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Minerva Ginecologica 2016 February;68(1):55-66

Copyright © 2016 EDIZIONI MINERVA MEDICA

lingua: Inglese

Surgical techniques for advanced stage pelvic organ prolapse

Douglas N. BROWN 1, Christopher STRAUCHON 2, Hector GONZALEZ 2, Daniel GRUBER 2

1 Division of Minimally Invasive Gynecologic Surgery, Vincent Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA, USA; 2 Division of Urogynecology, Department of Obstetrics and Gynecology, Walter Reed National Military Medical Center, Bethesda, MD, USA


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Pelvic organ prolapse is an extremely common condition, with approximately 12% of women requiring surgical correction over their lifetime. This manuscript reviews the most recent literature regarding the comparative efficacy of various surgical repair techniques in the treatment of advanced stage pelvic organ prolapse. Uterosacral ligament suspension has similar anatomic and subjective outcomes when compared to sacrospinous ligament fixation at 12 months and is considered to be equally effective. The use of transvaginal mesh has been shown to be superior to native tissue vaginal repairs with respect to anatomic outcomes but at the cost of a higher complication rate. Minimally invasive sacrocolpopexy appears to be equivalent to abdominal sacrocolpopexy (ASC). Robot-assisted sacrocolpopexy (RSC) and laparoscopic sacrocolpopexy (LSC) appear as effective as abdominal sacrocolpopexy, however, prospective studies of comparing long-term outcomes of ASC, LSC, and RSC in relation to health care costs is paramount in the near future. Surgical correction of advanced pelvic organ prolapse can be accomplished via a variety of proven techniques. Selection of the correct surgical approach is a complex decision process and involves a multitude of factors. When deciding on the most suitable surgical intervention, the chosen route must be individualized for each patient taking into account the specific risks and benefits of each procedure.

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dnbrown@mgh.harvard.edu