Sacrocolpopexy: The Way I Do It.

IF 1.8 3区 医学 Q3 OBSTETRICS & GYNECOLOGY International Urogynecology Journal Pub Date : 2024-10-15 DOI:10.1007/s00192-024-05922-0
Usama Shahid, Zhouran Chen, Christopher Maher
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Abstract

Introduction and hypothesis: Sacrocolpopexy (SCP) is an established surgical procedure for apical vaginal vault prolapse. There remains significant variation amongst surgeons in both the surgical steps and concomitant surgeries utilised when undertaking an SCP.

Methods: This review article is aimed at summarising the evidence and providing a detailed update of SCP in modern practice, reviewing contemporary evidence behind its indications, efficacy, outcomes, surgical steps, and complications.

Results: Sacrocolpopexy remains the gold standard for post-hysterectomy apical prolapse based on good long-term outcomes, patient satisfaction and low complication rates. SCP with concomitant total hysterectomy is not recommended owing to high rates of mesh exposure. The laparoscopic approach remains the preferred option in terms of low morbidity, quicker recovery and lower cost than alternative access options. For optimal outcomes an SCP should be performed with monofilament mesh, using absorbable sutures and with a paravaginal repair for cystocele.

Conclusions: Although SCP has become increasingly utilised for apical prolapse, its established efficacy regarding anatomical outcomes, patient satisfaction, and complications is in the context of post-hysterectomy prolapse. SCP with concomitant total hysterectomy has higher rates of mesh exposure. The efficacy and safety of SCP with sub-total hysterectomy or hysteropexy have not been clearly established and require further assessment through well-designed, rigorous randomised controlled trials.

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骶骨整形术:我的方法
导言和假设:骶骨阴道成形术(SCP)是治疗阴道顶端穹隆脱垂的一种成熟手术方法。在进行 SCP 手术时,外科医生在手术步骤和同时进行的手术方面仍存在很大差异:这篇综述文章旨在总结证据,并详细介绍 SCP 在现代实践中的最新情况,回顾其适应症、疗效、结果、手术步骤和并发症背后的当代证据:结果:骶骨后结肠切除术因其良好的长期疗效、患者满意度和较低的并发症发生率,仍是子宫切除术后子宫尖脱垂的金标准。由于网片暴露率较高,因此不建议同时进行全子宫切除术和骶骨结节成形术。与其他入路相比,腹腔镜方法具有发病率低、恢复快、费用低等优点,仍然是首选方案。为了达到最佳效果,SCP 应使用单丝网片、可吸收缝合线和阴道旁膀胱囊肿修补术:虽然 SCP 越来越多地被用于治疗子宫尖部脱垂,但其在解剖效果、患者满意度和并发症方面的公认疗效是针对子宫切除术后脱垂而言的。同时进行全子宫切除术的 SCP 网片暴露率较高。SCP与子宫次全切除术或子宫切除术的疗效和安全性尚未明确确定,需要通过精心设计、严格的随机对照试验进行进一步评估。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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来源期刊
CiteScore
3.80
自引率
22.20%
发文量
406
审稿时长
3-6 weeks
期刊介绍: The International Urogynecology Journal is the official journal of the International Urogynecological Association (IUGA).The International Urogynecology Journal has evolved in response to a perceived need amongst the clinicians, scientists, and researchers active in the field of urogynecology and pelvic floor disorders. Gynecologists, urologists, physiotherapists, nurses and basic scientists require regular means of communication within this field of pelvic floor dysfunction to express new ideas and research, and to review clinical practice in the diagnosis and treatment of women with disorders of the pelvic floor. This Journal has adopted the peer review process for all original contributions and will maintain high standards with regard to the research published therein. The clinical approach to urogynecology and pelvic floor disorders will be emphasized with each issue containing clinically relevant material that will be immediately applicable for clinical medicine. This publication covers all aspects of the field in an interdisciplinary fashion
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