title: Iliococcygeus fixation or abdominal sacral colpopexy for the treatment of vaginal vault prolapse: a retrospective cohort study.
abstract: OBJECTIVE
  To compare the efficacy and safety of iliococcygeus fixation (ICG) and abdominal sacral colpopexy (SCP) in the treatment of vaginal vault prolapse.
  
  
  METHODS
  Patients with symptomatic vaginal vault prolapse after hysterectomy were considered in this analysis. Surgical outcomes, i.e., the capacity to restore the anatomy of the vaginal cuff and improvement in the prolapse-related symptoms were compared. Continuous variables were compared using the Student's t test, while non-continuous variables using a Chi-squared test or Fisher's exact test.
  
  
  RESULTS
  Sacrocolpopexy was performed in 41 patients, while ICG fixation was carried out in 36 patients. Operative time was significantly shorter (78 vs 140 min, p < 0.001) and median blood loss higher in the ICG group (150 ml vs 100 ml, p=0.01). The rates of postoperative complications of the two groups were not statistically different. Relapse rate was similar in the two groups (15 % in the SCP and 22 % in the ICG group respectively, p=0.36). Considering the POP-Q score, both SCP and ICG achieved a significant and comparable correction of vaginal prolapse. The evaluation of postoperative subjective symptoms revealed a significant improvement in voiding and vaginal bulging related to pelvic organ prolapse in both groups.
  
  
  CONCLUSIONS
  Both ICG fixation and SCP are effective in restoring normal anatomy in patients with vaginal vault prolapse and in relieving associated symptoms. Owing to its lower morbidity and to the advantage of not using a synthetic device, ICG might be an excellent option for the treatment of recurrent vaginal vault prolapse following hysterectomy.
authors.affiliation: Clinic of Obstetrics and Gynecology, University of Milan-Bicocca, San Gerardo Hospital, Via Pergolesi 33, Monza, Italy.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Milani
authors.forename: Maria Cristina
authors.initials: MC
authors.lastname: Cesana
authors.forename: Federico
authors.initials: F
authors.lastname: Spelzini
authors.forename: Martina
authors.initials: M
authors.lastname: Sicuri
authors.forename: Stefano
authors.initials: S
authors.lastname: Manodoro
authors.forename: Robert
authors.initials: R
authors.lastname: Fruscio
mesh_terms: D000009:Abdominal Muscles / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D003127:Colposcopy / Q000379:methods*; D005260:Female; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D018482:Muscle, Skeletal / Q000601:surgery*; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D016896:Treatment Outcome; D014621:Vagina / Q000601:surgery
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