Abdominal Mesh Colpopexy Without Promontory Fixation: 10-Year Follow-up Results of the Peritoneocolpopexy Technique

Abstract

ObjectivesTo restore apical vaginal prolapse support when the access to the promontory is challenging, a modified method of colpopexy may be needed. We present our 10-year results on the peritoneocolpopexy (PCP) technique without promontory fixation relying on unidirectional barbed delayed absorbable sutures (V-Loc). MethodsFourteen women who underwent PCP for vaginal vault prolapse between 2011 and 2014 participated in an IRB-approved prospective study (11 non-infected; 3 with infected mesh needing excision). Ten-year follow-up data including validated questionnaires (UDI-6, IIQ-7, QoL), pelvic organ prolapse quantifications (POP-Q), complications, re-operations, and secondary prolapses were collected. Paired statistical analyses compared various timepoints and mixed model analysis assessed questionnaire and POP-Q trends over time. ResultsMedian follow-up was 9.7 years (IQR: 6.0 – 0.7) to last POP-Q and 10.4 years (IQR: 9.6 – 11.5) to last contact. No patients were lost to follow-up. Mean baseline C point for all patients was -4.3 and -2.9; 1-year C point was -9.1 and -9.2 and -8.6 and -8.5, respectively at last visit. POP-Q findings improved between pre-PCP and 1-year post surgery and did not significantly change until the last visit. Trends in UDI-6, IIQ-7, QoL and POP-Q findings showed no significant change in any category per year (95% CI, p = 0.2 – 0.9). Secondary anterior compartment prolapse was noted in 3 patients with 1 requiring a repair. ConclusionsPeritoneocolpopexy provides durable vaginal apical support when access to the promontory is compromised. PCP can also be used to prevent secondary prolapse after an infected mesh removal.