Is sacrospinous ligament fixation a safer method for treating pelvic organ prolapse?

China: A new study published in Urology shows that uterosacral ligament suspension (ULS) and sacrospinous ligament fixation (SLF) are both safe and effective surgical treatments for pelvic organ prolapse.

Pelvic organ prolapse (POP) is a gynecological disorder in which the pelvic organs protrude into the vagina as a result of ligament or muscle weakening. POP is classified based on the compartment of descent. Yuanzhuo Chen and colleagues carried out this research to examine the safety and effectiveness of sacrospinous ligament fixation (SSLF) and uterosacral ligament suspension (ULS) for surgical repair of pelvic organ prolapse (POP).

Comparative studies were found in the databases EMBASE, PubMed, Cochrane Library, MEDLINE, Medicine, and clinicaltrials.gov for this study. There were randomized controlled trials, as well as prospective and retrospective cohort studies. Anatomical rate of success (defined as anterior or posterior vaginal wall beyond the hymen), surgical rate of success, recurrence, and total complication rate were recorded as primary outcomes, while specific problems rates were obtained as secondary outcomes. Revman was used to examine the data (Version 5.4).

The key findings of this study were as follows:

1. After scanning databases and eliminating duplicate research, 57 publications made it to the screening step.

2. Finally, 9 studies of moderate to high quality (4 randomized controlled trials and 5 retrospective studies) with a total of 4516 people were selected.

3. There was no statistical difference between the two groups in terms of anatomical success, surgical success rate, recurrence rate, or overall complication rate.

4. A subgroup study of different follow-up intervals (1, 2, and 5 years) and stages (Stage 2 and Stage 3-4) revealed similar main outcomes.

In conclusion, sacrospinous ligament fixation appears to have reduced complication rates of vaginal granulation tissue and urethral damage and is rapidly becoming more popular among surgeons due to its quick surgery duration and simplicity. More high-quality research is still needed, particularly on the occurrence of problems.

Reference:

Chen, Y., Peng, L., Zhang, J., Shen, H., & Luo, D. (2022). Sacrospinous Ligament Fixation vs Uterosacral Ligaments Suspension for Pelvic Organ Prolapse: A Systematic Review and Meta-Analysis. In Urology. Elsevier BV. https://doi.org/10.1016/j.urology.2022.04.012