Traitement chirurgical du prolapsus par promontofixation cœlioscopique. Techniques et résultats

Abstract

The laparoscopic sacrocolpopexy is the preferred procedure for the young woman. The procedure is that used for pelvic laparoscopy. The steps are identical as during open sacrocolpopexy, with the advantages of pneumodissection and better vision. The success rate is more than 90% and redux is mostly cystocele. Mesh erosion is reported in 2,7 to 9%. The indication for a posterior mesh is recommended if there is a rectocele or if a colposuspension at the same time. The fixation of the mesh must be posteriorly on the central tendon of perineum and the levator ani with a non resorbable stitches. The best mesh is type I in Amid classification. The comparative studies with open sacrocolpopexy and sacrospinifixation show an advantage for pain and hospital stay, but greater operative time for identical results. In preliminary results, the robotic abdominal sacrocolpopexy give the same results with a greater cost.