Pelvic organ prolapse (POP) is often associated with a feeling of discomfort or vaginal bulge, urinary, bowel and sexual dysfunction, among other symptoms, which may impair patients’ quality of life. Reconstructive POP surgery aims to maintain a functional vagina while improving the above-mentioned symptoms. Sacrocolpopexy (SCP) is currently considered the gold standard technique for complex POP, involving two or more compartments and high grade prolapse [1]. 
The aim of this study is to evaluate the anatomical and functional outcomes, as well as the safety of SCP using a lightweight macroporous mesh.

A multicentric observational study was developed including five expert centres between March 2011 and December 2019.  A total of reported data of 325 cases of laparoscopic sacrocolpopexy (LSC) were included. Inclusion criteria consist of female patients who suffer from POP with a POP-Q stage ≥2 and who underwent a SCP.  A standard lightweight and macroporous mesh device (Surelift Uplift ®) was used. The posterior end was fixed to the sacral promontory, while the anterior mesh ends were sutured to the levator ani muscles posteriorly and the anterior vaginal wall, anteriorly. Baseline anatomical positions were evaluated using POP-Q score [2]. The primary outcomes were anatomical success, defined as POP-Q staging ≤ I, and subjective success, defined as no bothersome bulge symptoms, and no repeat surgery or pessary use for recurrent prolapse.  Secondary outcomes included: immediate and perioperative complications, new onset urinary or bowel symptoms, mesh exposure rate and reoperation rate secondary to prolapse recurrence. SPSS tool was used for the statistical analysis. Descriptive analysis is performed.  Continuous variables are presented as the mean and standard deviation if they had normal distribution or as median and interquartile range if distribution was non-normal.  Categorical variables are presented as frequency and percentage.

A total of 325 LSC were analyzed with a median patient age of 66 (IQR 61-73). The median operating time was 180 minutes (IQR 150-210). Simultaneous hysterectomy was performed in 16 patients (4.9%). 7% of the patients suffered an intraoperative complication:  2 rectal lesions (0.6%), 15 vesical lesions (4.6%) and 2 small bowel lesions (0.6%) were noticed and repaired intraoperatively. These complications were no obstacle to adequately complete the procedure.

After a median follow-up of 68 months (IQR 46.5-89), anatomical success was 88.9%. Subjective success was seen in 98.5% of the patients. 1.5% of patients had an anterior wall prolapse recurrence that required surgical repair.  De novo urinary incontinence was reported by 12.9% of the patients (42), of which 10 (23.8%) underwent a subsequent anti-incontinence procedure.

Although anatomical recurrence may happen in approximately 10-15% of the patients, subjective results are highly satisfactory using this technique. Laparoscopy has proved to be an excellent approach for this technique, with satisfactory results and low rate of complications. In the present study no concomitant anti-incontinence procedures were performed. This management is still controversial.

Our study provides evidence that LSC is a safe and effective minimally invasive approach to sacrocolpopexy for women with ≥2 grade pelvic organ prolapse.

Pelvic Organ Prolapse: ACOG Practice Bulletin, Number 214. Obstetrics and gynecology. Nov 2019;134(5):e126-e142. doi:10.1097/aog.0000000000003519
Bump RC, Mattiasson A, Bø K, et al. The standardization of terminology of female pelvic organ prolapse and pelvic floor dysfunction. American journal of obstetrics and gynecology. Jul 1996;175(1):10-7. doi:10.1016/s0002-9378(96)70243-0