Sacrocolpopexy: The Way I Do It

Abstract

Introduction and hypothesis: Sacrocolpopexy (SCP) is an established surgical procedure for apical vaginal vault prolapse. There remains significant variation amongst surgeons in both the surgical steps and concomitant surgeries utilised when undertaking an SCP.

Methods: This review article is aimed at summarising the evidence and providing a detailed update of SCP in modern practice, reviewing contemporary evidence behind its indications, efficacy, outcomes, surgical steps, and complications.

Results: Sacrocolpopexy remains the gold standard for post-hysterectomy apical prolapse based on good long-term outcomes, patient satisfaction and low complication rates. SCP with concomitant total hysterectomy is not recommended owing to high rates of mesh exposure. The laparoscopic approach remains the preferred option in terms of low morbidity, quicker recovery and lower cost than alternative access options. For optimal outcomes an SCP should be performed with monofilament mesh, using absorbable sutures and with a paravaginal repair for cystocele.

Conclusions: Although SCP has become increasingly utilised for apical prolapse, its established efficacy regarding anatomical outcomes, patient satisfaction, and complications is in the context of post-hysterectomy prolapse. SCP with concomitant total hysterectomy has higher rates of mesh exposure. The efficacy and safety of SCP with sub-total hysterectomy or hysteropexy have not been clearly established and require further assessment through well-designed, rigorous randomised controlled trials.

Keywords: Apical; Exposure; Mesh; Prolapse; Sacrocolpopexy; Vault.

Fig. 1

Sacrocolpopexy management flowchart. RCT randomised controlled trial, SCP sacrocolpopexy, SHP sacrohysteropexy

Fig. 2

Conclusions. SCP sacrocolpopexy, SHP sacrohysteropexy