Sacrocolpopexy for pelvic organ prolapse: evidence-based review and recommendations
Abstract
Sacrocolpopexy is considered a reference operation for pelvic organ prolapse repair but its indications and technical aspects are not standardized. A faculty of urogynecology surgeons critically evaluated the peer-reviewed literature published until September 2015 aiming to produce evidence-based recommendations. PubMed, MEDLINE, and the Cochrane Library were searched for randomized controlled trials published in English language. The modified Oxford data grading system was used to access quality of evidence and grade recommendations. The Delphi process was implemented when no data was available. Thirteen randomized, controlled trials were identified, that provided levels 1 to 3 of evidence on various aspects of sacrocolpopexy. Sacrocolpopexy is the preferred procedure for vaginal apical prolapse (Grade A), monofilament polypropylene mesh is the graft of choice and the laparoscopic approach is the preferred technique (Grade B). Grade B recommendation supports the performance of concomitant procedures at the time of sacrocolpopexy. Grade C recommendation suggests either permanent or delayed sutures for securing the mesh to the vagina, permanent tackers or sutures for securing the mesh to the sacral promontory and closing the peritoneum over the mesh. A Delphi process Grade C recommendation supports proceeding with sacrocolpopexy after uncomplicated, intraoperative bladder or small bowel injuries. There is insufficient or conflicting data on hysterectomy (total or subtotal) or uterus preservation during sacrocolpopexy (Grade D). Sacrocolpopexy remains an excellent option for vaginal apical prolapse repair. The issue of uterine preservation or excision during the procedure requires further clarification. Variations exist in the performance of most technical aspects of the procedure.
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“Therefore, surgery for treatment of apical prolapse should be sufficient since it prevents prolapse of the other compartments [7,8].”
- Authors
- Costantini, E., Brubaker, L., Cervigni, M., Matthews, C. A., O’Reilly, B. A., Rizk, D., Giannitsas, K., & Maher, C. F.
- Affiliations
- University of Perugia (IT)
- University of North Carolina at Chapel Hill (US)
- Cork University Hospital (IE)
- Arabian Gulf University (BH)
- University of Patras (GR)
- The University of Queensland (AU)
- Corresponding author
- Costantini, Elisabetta
- ORCID
- Venue
- European Journal of Obstetrics & Gynecology and Reproductive Biology
- Publisher
- Elsevier BV
- Published
- 2016-10
- Volume
- 205
- Pages
- 60-65
- ISSN
- 0028-2243 (ISSN-L)
- 0301-2115
- OpenAlex
- W2503277342
- Cited by
- 110
- References
- 29
- Citations by year
- 2026: 6 · 2025: 15 · 2024: 14 · 2023: 8 · 2022: 16 · 2021: 16 · 2020: 13 · 2019: 9 · 2018: 5 · 2017: 5 · 2016: 1
- FWCI
- 1.05
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- European Journal of Obstetrics & Gynecology and Reproductive Biology (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Rheumatology › Pelvic floor disorders treatments
- Health Sciences › Medicine › Obstetrics and Gynecology › Uterine Myomas and Treatments
- Health Sciences › Medicine › Surgery › Hernia repair and management
- Keywords
- sacrocolpopexy, pelvic organ prolapse, laparoscopic surgery, mesh fixation, combined surgery, bladder injury, intestinal injury, hysterectomy, uterine preservation, surgical indications
- MeSH terms
- Female, Humans, Gynecologic Surgical Procedures, Surgical Mesh, Treatment Outcome, Pelvic Organ Prolapse
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