Abstract
Introduction. Sacrocolpopexy is a generally applied treatment for vault prolapse which can be performed laparoscopically or by open laparotomy. Methods. Between October 2007 and December 2012, we performed a multicenter prospective cohort study in 2 university and 4 teaching hospitals in the Netherlands. We included patients with symptomatic posthysterectomy vaginal vault prolapse requiring surgical treatment, who either had abdominal or laparoscopic sacrocolpopexy. We studied surgery related morbidity, which was divided in pre-, peri-, and postoperative characteristics. Results. We studied 85 patients, of whom 42 had open abdominal and 43 laparoscopic sacrocolpopexy. In the laparoscopic sacrocolpopexy group, estimated blood loss was significantly less compared to the abdominal group: 192 mL (±126) versus 77 mL (±182), respectively (P ≤ .001). Furthermore, hospital stay was significantly shorter in the laparoscopic group (4.2 days) as compared to the abdominal group (2.4 days) (P ≤ .001). The overall complication rate was not significantly different (P = .121). However there was a significant difference in favor of the laparoscopic group in peri- and postoperative complications requiring complementary (conservative) treatment and/or extended admittance (RR 0.24 (95%-CI 0.07–0.80), P = .009). Conclusion. Laparoscopic sacrocolpopexy reduces blood loss and hospital stay as compared to abdominal sacrocolpopexy and generates less procedure related morbidity.
Highlights
Sacrocolpopexy is a generally applied treatment for vault prolapse which can be performed laparoscopically or by open laparotomy
According to a Cochrane review on the subject, abdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse compared to the Obstetrics and Gynecology International vaginal sacrospinous fixation [5]
In the laparoscopic sacrocolpopexy group estimated blood loss was significantly less compared to the abdominal group: 192 mL (±126) versus 77 mL (±182), respectively (P ≤ .001)
Summary
The incidence of posthysterectomy vault prolapse requiring surgery has been estimated at 36 per 10,000 women years [1]. A variety of different surgical procedures to correct vaginal vault prolapse have been reported [4]. These reconstructive techniques can principally be divided into vaginal or abdominal procedures. Previous studies showed less blood loss and a significantly shorter hospital stay in the laparoscopic group [5, 9, 10]. These studies show no significant difference in complication rate; in the abdominal group more severe complications occurred [9]. We performed a prospective cohort study to compare complication rates of the open abdominal sacrocolpopexy and the laparoscopic sacrocolpopexy
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