Does sacrocolpopexy present heterogeneity in its surgical technique? A systematic review

Abstract

Aims: Sacrocolpopexy (SCP) is an extensively studied and highly efficacious treatment for female pelvic organ prolapse (POP). We aimed to analyze the technical steps for performance of a SCP among all RCTs in the literature that compared it with different procedures, or that studied different routes for performing SCP.

Methods: Systematic review searching electronic databases for RCTs only. We extracted data for 13 points of interest; main outcomes were procedure standardization; depth of vaginal dissection; number of sutures in the vaginal wall; type of suture in the vaginal wall; type of mesh fixation to the sacrum; and type and shape of mesh used.

Results: Twenty-two RCTs were included. Most of them did not provide a full standardized description of the procedure steps. There was great heterogeneity in almost all steps of the operation, including the choice of materials for attaching the mesh to the vagina and sacrum-with both absorbable and non-absorbable sutures being used-and the extent of vaginal dissection for mesh fixation, with some studies dissecting only the apex, superficially, while others performed a full-length dissection. Choice of mesh material was more consensual, with polypropylene mesh being the most commonly used.

Conclusions: SCP is a highly unstandardized procedure in the literature, albeit being used as a major comparator. Various RCTs compared alternative procedures with SCP, but the technical aspects have varied greatly, and studied outcomes could have been potentially influenced by these technical choices.

Keywords: genital prolapse; graft; sacrocolpopexy; surgical technique; sutures; systematic review.