Objectives: To evaluate the results of the laparoscopic sacrocolpopexy using a polypropylene mesh. Methods: We performed laparoscopic sacrocolpopexy on 64 pts who presented a prolapse of the vaginal vault between the II and the IV degree according to HWS classification. The mean age was 65 (range 58-76) with variable parity. The vaginal vault prolapse was present after abdominal hysterectomy in 33 pts.(51%) and after vaginal hysterectomy in 24 pts. (38%). 7 pts. (11%) were affected by an isterocele of III -IV . 8pts(12%) presented a vault prolapse of I degree, 16pts.(25%) of II degree, 15pts.(23%) of III degree, 18 pts.(%) of VI degree.They were also affected by different degrees of cystourethrocele and rectocele, respectively 45 pts. (70%) and 40 pts. (60%).Moreover 40 pts.(62.5%) were also affected by SUI type II. All the women underwent a complete urogynecological work up (Q tip test, Vaginal profile, Pad test, Stress test, Urodynamic investigation and Urethrocistoscopy). We used a polypropylene mesh modelled in a y shaped to repair a vaginal vault prolapse fixed with a no reabsorbable suture (Ethibond) respectively to the anterior and posterior vaginal wall, the tail of the y is fixed to the sacral ligament. In patients with rectocele we positioned a mesh in rectovaginal space until to pubo- coccigeo muscle to substitute recto-vaginal septum. In those pts. with SUI we performed colposospension according to Burch and in those ones with cystocele and paravaginal defect we associated a paravaginal repair. Results: The mean operating time was 118 min. (range 90-150 min.). Intraoperative complications were: 2 bladder injuries and 1 sigma perforation (5%; all laparoscopicaly repaired). Post-operative complications were: 2 lumbosciatica, 2 de novo instability, 1 vaginal haemathoma, 3 cases of minimal dispareunia. Mean hospital stay was 3 days (2-7d). Our goal is to anaslyse the results with a (after) five year follow-up. In this moment we have reached a 30 months follow-up (6-42 m.): the procedure was successefull in 59 pts (92%). Failures were registred in 5 pts (8%): 3 of these were treated(cured) with Vyprol mesh (so we stopped to use them). No erosions were reported. Conclusions: Laparoscopic sacrocolpopexy is the first choice procedure for the treatment of vaginal vault prolapse. Is a feasible method that allows to fully exploit of the advantages of laparoscopy
Cucinella, G., Adile, B., Pardo, B., Granese, R. (2003). LAPAROSCOPIC SACROCOLPOPEXY IN THE TREATMENT OF VAGINAL VAULT PROLAPSE AND RECTOCELE. RETROSPECTIVE STUDY OF 64 CASES.
LAPAROSCOPIC SACROCOLPOPEXY IN THE TREATMENT OF VAGINAL VAULT PROLAPSE AND RECTOCELE. RETROSPECTIVE STUDY OF 64 CASES
CUCINELLA, Gaspare;
2003-01-01
Abstract
Objectives: To evaluate the results of the laparoscopic sacrocolpopexy using a polypropylene mesh. Methods: We performed laparoscopic sacrocolpopexy on 64 pts who presented a prolapse of the vaginal vault between the II and the IV degree according to HWS classification. The mean age was 65 (range 58-76) with variable parity. The vaginal vault prolapse was present after abdominal hysterectomy in 33 pts.(51%) and after vaginal hysterectomy in 24 pts. (38%). 7 pts. (11%) were affected by an isterocele of III -IV . 8pts(12%) presented a vault prolapse of I degree, 16pts.(25%) of II degree, 15pts.(23%) of III degree, 18 pts.(%) of VI degree.They were also affected by different degrees of cystourethrocele and rectocele, respectively 45 pts. (70%) and 40 pts. (60%).Moreover 40 pts.(62.5%) were also affected by SUI type II. All the women underwent a complete urogynecological work up (Q tip test, Vaginal profile, Pad test, Stress test, Urodynamic investigation and Urethrocistoscopy). We used a polypropylene mesh modelled in a y shaped to repair a vaginal vault prolapse fixed with a no reabsorbable suture (Ethibond) respectively to the anterior and posterior vaginal wall, the tail of the y is fixed to the sacral ligament. In patients with rectocele we positioned a mesh in rectovaginal space until to pubo- coccigeo muscle to substitute recto-vaginal septum. In those pts. with SUI we performed colposospension according to Burch and in those ones with cystocele and paravaginal defect we associated a paravaginal repair. Results: The mean operating time was 118 min. (range 90-150 min.). Intraoperative complications were: 2 bladder injuries and 1 sigma perforation (5%; all laparoscopicaly repaired). Post-operative complications were: 2 lumbosciatica, 2 de novo instability, 1 vaginal haemathoma, 3 cases of minimal dispareunia. Mean hospital stay was 3 days (2-7d). Our goal is to anaslyse the results with a (after) five year follow-up. In this moment we have reached a 30 months follow-up (6-42 m.): the procedure was successefull in 59 pts (92%). Failures were registred in 5 pts (8%): 3 of these were treated(cured) with Vyprol mesh (so we stopped to use them). No erosions were reported. Conclusions: Laparoscopic sacrocolpopexy is the first choice procedure for the treatment of vaginal vault prolapse. Is a feasible method that allows to fully exploit of the advantages of laparoscopy
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