Is Transvaginal Minimally Invasive Sacrospinous Ligament Fixation a Safe and Effective Surgical Approach for Treating Recurrent Apical Pelvic Organ Prolapse?

Background

Recurrent apical pelvic organ prolapse (POP) presents significant management challenges, with limited evidence on optimal surgical approaches. This study evaluated the safety and long-term effectiveness of minimally invasive sacrospinous ligament (SSL) fixation using the EnPlace® device for treating recurrent apical POP.

Methods

A cohort analysis was performed on 82 consecutive patients (mean age 65.9 ± 8.6 years) with stage III or IV recurrent symptomatic apical POP. All patients underwent transvaginal SSL fixation using the EnPlace® device between January 2021 and July 2023. Primary outcomes included anatomical cure rates, patient satisfaction, and complications. Long-term follow-up was conducted via a structured telephone survey in December 2024.

Results

The mean interval between primary and recurrent repair was 3.2 ± 2.6 years. Most patients (64.6%) underwent surgery under regional anesthesia with a mean operative time of 24.1 ± 7.1 min and minimal blood loss (23.8 ± 6.5 mL). No intraoperative complications occurred, and 98.8% of patients were discharged the same day. Two early postoperative complications occurred, neither requiring surgical intervention. At six-month follow-up, significant improvements were observed in POP-Q measurements for apical prolapse, cystocele, and rectocele. Long-term follow-up (mean 31.6 ± 8.3 months) revealed that only 11 patients (13.4%) reported mild POP symptoms. Patient satisfaction scores averaged 90.8 ± 17.1, with only 8.5% reporting low satisfaction. Only two patients (2.4%) required additional intervention for recurrent apical POP.

Conclusions

Minimally invasive SSL fixation using the EnPlace® device demonstrates favorable safety and efficacy for recurrent apical POP, offering a viable alternative to more invasive procedures with high patient satisfaction and low recurrence rates.