LAPAROSCOPIC SACROCOLPOPEXY IN THE TREATMENT OF VAGINAL VAULT PROLAPSE AND RECTOCELE. RETROSPECTIVE STUDY OF 64 CASES

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