Abdominal sacrocolpopexy: a comprehensive review.
OBJECTIVE
To summarize published data about abdominal sacrocolpopexy and to highlight areas about which data are lacking.


METHODS
We conducted a literature search on MEDLINE using Ovid and PubMed, from January,1966 to January, 2004, using search terms "sacropexy," "sacrocolpopexy," "sacral colpopexy," "colpopexy," "sacropexy," "colposacropexy," "abdominal sacrocolpopexy" "pelvic organ prolapse and surgery," and "vaginal vault prolapse or surgery" and included articles with English-language abstracts. We examined reference lists of published articles to identify other articles not found on the electronic search.


METHODS
We examined all studies identified in our search that provided any outcome data on sacrocolpopexy. Because of the substantial heterogeneity of outcome measures and follow-up intervals in case studies, we did not apply meta-analytic techniques to the data.


RESULTS
Follow-up duration for most studies ranged from 6 months to 3 years. The success rate, when defined as lack of apical prolapse postoperatively, ranged from 78-100% and when defined as no postoperative prolapse, from 58-100%. The median reoperation rates for pelvic organ prolapse and for stress urinary incontinence in the studies that reported these outcomes were 4.4% (range 0-18.2%) and 4.9% (range 1.2% to 30.9%), respectively. The overall rate of mesh erosion was 3.4% (70 of 2,178). Some reports found more mesh erosions when concomitant total hysterectomy was done, whereas other reports did not. There were no data to either support or refute the contentions that concomitant culdoplasty or paravaginal repair decreased the risk of failure. Most authors recommended burying the graft under the peritoneum to attempt to decrease the risk of bowel obstruction; despite this, the median rate (when reported) of small bowel obstruction requiring surgery was 1.1% (range 0.6% to 8.6%). Few studies rigorously assessed pelvic symptoms, bowel function, or sexual function.


CONCLUSIONS
Sacrocolpopexy is a reliable procedure that effectively and consistently resolves vaginal vault prolapse. Patients should be counseled about the low, but present risk, of reoperation for prolapse, stress incontinence, and complications. Prospective trials are needed to understand the effect of sacrocolpopexy on functional outcomes.
Department of Obstetrics and Gynecology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242, USA. ingrid-nygaard@uiowa.edu
Ingrid E
IE
Nygaard
Rebecca
R
McCreery
Linda
L
Brubaker
AnnaMarie
A
Connolly
Geoff
G
Cundiff
Anne M
AM
Weber
Halina
H
Zyczynski
D005260:Female; D006801:Humans; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications; D012447:Sacrum / Q000601:surgery*; D013536:Suture Techniques; D016896:Treatment Outcome; D014481:United States; D013519:Urogenital Surgical Procedures / Q000009:adverse effects / Q000379:methods*; D014596:Uterine Prolapse / Q000601:surgery*