Recurrence After Anterior Versus Posterior Approach to Sacrospinous Hysteropexy

Sacrospinous hysteropexy (SSH) is increasingly being performed, yet limited evidence exists on whether an anterior versus posterior compartment surgical approach may affect postoperative prolapse symptoms or differences in adverse events.

The objectives of this study were to evaluate whether an anterior versus posterior approach to SSH affects short-term postoperative bulge symptoms; secondarily, assess differences in intraoperative and 30-day postoperative complication rates.

A retrospective cohort analysis of women who underwent anterior or posterior compartment approach native tissue transvaginal SSH between 2016 and 2024 at 2 academic institutions was performed. The primary outcome was the presence of bulge symptoms. Secondary outcomes were retreatment with pessary or surgery, operative data, and 30-day postoperative adverse events categorized by the Clavien-Dindo system.

Study inclusion criteria were met by 316 women. Women in the anterior approach group were older (mean ± SD shown), (70 ± 7 vs 64 ± 15) years, P < 0.0001, had a higher Charlson Comorbidity Index (CCI), median (IQR) (3 [2-4] vs 0 [0-0], P <0.0001), proportion of stage 3 and 4 prolapse (95/162 [58.6%] vs 65/154 [42.2%], P = 0.004), and greater point Ba on Pelvic Organ Prolapse Quantification (POP-Q) examination (2 [1, 3] vs 0 [-1, 2], P < 0.0001), respectively. Controlling for age, preoperative POP-Q stage, preoperative dominant prolapse compartment, and concomitant midvaginal repairs, proportional hazards modeling showed bulge symptoms earlier in the posterior approach group ( P = 0.002). There was a higher proportion of Clavien-Dindo I and II 30-day complications in the anterior approach group (21.6% vs 7.1%, P = 0.0002).

Undergoing an anterior approach to native tissue SSH may be protective to both bulge symptom recurrence and retreatment but was associated with higher short-term complications. Prospective longer-term outcomes are needed.