Abstract
(1) Background: Sacrocolpopexy (SCP) with subtotal hysterectomy (SH) is a standard procedure for the treatment of utero-vaginal prolapse. Several disadvantages are associated with the remaining cervix; therefor, SCP with total hysterectomy (TH) may be preferred. According to some publications, SCP with concomitant TH is associated with higher rates of mesh extrusion. Our hypothesis is that mesh extrusion at the apex can be avoided through prevention of thermal injury and through vaginal cuff suturing when performing the laparoscopic sacrocolpopexy combined with a laparoscopic-assisted vaginal total hysterectomy (LAVH). (2) Methods: This prospective cohort study was performed from 2016 until January 2019 including women with a utero-vaginal prolapse undergoing laparoscopic SCP with LAVH. The SCP was performed utilizing a non-absorbable polypropylene macroporous mesh (EndoGYNious®). The primary outcome was the mesh extrusion rate after SCP with concomitant LAVH. The secondary outcome was the objective and functional outcome. (3) There were 50 women included in this prospective cohort. At follow up of 6–12 weeks postoperatively, no mesh extrusion was detected and objectified. Overall, all women showed excellent anatomical and functional outcome. The median time from surgery was 42 months. (4) Laparoscopic SCP with concomitant LAVH showed no increased risk of mesh extrusion and good objective and functional outcomes.
Highlights
With the steady decrease in hysterectomy rate over the last few decades [1], we will be undoubtedly ask how to repair apical and multicompartment prolapse in young, sexually and physically active women with a uterus.Sacrocolpopexy (SCP) with subtotal hysterectomy (SH) has become a standard surgical treatment option during the last decade for correction of pelvic organ prolapse (POP) in women with a uterus [2,3,4,5,6].There are controversial discussions on retaining the cervix
There is a higher rate of resolutions of symptoms for the domains of prolapse, bowel function and sexual function compared to bladder function
Our study demonstrates that women undergoing SCP with a concomitant laparoscopic-assisted vaginal total hysterectomy (LAVH) for utero-vaginal prolapse have excellent objective and subjective outcomes
Summary
With the steady decrease in hysterectomy rate over the last few decades [1], we will be undoubtedly ask how to repair apical and multicompartment prolapse in young, sexually and physically active women with a uterus.Sacrocolpopexy (SCP) with subtotal hysterectomy (SH) has become a standard surgical treatment option during the last decade for correction of pelvic organ prolapse (POP) in women with a uterus [2,3,4,5,6].There are controversial discussions on retaining the cervix. With the steady decrease in hysterectomy rate over the last few decades [1], we will be undoubtedly ask how to repair apical and multicompartment prolapse in young, sexually and physically active women with a uterus. Sacrocolpopexy (SCP) with subtotal hysterectomy (SH) has become a standard surgical treatment option during the last decade for correction of pelvic organ prolapse (POP) in women with a uterus [2,3,4,5,6]. Removing the uterus body and retaining the cervix ameliorates the mesh placement anteriorly along the apex down to the level of the bladder neck. To remove the uterus body morcellation has to be performed with the possible risk of spillage [7]. In the case of a later cervical dysplasia, an eventual later removal of the cervix would be more challenging
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