title: Sacrospinous hysteropexy: review and meta-analysis of outcomes.
abstract: BACKGROUND
  Sacrospinous hysteropexy is a uterine-preserving procedure for treatment of apical prolapse. We present a literature review evaluating the sacrospinous hysteropexy procedure and its current place in the surgical management of pelvic organ prolapse. Additionally, to assess the efficacy of the procedure, we performed a meta-analysis of studies comparing sacrospinous hysteropexy to vaginal hysterectomy and repair in terms of anatomical outcomes, complications, and repeat surgery.
  
  
  METHODS
  Major literature databases including MEDLINE (1946 to 2 April 2016), Cochrane Central Register of Controlled Trials (CENTRAL; 2016, Issue 3), and Embase (1947 to 2 April 2016) were searched for relevant studies. We used Cochrane Collaboration's Review Manager software to perform meta-analysis of randomized controlled studies and observational studies.
  
  
  RESULTS
  Vaginal sacrospinous hysteropexy was first performed in 1989 and is similar in technique to sacrospinous colpopexy. Two randomized controlled trials and four cohort studies (n = 651) were included in the meta-analysis. Apical failure rates after sacrospinous hysteropexy versus vaginal hysterectomy were not significantly different, although the trend favored vaginal hysterectomy [odds ratio (OR) 2.08; 95% confidence interval (CI) 0.76-5.68]. Rates of repeat surgery for prolapse were not significantly different between the two groups (OR 0.99; 95% CI 0.41-2.37). The most significant disadvantage of uterine-preservation prolapse surgery when compared with hysterectomy is the lack of prevention and diagnosis of uterine malignancy.
  
  
  CONCLUSIONS
  Sacrospinous hysteropexy is a safe and effective procedure for pelvic organ prolapse and has comparable outcomes to vaginal hysterectomy with repair.
authors.affiliation: Ipswich Hospital, QLD Health, University of Queensland, Chelmsford Avenue, Ipswich, QLD, 4305, Australia.
authors.forename: Shveta
authors.initials: S
authors.lastname: Kapoor
authors.affiliation: Ipswich Hospital, QLD Health, University of Queensland, Chelmsford Avenue, Ipswich, QLD, 4305, Australia. sivanezan@gmail.com.
authors.forename: Kanapathippillai
authors.identifier: http://orcid.org/0000-0001-9801-0140
authors.initials: K
authors.lastname: Sivanesan
authors.affiliation: Ipswich Hospital, QLD Health, University of Queensland, Chelmsford Avenue, Ipswich, QLD, 4305, Australia.
authors.forename: Jessica Amy
authors.initials: JA
authors.lastname: Robertson
authors.affiliation: Ipswich Hospital, QLD Health, University of Queensland, Chelmsford Avenue, Ipswich, QLD, 4305, Australia.
authors.forename: Mayooran
authors.initials: M
authors.lastname: Veerasingham
authors.affiliation: Lady Cilento Children's Hospital, QLD Health, University of Queensland, South Brisbane, QLD, Australia.
authors.forename: Vishal
authors.initials: V
authors.lastname: Kapoor
mesh_terms: D005260:Female; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000379:methods; D015907:Hysteroscopy / Q000379:methods*; D059351:Organ Sparing Treatments / Q000379:methods*; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D012447:Sacrum / Q000601:surgery; D013131:Spine / Q000601:surgery; D016896:Treatment Outcome; D014599:Uterus / Q000601:surgery; D014621:Vagina / Q000601:surgery
keywords: Apical prolapse; Sacrospinous hysteropexy; Uterine preservation; Vaginal hysterectomy