LAPAROSCOPIC SACRAL COLPOPEXY IN TREATMENT OF VAGINAL VAULT PROLAPSE: ASSESSMENT OF EFFICACY AND CLINICAL RESULTS

Abstract

One of the first descriptions of sacral colpopexy for treatment of pelvic organ prolapse, using an intervening graft between the vagina and the sacrum, was described in 1962 (Lane, 1962). Sacral colpopexy is considered one of the most effective operations for treatment of vaginal vault prolapse (Gadonneix et al., 2006). In an attempt to minimize morbidity and maintain high cure rates, the laparoscopic approach to this procedure was first described in 1994 to 1995 (Nezhat et al., 1994, Dorsey and Cundiff, 1994, Lyons, 1995). Laparoscopic sacrocolpopexy provides the potential to combine the success rate of an abdominal approach with the faster recovery time associated with a minimally invasive technique. The laparoscopic approach contributes to superior visualization of the operative field and is associated with less postoperative pain, shorter hospital stay, shorter recovery time and earlier return to a better quality of life, with less loss of blood (Rardin et al., 2009). The current study aimed at evaluating the feasibility, safety and efficacy of the laparoscopic sacral- colpopexy as a treatment option in vaginal vault prolapse and other compartmental prolapse and detecting the early postoperative and peri-operative complications. The study included 52 patients suffering from POP admitted at Department of Gynecology, Geoffroy St. Hilaire Clinic, Paris, France and Department of Urology, Ain Shams university hospitals, Cairo, Egypt from January 2013 till December 2014. All patients received a comprehensive conversation on the result of sacral colpopexy, then after general and local examination and detailed history for the medical and surgical co-morbidities, the patients are counseled on the possibilities and risks of the laparoscopic approach and informed consent for the procedure based on the results of examination, investigation and patient’s wish was obtained. On evaluation of the operative outcomes, the operative time ranged from 45-540 min (mean time was 109.71 minutes). Anterior mesh was applied in all patients, while posterior mesh was applied in 50 patients, as 2 patients did not have associated rectocele. Absorbatak was used in 32 patients. Concomitant TOT was done for 1 patient to treat associated SUI.