ABDOMINAL VERSUS LAPAROSCOPICSACROCOLPOPEXY; A SYSTEMATIC REVIEW AND META-ANALYSIS.
P. C. CAMPBELL, L. CLONEY, S.JHA;
Sheffield Teaching Hosp., Sheffield, United Kingdom.
Introduction: Sacrocolpopexy(SC) is considered the gold standard treatment for management ofvaginal vault prolapse (VVP)  and laparoscopic sacrocolpopexy(LSC) has become a popular alternative to the abdominal approach .However, there is limited definitive data comparing the twoprocedures.
Objective: The aim of this meta-analysis was tocompare abdominal sacrocolpopexy (ASC) with LSC for the management ofVVP.
Methods: Electronic searches of Medline, Embase,Pubmed, Cochrane register of controlled trials (CCTR), Cochranedatabase of systematic reviews (CDSR) CINAHL and Google scholar wereperformed. A systematic review and meta-analysis of studies comparingASC and LSC for the management of VVP was performed.
Results:Seven studies were included with a total of 1461 patients: 589 in theLSC group and 872 in the ASC group. The conversion rate for LSC toASC was 3% (17 cases). One LSC and one ASC were each converted tovaginal procedures. The operative time was significantly greater withLSC (MD: 25 minutes; 95% CI 5.43, 45.07) (Figure 1) however ASC hadsignificantly greater intra-operative blood loss (MD: 107mls; 95% CI-139.59, -73.73), longer hospital stay (MD 1.71 days; 95% CI -2.21,-1.22) and increased risk of postoperative ileus/small bowelobstruction (SBO) (OR 2.88; CI: 1.31-6.33) (Figure 2). There was nosignificant difference in rate of bladder injury, bowel injury, meshexposure or repeat prolapse surgery.
Conclusions: LSC takeslonger, however is associated with less intra-operative blood loss,shorter hospital stay and reduced post-operative ileus / SBO andhence is a suitable alternative to the abdominaltechnique.
References: 1. Obstetrics & Gynaecology1962: 20; 72-77.2. BJOG 2009: 116(9); 1251-7.