Surgical Practice Patterns for Concomitant Anterior Colporrhaphy at the Time of Vaginal Apical Repair: An International Survey of FPMRS Specialists

Introduction and hypothesis There is a dearth of high-quality evidence to support concomitant anterior colporrhaphy (AC) during vaginal apical repair to reduce pelvic organ prolapse recurrence. This research aims to understand the practice of FPMRS surgeons regarding concomitant repair of anterior and apical compartments during a vaginal approach and explore new options to improve the current often suboptimal results for the anterior compartment. We hypothesized that significant variability in concomitant anterior colporrhaphy practice exists among Female Pelvic Medicine and Reconstructive Surgery (FPMRS) surgeons worldwide.Methods An IRB-approved online survey was developed to evaluate surgical practices related to apical vaginal repair and the concurrent use of anterior colporrhaphy.Results Eight hundred forty-five surgeons (77.0% gynecologists, 21.4% urologists, 1.4% other) from 59 countries responded. Seven hundred eighty (92.3%; 95% CI 90.3-93.9%) perform vaginal apical support surgeries, and only those are included in the following analysis: 93.2% (95% CI 91.2-94.8%) would change how they performed AC if there was guidance from a well-designed RCT, 82.3% (95% CI 79.5-84.8%) perform AC in all apical repairs, 16.7% (95% CI 14.2-19.4%) perform AC only if there are defects during apical vaginal suspension, depending on the individual case, and 1.0% (95% CI 0.5-2.0%) do not perform AC.Conclusions There is high variability in how the anterior compartment is managed during apical suspension. Of note, 16.7% (95% CI 14.2-19.4%) of surgeons apply AC selectively based on individual case assessment, and 1.0% (95% CI 0.5-2.0%) do not perform AC regardless of the presence of an anterior defect. Surgeons are aware of the high anatomical/symptomatic failure for AC at the time of apical repair. Most surgeons would change their practice based on a well-designed RCT. Several strategies to improve the anterior results were proposed and these could be used to plan an RCT that would be well received by the FPMRS surgeons community.