The National Institute for Health and Clinical Excellence (NICE) has issued full guidance to the NHS in England, Wales, Scotland and Northern Ireland on infracoccygeal sacropexy using mesh for vaginal vault prolapse repair .
It replaces the previous guidance on posterior infracoccygeal sacropexy for vaginal vault prolapse (NICE interventional procedures guidance 125, May 2005).
NICE was notified of various procedures for the treatment of pelvic organ prolapse. NICE asked the Review Body for Interventional Procedures to undertake a systematic review of these procedures.The Interventional Procedures Advisory Committee (IPAC) considered the systematic review and have also produced guidance on: infracoccygeal sacropexy using mesh for uterine prolapse repair, sacrocolpopexy using mesh for vaginal vault prolapse repair, sacrocolpopexy using mesh for uterine prolapse repair and insertion of uterine suspension sling (including sacrohysteropexy) using mesh for uterine prolapse repair.
Vaginal vault prolapse occurs in women with previous surgical removal of the womb when the upper vaginal wall slips down from its normal position down into the vaginal canal or outside of the vagina. Infracoccygeal sacropexy is an operation that involves the insertion of a piece of material (mesh) with the aim of holding the vaginal vault in place.
P24.6 Repair of vault of vagina with mesh using vaginal approach
P24.7 Sacrospinous fixation of vagina
This guidance represents the view of NICE, arrived at after careful consideration of the evidence available. When exercising their judgement, healthcare professionals are expected to take this guidance fully into account. However, the guidance does not override the individual responsibility of healthcare professionals to make decisions appropriate to the circumstances of the individual patient, in consultation with the patient and/or guardian or carer.
Commissioners and/or providers have a responsibility to implement the guidance, in their local context, in light of their duties to have due regard to the need to eliminate unlawful discrimination, advance equality of opportunity, and foster good relations. Nothing in this guidance should be interpreted in a way that would be inconsistent with compliance with those duties.