[Laparoscopic sacrocolpopexy for pelvic organ prolapse: guidelines for clinical practice].
BACKGROUND
Open sacrocolpopexy have demonstrated its efficiency in surgical treatment of pelvic organ prolapse with an important backward on a large number of patients. Laparoscopic sacrocolpopexy reproduced the same surgical technique with reduced morbidity and may benefits from the recent development of robotic. Numerous technical variants have been developped around the original procedure but results seems not ever equivalent. Our objectives are to establish practical recommendations issues from the data of the litterature on the various technical aspects of this technique.


METHODS
This work leans on an exhaustive lecture of the literature concerning meta analyses, randomized tries, registers, controlled studies and the largest non controlled studies published on the subject. Recommendations were developed by a multidisciplinary workgroup then reread and amended by an also multidisciplinary group of proofreaders (urologists, gynecologists, gastroenterologists and surgeons). The methodology follows at best the recommendations of the HAS with a scientific argument for every question (accompanied with the level of proof, NP) and the recommendations, the officers (In, B, C and agreement of experts) and validated at the end of the phase of review.


RESULTS
Surgical treatment of uro-genital prolapse by abdominal route classically associated hystero and anterior vaginopexy on the sacral ligament with a synthethic mesh. There are no argument to systematically associated a posterior vaginopexy to prevent secondary rectocele (level C). The consensual indication of laparoscopic rectopexy is represented by symptomatic rectal prolapse, the anatomical and functional results of which are the best estimated (level C). The surgical treatment of rectocele, elytrocele and enterocele with a posterior vaginopexy is not well estimated (level 3). Thus, it is not possible to conclude on the results of a posterior vaginal fixation with a mesh in these indications (AP). In the absence of colpocèle, the interest brought by the posterior vaginal mesh is not established (level 3). There is no comparative studies which allows to conclude on the type and mode of fixation of the prostheses of sacrocolpopexy. We would only report the most common practices without other conclusion. The anterior mesh is usually fixed upper on the anterior part of uterus cervix and lower on the anterior vaginal wall. These fixations are most of the time made by suture and on the promontory with non absorbable suture. The great majority of the authors recommend to make a peritonisation of prostheses to limit the risk of post-operative occlusion. It is now recommended to use only 2 kind of not absorbable prostheses: type I (macroporous polypropylene) or type III (polyester) and not to use any more prostheses type II (PTFE, Silicone) (level C) because of a high rate of mesh erosion: PTFE (9 %) or Silicone (19%) (level 3). Biological prostheses are no more recommended, because of short and medium-term lower anatomical results (level B). Anatomical and functional results are not stastistically differents between laparotomy and coelioscopy (NP1) but the comparison of tong-term results between both ways is not yet established. Coelioscopy allows significant reduction of blood losses, hospital stay and return to normal activity (level 1). Furthemore, there is a higher level of post-operative complications in laparotomy (level 1). When sacrocolpopexy is indicated, coelioscopy is thus recommended (level B). During coelioscopic sacrocolpopexy, anatomical and functional result have not shown any significance difference when using or no a robotics assistance but real randomised studies does not exist (level 2). In comparison to coelioscopy, robotic seems not to improve post-operative consequences and not to decrease the rate of complications of sacrocolpopexy (level 3). Robotic assistance cannot be yet recommended when a coelioscopic sacrocolpopexy is indicated (rank B).


CONCLUSIONS
Sacrocolpopexy using not absorbable meshes allows to cure pelvic organ prolapses with very good results with few complications in terms of prothetic exposure and infection and thus is now considered as the referent prothetic surgical technique in this indication. Thus, it seems very important to establish clear recommendations on the numerous operating technical variants which developed around the original technique. © 2016 Published by Elsevier Masson SAS.
Service d'urologie, CHU de Nîmes, place du Professeur-Debré, 30065 Nîmes Cedex 9, France. Electronic address: laurent.wagner@chu-nimes.fr.
L
L
Wagner
Service de chirurgie digestive et endocrinienne, CHU Nantes, place Alexis-Ricordeau, 44093 Nantes Cedex 1, France.
G
G
Meurette
Service d'urologie, hôpital André-Mignot, 177, route de Versailles, 78150 Le Chesnay, France.
A
A
Vidart
Service de gynécologie, CHRU Carémeau, rue du Professeur-Debré, 30029 Nîmes Cedex 9, France.
S
S
Warembourg
Hôpital privé La Casamance, 33, boulevard des Farigoules, 13675 Aubagne, France.
J-B
JB
Terassa
Clinique Ambroise-Paré, 387, route de Saint-Simon, 31082 Toulouse, France.
N
N
Berrogain
Service d'urologie, hôpital Nord, chemin des Bourrely, 13015 Marseille, France.
E
E
Ragni
Service d'urologie, CHU Nantes, place Alexis-Ricordeau, 44093 Nantes Cedex 1, France.
L
L
Le Normand
D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods / Q000592:standards*; D006801:Humans; D010535:Laparoscopy / Q000592:standards*; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D017410:Practice Guidelines as Topic; D012447:Sacrum; D013526:Surgical Mesh; D014621:Vagina
Genital prolapse; Guidelines; Prolapsus génital; Promontofixation; Recommandations; Sacral colpopexy; Surgical treatment; Traitement chirurgical