Lateral Suspension and Sacropexy for Pelvic Organ Prolapse
Condition: Pelvic Organ Prolapse
MeSH terms: Prolapse; Pelvic Organ Prolapse
Study type: Interventional

Summary: 
      Pelvic organ prolapse (POP) is considered one of the commonest gynecologic health problems
      all over the world. Pelvic organ prolapse (POP) is common and can be seen in up to 50% or
      more of parous women. The annual aggregated rate of associated surgery for pelvic organ
      prolapse is in the range of 10-30 per 10,000 women. It is estimated that women have an 11-19%
      life-time risk of undergoing surgery for POP. This rate is projected to increase over the
      next 2-3 decades. Apical POP refers any descent of the cervix or the vaginal cuff scar(as
      after hysterectomy) below a point which is 2 cm less than the total vaginal length about the
      plane of the hymen. Apical POP is due to defect in apical support with damage to the cardinal
      and uterosacral ligaments. Apical pelvic organ prolapse is a common issue in our country with
      significant incidence rate due to many predisposing factors including increasing age, higher
      gravidity and parity (especially the number of vaginal births)
    

Detailed description: 
      By one estimate, the demand for health care services related to pelvic floor disorders will
      increase at twice the rate of the population itself . So we need adequate understanding of
      the best surgical method for treating apical POP which is accepted worldwide and also must be
      cost effective with least perioperative complications. Abdominal sacropexy is considered now
      the gold standard operation for treatment of apical pelvic organ prolapse. In this technique,
      the mesh is ﬁxed to the anterior longitudinal ligament at the sacral promontory. It is used
      either with uterine preservation (sacrohysteropexy) or after hysterectomy (sacrocolpopexy)
      for treatment of vault prolapse .However , many intraoperative complication can occur
      including hemorrhage or transfusion or both occurred in 4.4% , intestinal injury or rectal
      injury in 1.6% (0.4% to 2.5%),and ureteral injury in 1.0% of cases. Postoperative
      complications include paralytic ileus in 3.6%.transient femoral nerve injury and vertebral
      osteomyelitis . Also, despite that sacropexy provide good apical support, but the high
      prevalence of cystocele and urinary tract symptoms in patients reaches up to 8% .
      Consequently, it is not surprising that the majority of failures following sacrocolpopexy
      occur in the anterior compartment. Lateral suspension with mesh was ﬁrst reported by
      Dubuisson in 1998 for the treatment of pelvic organ prolapse . The lateral suspension avoids
      both the risk of vascular injury and nerve damage of sacrocolpopexy with success rate up to
      88% of cases.
    

Intervention name(s): lateral suspension; sacropexy
Intervention type(s): Procedure; Procedure
Intervention description(s): • The vesico-vaginal space was found between the bladder and the anterior vaginal wall in the fascia plane. A polypropylene mesh (25 , 25 cm, Ethicon, Inc., Somerville, NJ) was cut to obtain two long arms (15-20 mm wide) and a rectangular piece (4-7 cm wide).; • The mesh is fixed on the anterior longitudinal ligament of sacrum with separated number 1 prolene sutures. The other end of the mesh is passed through the peritoneal tunnel and fixed to the cervix using prolene 1 and vicryl o sutures.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: None (Open Label)
Primary purpose: Treatment