Sacrocolpopexy: is there a consistent surgical technique?

Abstract

Sacrocolpopexy is the gold standard treatment for vault prolapse. Current reported standards regarding surgical approach and technique vary. Our aim was to evaluate the surgical techniques used and identify any consistency. Electronic surveys were sent to 148 candidates enrolled in a sacrocolpopexy workshop at the 2012 American Urogynecologic Society (AUGS) annual meeting and as a link in the International Urogynecology Association (IUGA) e-magazine. The survey assessed demographics, specific surgical steps including dissection techniques, number and type of sutures, graft materials, and the approach to intraoperative complications. Within the AUGS group, 61 candidates responded (41%). From the IUGA membership, 128 responded for a total of 189. Overall, 59% identified their primary practice as urogynaecology, 43% having completed a fellowship. Only 33% reported performing sacrocolpopexy as the primary surgery for vault prolapse. Technical aspects: 99.4% used polypropylene mesh, with 57% attaching it to the vagina using non-absorbable monofilament sutures. An average of 3-4 sutures were used on the anterior and posterior walls respectively. Suture location: 22.5% reported not placing apical sutures and 55.7% place their anterior wall sutures midway down the vagina. Posteriorly, 47 (30%) placed sutures through the uterosacral ligaments, 19 (12.4%) through the levator ani and 15% extend the mesh to the perineal body. The mesh was attached to the sacrum using permanent sutures by 75%. Dissection of the sacrum was deemed the most technically difficult aspect. Surgical technique varies widely despite the level of expertise and training. This study highlights the need for an evaluation of the effect of surgical technique on outcomes.