Iliococcygeus fixation for the treatment of vaginal vault prolapse: a systematic review and meta-analysis

INTRODUCTION: It has been reported that approximately 80-90% of apical prolapse repair is through reconstructive or obliterative vaginal surgery. Although several procedures have been described, to date there is a lack of consensus on the best surgical procedure. The aim of this study was to perform a thorough review of the current literature on the efficacy and safety of the iliococcygeus fixation technique for the treatment of vaginal vault prolapse. EVIDENCE ACQUISITION: A systematic literature search according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidelines. was conducted using the PubMed/MEDLINE and Cochrane CENTRAL databases. Our analysis included randomized control trials and observational prospective or retrospective cohort studies that assessed the Iliococcygeus fixation, in terms of overall cure rate, failure rate, reoperation rate, and complications rate. EVIDENCE SYNTHESIS: The overall cure rate ranged from 74.4% to 98% in the considered studies with a pooled value of 84.9% (95% CI: 73.3% to 96.4%). The overall failure rate ranged from 4.8% to 23% with a pooled value of 13.6% (95% CI: 5.5% to 21.7%) while the pooled value of overall re-operation rate was 3.3% (95% CI: 0.6% to 6%), ranging from 0% to 6.8. The overall complication rate ranged from 0% to 33% with a pooled value of 10.4% (95% CI: 1.4% to 19.3%). CONCLUSIONS: Despite limitations due to the heterogeneity of study designs, our review, for the first time in the literature, demonstrated that fixation of the iliococcygeus appears to be an effective and safe option for the treatment of vaginal vault prolapse. However, future randomized controlled trials with rigorous methodological protocols are needed.