The Surgical Challenge of the Repeat Sacrocolpopexy.

INTRODUCTION AND HYPOTHESIS: Sacrocolpopexy (SCP) is considered the "gold standard" of pelvic organ prolapse (POP) repair. There are no clear guidelines on the ideal mode of surgical retreatment when SCP fails. We aimed to summarize the existing literature regarding the performance of repeat SCP.

METHODS

We reviewed existing literature regarding surgical retreatment after SCP failure. Four hundred twenty-seven unique abstracts were identified, and two authors independently assessed eligibility and abstracted data from each study. Thirty-two full-text articles were reviewed, and 15 specifically concerning repeat SCP were included in the analysis.

RESULTS

The 15 articles included information on 116 patients. The majority (62.1%) underwent laparoscopic sacrocolpopexy (LSCP) as their index surgery, with a median time to recurrence of 24.0 months. Median prolapse stage at time of recurrence was stage 3. Repeat LSCP was the most common surgical technique (80.2%) after SCP failure. Mesh detachment was noted from the vagina (51.7%) and from the sacrum (9.5%). Only 23.3% of cases reported excising prior mesh. The median follow-up time after repeat surgery was 6.0 months. Mean subjective success rates were 89.7%, objective success rates (with varying definitions) were 85.2%, and the reoperation rate was 6.6%.

CONCLUSIONS

SCP failure, though rare, presents a surgical challenge due to the procedural complexity and the limited information regarding the optimal mode of management. In this review, LSCP was the preferred method of reoperation. Short-term objective and subjective success rates after repeat SCP were high, and reoperation rates were low. Additional studies with longer-term follow-up are needed.