 Recently, the clinical focus has turned to minimally invasive approaches, such as laparoscopic sacrocolpopexy (LSC) and laparoscopic sacrohysteropexy (LSH), which are associated with reduced postoperative pain and fewer complications, 7 and decreased recovery time. 8 With a success rate of approximately 95%, LSC/LSH is comparable to ASC in terms of enhancing quality of life.…”

Sacrospinous Ligament Fixation – A Malaysian’s Tertiary Centre Experience

“…Vaginal route offers greater cost effectiveness as it enables concurrent pelvic floor repair with preservation of coital function, avoidance of laparotomy and general anaesthesia, reduction of intra-operative bleeding, post-operative pain and complications, hence hospital stay (7,10,17). Other options for apical prolapse surgeries include sacral colpopexy which can be done via abdominal, laparascopic or robotic approach (11).…”

Postoperative pain and perceptions of recuperation after suture‐ and mesh‐based apical sacrospinous ligament suspension

“…Nerve injury related to suture-based SSLS has been associated with paresthesia that lasts for several weeks, [2][3][4][5] and sometimes requires reoperation and replacement of the suture. 6,7 Mesh-based SSLS has been associated with postoperative pelvic pain, commonly in the thighs and sacral and perianal areas. 8 The pain usually resolves by 6 months after surgery.…”