Surgical management of pelvic organ prolapse: abdominal and vaginal approaches

Pelvic organ prolapse (POP) is a common condition, affecting women of all ages. Both abdominal (open and laparoscopic) and vaginal approaches are utilised by the surgeon to achieve the best result for the patient. The aim of this review is to evaluate the most common surgical techniques used to correct POP based on current evidence and our experience.

PubMed was searched using the following terms: ‘pelvic organ prolapse; vaginal prolapse surgery; abdominal prolapse surgery’. These studies were complimented by our personal experience in diagnosing and treating women with prolapse.

Current evidence suggests that attention to the apical compartment is paramount to decrease the risk of recurrent POP. Apical procedures include abdominal sacrocolpopexy (hysteropexy), vaginal uterosacral ligament suspension and sacrospinous ligament suspension. The use of vaginal polypropylene mesh is controversial but may have a place in repair of recurrent prolapse, particularly of the anterior compartment. The vaginal approach has a lower morbidity and is appropriate especially in the elderly or medically compromised. The abdominal sacrocolpopexy or sacrohysteropexy is our preferred procedure when vaginal capacity is reduced and ongoing sexual function is important, or when fertility and future pregnancies are desired.

POP is a complex condition requiring individualised patient care. The pelvic surgeon needs to be proficient in a number of different prolapse surgical techniques so that surgical treatment can be tailored to patient needs.