ABSTRACT
It is well established that apical failure is highly associated with anterior wall prolapse and therefore obtaining level one support is imperative for most women undergoing prolapse surgery. This recognition, along with an increasing patient desire for uterine preservation has led to a re-think as to how vaginal prolapse is managed. Laparoscopic sacrohysteropexy and specifically the Oxford Hysteropexy offers a uterine preserving, minimally invasive, and mesh augmented approach to prolapse, and its emergence is likely to explain the increasing rates of uterine sparing prolapse surgery.
While data remain limited, a recent number of large prospective studies as well as cross-sectional data have compared laparoscopic sacrohysteropexy to the standard vaginal hysterectomy with apical support, as well as examined its safety, particularly important given concerns about mesh use in gynaecological surgery. It would appear to be at least as effective as vaginal hysterectomy and apical suspension and likely confers benefits with respect to higher apical support, a lower risk of apical reoperation, and reduced surgical morbidity. Furthermore, the Oxford Hysteropexy avoids placement of mesh on the vagina and therefore reduces the primary concern with mesh that is vaginal extrusion. However, data continue to emerge and given the concerns about mesh implantation its use requires high-quality counselling, consent processes, and governance structures.
