Chapter 4.2.2 86 INTRODUCTION Pelvic organ prolapse (POP) is a common condition involving the descent of one or more of the following, i.e. the anterior vaginal wall, posterior vaginal wall, the uterus (cervix) or the apex of the vagina (vaginal vault after hysterectomy).33 The life-time risk for POP surgery ranges between 13 and 19%.165,166 Although many patients can be managed by vaginal native tissue repair, abdominal sacrocolpopexy (SCP) is associated with higher cure rates and a lower risk of dyspareunia when compared to a variety of vaginal interventions.167 Despite its subjective success rate as high as 92%, a limited number of patients (3-6%) may require a reintervention for recurrence of prolapse.31,168,169 Typically, anatomical failure occurs in the anterior and posterior compartments, with rates as high as 22.2% and 28.6% respectively.31,168,169 In the uncommon case of recurrent apical prolapse, one may consider a redo laparoscopic sacrocolpopexy (LSCP). Currently, data on the safety and efficacy of redo LSCP is limited to case series mainly focusing on operative details and one retrospective observational study with follow-up limited to 24 months.170-174 Therefore, we aimed to review the experience of our center. We hypothesized that redo LSCP may have an increased risk for complications, and we wanted to document the functional and anatomical outcomes on the medium-term, when compared to primary LSCP. MATERIALS AND METHODS This is a single-center matched case-control study, comparing all consecutive women undergoing a redo LSCP (cases) with women having a primary procedure (controls) for symptomatic apical prolapse between 2002 and 2020 with a minimum follow-up of 12 months. All procedures were performed in an academic teaching hospital. Each case was matched with four controls, which were selected based on the date of surgery, i.e. the primary case that was the closest on the operation list. Throughout the study period we used a standardised surgical technique, and operations were performed by or under the direct supervision of one experienced surgeon (JD), as described earlier.30 All patients agreed to participate in an ongoing prospective cohort study, including all consecutive patients having a LSCP at our center.28,31,175,176 By definition, sacrocolpopexy patients presented with symptomatic prolapse (Pelvic Organ Prolapse Quantification [POP-Q] system stage 2 or greater) with involvement of the apical compartment.5 Standard clinical follow-up included at least one visit within 3 months postoperatively, but most patients returned for yearly clinical assessment. If there was no recent visit, patients were invited for auditing purposes at the earliest 12 months after surgery. The last audit was performed in 2021. Clinical assessment and standardized interview were performed by independent assessors, i.e. subspecialty trainees in urogynecology (ASP and LC), who were neither involved in the index
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