Abdominal sacrocolpopexy: could we simplify the technique?

Abstract Objective: To compare the efficacy of a traditional open ASC technique (ASC-T) to an open modified technique (ASC-M). Methods: Retrospective cohort study with stage 3 or 4 apical prolapse women, who operated on using one of the two techniques were included in the study: ASC-T (vaginal mesh is secured with eight sutures) and ASC-M (four sutures). The POP-Q was used to objectively assess anatomical improvement. Women with less than one year of follow-up, without POP-Q classification, or with incomplete data were excluded. Results: A total of 223 women underwent ASC: 120 in ASC-T and 103 in ASC-M. The average age was 65.3 (±6.5) years in the ASC-T group and 65 (±8.5) years in the ASC-M group, with no difference between them (p=0.706). There was no difference in intraoperative increased bleeding (p=1.000) and bladder injury (p=0.706) in both groups. Comparing the POP-Q points pre- and postoperatively, we observed improvement in all points in both groups (p<0.001) without difference between them. The analysis of variance for repeated measures was used to compare the outcomes between the two groups. The postoperative prolapse stage was similar between the two groups in the apical (p=0.251) and anterior (p=0.052) vaginal compartments. In the subjective evaluation, we observed a high rate of cure and improvement in both groups, respectively 81.7% and 16.7% in the ASC-T group, and 91.3% and 8.7% in the ASC-M group (p=0.100). Conclusion: Both sacrocolpopexy techniques were effective in treating apical prolapse, as evidenced by both objective and subjective cure rates, with a low complication rate.