Abdominal Pectopexy Versus Abdominal Sacral Hysteropexy.
Condition: Genital Prolapse
MeSH terms: Prolapse
Study type: Interventional

Summary: 
      This study aims to compare between abdominal pectopexy and abdominal sacral hysteropexy in
      terms of efficacy (assessed by POP-Q system), intra and postoperative complications.
    

Detailed description: 
      Pelvic organ prolapse (POP), the herniation of the pelvic organs to or beyond the vaginal
      walls, is a common condition. Many women with prolapse experience symptoms that impact daily
      activities, sexual function, and exercise. The presence of POP can have a detrimental impact
      on body image and sexuality (Lowder et al., 2011). Nulliparous prolapse is reported to
      account for 1.5% to 2% of all cases of genital prolapse (Virkud, 2016). The incidence rises
      to 5 -8 % for young women who have delivered one or two children. As this type of prolapse
      occurs at a younger age, the surgical technique should not only reduce the prolapse but also
      retain the reproductive function. Various conservative surgeries have been described in the
      past, each having their own merits and de-merits (Rameshkumar et al., 2017).

      Pelvic organ prolapse (POP) is affecting women of all ages. Epidemiological studies suggest a
      lifetime risk of prolapse or incontinence surgery of between 7 and 19% (Olsen et al., 1997;
      Smith et al., 2010). In an ageing population, the incidence of these surgeries would only be
      expected to increase, although the increasing Caesarean Section rates and smaller family size
      in recent years will have a negative impact on the prevalence of these conditions. There are
      many approaches to the surgical correction of POP, which frequently reflect the nature and
      anatomical site of the defective support, but essentially the surgeon has to decide whether
      to perform this surgery vaginally or via the abdomen as an open or laparoscopic procedure. If
      performed vaginally, further decisions regarding the use of synthetic or biological graft to
      reinforce the repair need to be made (Cvach and Dwyer, 2012).

      Pectopexy is a new technique for apical repair in which lateral parts of the iliopectineal
      ligament are used for cuff or cervix suspension. This new method is considered a simple, safe
      procedure, especially in patients whose surgical exploration is difficult (Banerjee and Noé,
      2011).

      This method uses the iliopectineal ligament on both sides for the mesh ﬁxation, (Banerjee and
      Noé, 2011). so there is no restriction caused by the mesh. The mesh follows natural
      structures (round and broad ligaments) without crossing sensitive spots, such as the ureter
      or bowel. The hypogastric trunk is at a safe distance and out of danger.

      The iliopectineal ligament is an extension of the lacunar ligament that runs on the pectineal
      line of the pubic bone (Faure et al., 2001), and is significantly stronger than the
      sacrospinous ligament and the arcus tendineus of the pelvic fascia (Cosson et al., 2003). The
      structure is strong, and holds suture well Abdominal sacral hysteropexy remains a viable
      alternative for women undergoing pelvic reconstructive surgery who wish to retain their
      uteri, providing comparable rates of overall improvement and symptom change. Avoiding
      hysterectomy decreases the risk of mesh erosion but may increase the risk of subsequent
      recurrent prolapse, specifically in the anterior compartment (Cvach and Cundiff, 2008).

      Although sacrocolpopexy has been the most effective option over time, the procedure is still
      associated with some problems, and the most frequently reported complications include
      defecation disorders and stress urinary incontinence (SUI)
    

Intervention name(s): Abdominal Pectopexy; Abdominal Sacral Hysteropexy
Intervention type(s): Procedure; Procedure
Intervention description(s): Pectopexy is a new technique for apical repair in which lateral parts of the iliopectineal ligament are used for cuff or cervix suspension.; Abdominal sacrocolpopexy is a procedure that uses a mesh material to support the top of the vagina to treat pelvic prolapse.
Intervention model: Single Group Assignment
Intervention model description: Study design: Randomized Controlled clinical Trial
Study Setting: Ain Shams maternity hospital.
Study Population: The study included 80 women divided into 2 groups:
Group A: 40 women underwent abdominal pectopexy. Group B: 40 women underwent abdominal sacral hysteropexy.
Masking: None (Open Label)
Primary purpose: Treatment