Mesh Sacrocolpopexy Compared With Native Tissue Vaginal Repair: A Systematic Review and Meta-analysis

Adult women have a 12.6% lifetime risk of undergoing pelvic organ prolapse surgery.(1) Apical prolapse encompasses descent of any apical vaginal structure, including the uterus, cervix, or vaginal cuff after hysterectomy.(2) During surgery, adequate apical support is important for minimizing recurrent prolapse in any area of the vagina.(3, 4) Thus, repair of the vaginal apex is an important component of many prolapse surgeries. Surgical treatment options for apical prolapse are varied. Vaginal approaches that utilize sutures and a woman’s own “native tissue” include McCall’s culdoplasty, uterosacral ligament suspension (USLS), sacrospinous ligament fixation (SSLF), and iliococcygeus muscle suspensions.(5) The abdominal sacrocolpopexy (ASC) typically utilizes a synthetic mesh to augment the repair,(6) and minimally-invasive sacrocolpopexy options also exist.(7) In many instances, a permanent mesh may reduce prolapse recurrence but often the potential benefits in durability must be weighed against the potential risks of permanent mesh. Transvaginal mesh procedures have been utilized for apical prolapse but these procedures have decreased in light of reported adverse events and safety concerns raised in the scientific literature.(8, 9) While further data are collected regarding transvaginal mesh, many surgeons have continued using native tissue vaginal repairs or mesh sacrocolpopexy for prolapse repair. When discussing surgical options with patients, data comparing effectiveness and adverse events is helpful. Although previous large reviews of prolapse surgery exist, they tend to include all types of prolapse surgery (e.g. transvaginal mesh, non-apical prolapse procedures) and focus either on surgical effectiveness or complications.(10, 11) Reviews that include comparative data on both effectiveness and adverse events are lacking. Since surgeons and patients must weigh potential risks and benefits of surgical procedures, we performed a systematic review of native tissue vaginal repairs compared with mesh sacrocolpopexy in women with apical prolapse. We evaluated published anatomic and patient symptom outcomes six months or more after surgery, and any related adverse events.