Gynaecologists’ views on the management of Vaginal Vault Prolapse: A qualitative study

Omaema Al-Baghdadi,Hassan Elbiss,Garima Srivastava,Christian Barnick

doi:10.12669/pjms.38.3.5215

Omaema Al-Baghdadi, Hassan Elbiss + Show 2 more

Open Access

https://doi.org/10.12669/pjms.38.3.5215

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Abstract

Objective:This study examined gynaecologists’ experience and views on the management of vaginal vault prolapse (VVP) using laproscopic sarcocolpopexy (LSCP) versus open sarcocolpopexy (OSCP).Methods:In a qualitative study conducted at the University of Surrey and Homerton University Hospital, UK, from 2016 to 2017, semi-structured interviews were conducted with 15 consultants experienced in minimal access surgery or urogynecology. Interviews were recorded and transcripts were analyzed using the qualitative description (QD) approach.Results:Eight broad themes emerged: VVP management, LSCP for management of VVP, OSCP and vaginal surgery with or without mesh use in VVP management, laparoscopic training and support as well as surgeons’ attitude towards LSCP. All participants acknowledged the importance of LSCP in the management of post-hysterectomy VVP as benefits outweighed risks in their view. OSCP was considered suitable in very specific circumstances. Vaginal surgery could be an excellent alternative to OSCP bearing in mind long-term efficacy and sexual activity in young women. Most participants agreed with national recommendations to avoid use of mesh in vaginal surgery for VVP and expressed the view that it should be done in specialised centres by trained surgeons who do such operations.Conclusions:This study showed that the acceptability of LSCP was dependent on participants’ experience and consideration of the balance between patient’s goals and potential risks. It provides useful guidance for future large-scale projects.

Highlights

Genital prolapse, a common condition among women over 50 years of age, severely affects their life quality leading to withdrawal from social activity due to urinary, bowel and sexual dysfunction.[1]
We investigated the reasons why gynaecologists are reluctant to adopt Laparoscopic sacrocolpopexy (LSCP) as the standard management of Vaginal vault prolapse (VVP) despite the advancement of minimal-invasive approaches in gynaecology
Vaginal surgery was done by all consultants but five didn’t do it for VVP; annual average 47.5 cases of SSF

Summary

Introduction

A common condition among women over 50 years of age, severely affects their life quality leading to withdrawal from social activity due to urinary, bowel and sexual dysfunction.[1]. The management of VVP involves pelvic floor physiotherapy, vaginal pessary and vaginal surgery including abdominal, vaginal and laparoscopic procedures to reinstate the normal anatomy including operations such as sacrospinous fixation, colpocliesis and sacrocolpopexy.[4] The. Pak J Med Sci March - April 2022 Vol 38 No 3 www.pjms.org.pk 583. Sacrocolpopexy, an abdominal surgical procedure for VVP that involves attaching a mesh between the vaginal vault and sacrum was first described as an open laparotomy.[5] Open abdominal sacrocolpopexy (OSCP) has been viewed as the gold-standard procedure,[6] being found to be superior to vaginal sacrospinous fixation.[7] OSCP takes longer to perform, has a longer recovery time and is more expensive.[7] Laparoscopic sacrocolpopexy (LSCP), first described in 1992,8 has evolved enormously with decreased morbidity, faster recovery and comparable outcomes.[6,7]

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