Abdominal sacral colpopexy versus sacrospinous ligament fixation

Abdominal sacral colpopexy and transvaginal sacrospinous ligament fixation are both well established and standardised surgical procedures to correct vaginal vault prolapse. Both methods have their own advantages, which enables an individualised operative planning. Procedures that cause vaginal mutilation (colpectomy, colpocleisis) are obsolete, even if sexual intercourse is not desired postoperatively. Preoperative assessment includes a thorough history, gynaecological examination, urodynamic evaluation and sometimes functional MRT of the pelvic floor. Operative techniques and results are described. Perioperative complications, rates of recurrence of vaginal vault prolapse, cystoceles and rectoceles are presented,as well as postoperative bladder and bowel function and sexual activity. Finally, the pros and cons of both of the operative techniques are discussed to give some assistance in reaching a decision which procedure suits best for a respective patient.