Abdominal sacrohysteropexy is considered a gold standard approach for the management of apical prolapse, and, the surgical technique is increasingly performed recently (1,2). Surgeons may prefer to perform sacrohysteropexy in separate variations, some by attaching the mesh to both dissection areas (anterior and posterior), and others by applying the mesh to the level of the trigon in the anterior dissection area only. The different approaches for the management of apical prolapse are neither standardized nor assessed by prospective-randomized controlled trials and meta-analyses. There is little data on the literature to guide surgeons in making their decision to perform with or without posterior mesh in patients who planned to undergo sacrohysteropexy (3). Comparing the anatomic outcomes, rates of success-failure, complications, technical aspects of the surgical approaches are useful for surgeons' clinical decision-making.  We aimed to present the surgical outcomes of sacrohysteropexy without posterior mesh placement for the management of patients with apical prolapse.

The patients who underwent abdominal sacrohysteropexy without posterior mesh placement for the treatment of symptomatic grade 3 and 4 anterior-apical prolapse + asymptomatic grade 1 and 2 rectocele, between May 2015 and January 2020 were evaluated retrospectively. All robotic or open surgical procedures were performed by an experienced single surgeon. All patients were informed of the advantages, disadvantages, and costs of open/robotic surgery. The surgical technique was decided with respect to patients' preferences after the decision-aid process. The success rate, the anatomic outcomes (for anterior, apical, and posterior POP), and perioperative data of the surgical procedure were assessed. Perioperative adverse events were categorized according to the Clavien-Dindo classification.

Fifty-one patients underwent sacrohysteropexy without posterior mesh. The mean age of the patients was 56.8±10 years. The success rates for the anterior-apical and posterior POP in the study group were 60.7%, 54.9%, and 58.8%, respectively, at a median follow-up time of 26 months. The median hospital stay was 3.1 (2-6) days. The mean estimated blood loss was 127.6 (80-150) ml. The mean operation time was 114 (90-156) minutes. The mean urethral and catheter removal times were 1.3 (1–2) and 2.1 (2–4) days, respectively. The mean recovery time of the gastrointestinal motility was 14.4 hours (11-35).

Sacrohysteropexy without posterior mesh placement might be associated with less pain, shorter operative time, and shorter recovery gastrointestinal motility time, without compromising the anatomic success.

Performing sacrohysteropexy without posterior mesh in patients with especially asymptomatic grade 1 and 2 rectoceles might be a good option. Prospective-randomized trials with larger samples are required to achieve a better understanding.

Ko KJ, Lee KS. Robotic Sacrocolpopexy for Treatment of Apical Compartment Prolapse. Int Neurourol J. 2020 Jun;24(2):97-110.
Sanci A, Akpinar C, Gokce MI, Süer E, Gülpinar O. Is robotic-assisted sacrocolpo(hystero)pexy safe and effective in women over 65 years of age? Int Urogynecol J. 2021 Aug;32(8):2211-2217
Wallace SL, Enemchukwu EA, Mishra K, Neshatian L, Chen B, Rogo-Gupta L, Sokol ER, Gurland BH. Postoperative complications and recurrence rates after rectal prolapse surgery versus combined rectal prolapse and pelvic organ prolapse surgery. Int Urogynecol J. 2021 Sep;32(9):2401-2411