Laparoscopic versus open sacrocolpopexy for treatment of prolapse of the apical segment of the vagina: a systematic review and meta-analysis

Pelvic organ prolapse is showing an increasing prevalence (3 - 50 %). The gold standard treatment of apical prolapse is sacrocolpopexy which can be performed via minimal access (laparoscopy or robotics) or open approaches. The aim of this review was to appraise the effectiveness of minimal access surgery versus the open approach in the treatment of apical prolapse. Keywords were searched in: CINAHL, MEDLINE, CENTRAL, Cochrane MDSG Trials Register, Cochrane Library, Current Controlled Trials, ClinicalTrials.gov, WHO International Trials Registry Platform search portal, LILACS, and Google Scholar databases. Data up to 31 April 2014 were considered. Randomized and nonrandomized controlled trials evaluating all women who underwent minimally invasive sacropexy (MISC) and open sacropexy (OSC) were included. A data extraction tool was used for data collection. MISC was compared with OSC using narrative analysis and meta-analysis (RevMan) where appropriate. MISC and OSC were compared in 12 studies involving 4,757 participants. MISC and OSC were equally effective in terms of point-C POP-Q measurements and recurrence rate. MISC was associated with a lower transfusion rate (odds ratio 0.41, 95 % CI 0.20 - 0.83), shorter length of hospital stay (mean difference -1.57 days, 95 % CI -1.91 - -1.23 days), and less blood loss (mean difference -113.27 mL, 95 % CI -163.67 - -62.87 mL) but a longer operating time (mean difference 87.47, 95 % CI 58.60 - 116.34, p < 0.0001). MISC showed similar anatomic results to OSC with a lower transfusion rate, shorter length of hospital stay and less blood loss. The rate of other complications was similar between the approaches. Cautious interpretation of results is advised due to risk of bias caused by the inclusion of nonrandomized studies.