Posthysterectomy Vaginal Vault Prolapse Research Articles

Robotic-assisted laparoscopic sacrocolpopexy for treatment of vaginal vault prolapse

Introduction To describe and demonstrate the use and benefit of robotic-assisted laparoscopic sacrocolpopexy in the treatment of posthysterectomy vaginal vault prolapse. Technical considerations The procedure combines the use of standard laparoscopy with the daVinci robotic system. The patient is placed in the dorsal lithotomy position. One camera port, two robotic ports, and two standard laparoscopic ports are placed transperitoneally. Standard laparoscopic dissection, in combination with an intravaginal retractor, is used for initial anterior and posterior vaginal mobilization and exposure of the sacral promontory. The daVinci robot is then docked and used to suture a silicone Y-shaped graft from the vagina to the sacral promontory. Culdoplasty, with plication of the uterosacral ligaments, is then performed, with the final step, retroperitonealization of the graft. Conclusions A total of 5 women have undergone this procedure, 3 with concomitant pubovaginal sling placement. All 5 women were discharged after 24 hours. No complications from the sacrocolpopexy were reported; however, 1 patient experienced transient vaginal bleeding related to the pubovaginal portion of the case. No recurrent anterior, posterior, or apical prolapse has occurred at mean of 4 months of follow-up. Using a robotic system for laparoscopic sacrocolpopexy facilitated precise intracorporeal suture placement so that the procedure could be done in a fashion similar to that of the open method. Robotic-assisted laparoscopic sacrocolpopexy may provide the same long-term durability of open sacrocolpopexy with the benefit of a minimally invasive approach.

Colpossacrofixação para correção do prolapso da cúpula vaginal

OBJETIVO: avaliar o resultado da técnica da colpossacrofixação (CSF) para tratamento de pacientes que apresentaram prolapso de cúpula vaginal pós-histerectomia e que foram tratadas no período de 1995 a 2000. MÉTODOS: foram incluídas, retrospectivamente, 21 pacientes com prolapso de cúpula vaginal pós-histerectomia e correção prévia de cistocele e retocele. Foram analisados a idade, paridade, peso e índice de massa corpórea (IMC) o intervalo entre a histerectomia e o aparecimento do prolapso. A colpossacrofixação foi realizada em 15 pacientes, das quais se avaliaram o tempo cirúrgico, perda sangüínea e recidiva. As pacientes submeteram-se a CSF com ou sem interposição de prótese de material sintético entre a cúpula vaginal e o sacro. RESULTADOS: para 15 das 21 pacientes acompanhadas em nosso serviço, a técnica de CSF foi a de eleição. Em um caso houve dificuldade técnica intra-operatória e optou-se pela correção a Te Linde. A média de idade das pacientes foi de 63,7 (47 a 95 anos), paridade 4,6 e o IMC 26,9. A CSF foi realizada, em média, 18 anos após histerectomia total abdominal e 3 anos após histerectomia vaginal. O tempo cirúrgico médio foi de 2 horas e 15 minutos, sem necessidade de transfusão sanguínea. Não houve recidiva do prolapso ou dos sintomas pré-operatórios (seguimento de 1 a 5 anos). CONCLUSÕES: o tratamento cirúrgico do prolapso de cúpula vaginal pode ser realizado pela via vaginal (colpocleise ou fixação ao ligamento sacroespinhoso) e pela via abdominal (colpossacrofixação). Esta última apresenta a vantagem de restaurar o eixo vaginal preservando sua profundidade, o que, além de melhorar o prolapso, permite o restabelecimento das funções sexuais, intestinal e urinária (principalmente quando associada a colpofixação - Burch). Assim, quando o diagnóstico e tratamento são adequados e a equipe cirúrgica tem pleno conhecimento da anatomia pélvica, podemos afirmar que a CSF atinge seu objetivo no tratamento do prolapso de cúpula vaginal, com excelente correção e mínima morbidade.

Small Bowel Obstruction Associated With Post-Hysterectomy Vaginal Vault Prolapse

Small Bowel Obstruction Associated With Post-Hysterectomy Vaginal Vault Prolapse

Selecting Suspension Points and Excising the Vagina During Michigan Four-Wall Sacrospinous Suspension

Obstetrical & Gynecological Survey: June 2003 - Volume 58 - Issue 6 - p 383-384 doi: 10.1097/01.OGX.0000070129.85032.F4

Selecting suspension points and excising the vagina during michigan four-wall sacrospinous suspension

Objective To describe the variations in the location of the vaginal apex and the length of vagina excised in women undergoing the Michigan four-wall sacrospinous suspension for posthysterectomy vaginal vault prolapse. Methods A prospective observational study of 76 women who had the Michigan modification sacrospinous suspension performed between 1998 and 2001 for posthysterectomy vaginal vault prolapse was carried out. Demographics and preoperative, operative, and postoperative findings were noted, including the pelvic organ prolapse quantification score. The locations of the suspension points relative to the hysterectomy scar were recorded. The amount of vagina excised at surgery and the pre- and postoperative vaginal lengths are reported. Results The mean length and standard deviation of vagina excised was 4.6 ± 2.5 cm. The apex created at sacrospinous fixation was at the hysterectomy scar in only seven women (9%). It was most often situated behind the hysterectomy scar, in 58 cases (76%); it was situated in front of it in 11 (14%). In seven women no vagina was excised, and in the remaining 69 women a mean length of 5.1 ± 2.2 cm was removed. The mean vaginal lengths were 9.7 ± 1.7 cm preoperatively and 9.4 cm ± 0.8 postoperatively, a 0.3-cm difference. Conclusion When one performs the Michigan modification sacrospinous suspension, the chosen suspension points are often not at the hysterectomy scar, and in women with large prolapses excess vagina frequently is excised without compromising postoperative vaginal length.

Vaginal mesh erosion 7 years after a sacral colpopexy

The performance of abdominal sacral colpopexy as the surgical treatment of posthysterectomy vaginal vault prolapse or complete uterine prolapse is well established with reported success rates ranging from 68 to 100%1-3). However the cure rate decreases during the follow-up period. Synthetic materials have several advantages: predictable strength, a size that can be shaped to the patients' anatomy, and their availability. No defect as described with the use of harvested autologous tissue is created. However all synthetic materials have the potential to erode adjacent tissues. A comprehensive MEDLINE search using query terms ‘sacro-colpopexy’ and ‘mesh erosion’ found no case of vaginal erosion occurring 7 years after a sacro-colpopexy. We report here a late case of vaginal mesh erosion after a sacro-colpopexy using Mersilène treated by the removal of the mesh using an exclusive vaginal approach. The patient was a 51-year-old woman, gravida 2, para 2, who underwent a total hysterectomy and a sacro-colpopexy for urogenital prolapse at the age of 44 years. The sacro-colpopexy was carried out with a Mersilene mesh (Ethicon, Sommerville, NJ). A single thickness anterio-posterior flap and permanent sutures were fixed to the vagina, limiting the foreign bodies at the vaginal apex as much as possible. The patient had an annual follow up without any complications. Seven years after the sacro-colpopexy, the woman complained of blood-stained vaginal discharge with lombalgy. The gynecological examination was significant for erosion of the vaginal apex; the Mersilène mesh was visible through this erosion (Fig. 1A). The clinical and biological work-up revealed no evidence of a vaginal abscess or a systemic infection. In particular, a MRI did not show any sign of sacral osteomyelitis. (A) Erosion of the vaginal apex with the Mersilène Mesh. (B,C) Vaginal advancement and transvaginal excision of the mesh. (D) Vaginal plasty. Under general anesthesia, a transvaginal resection of the mesh with vaginal advancement was performed (Fig. 1B,C). Traction was made on the mesh, and the surrounding tissues were progressively dissected. The vaginal advancement was conducted as far as possible. The mesh was then cut and the vagina repaired. The surrounding vaginal mucosa and its underlying fascia were mobilized circumferentially and closed in layers using interrupted, delayed and absorbable suture (Fig. 1D).The operative time was 29 min, and the hospital stay was 36 h. One month after the operation, the lumbar pain had disappeared. The patient was then sexually active without dispareunia. One year after the surgical procedure the patient had no complaints and there were no clinical symptoms of prolapse recurrence. The polytetrafluoroethylene has been widely used for anatomical defects repair such as hernias, vascular bypass, or urinary incontinence sling procedures. Several authors have recommended the use of Mersilène mesh to treat vaginal prolapse by mid-sacrum or sacral promontory fixation. Vaginal mesh erosions have been reported in 3.3% to 8.8% cases of sacral colpopexy 1-5). The mean interval between the sacro-colpopexy and the first symptoms of the vaginal mesh erosion varied from 14 months for Kholi et al. (2) to 22 months for Timmons et al. (1), with an extreme of 6 years. Some authors have described the management of vaginal mesh erosion after abdominal sacral colpopexy. A laparotomy with complete removal of the mesh may be required in cases of infected mesh, severe inflammatory reaction, or bladder erosion (1). However, this procedure is associated with high morbidity as a result of severe adhesions subsequent to synthetic material (1). Recently, a laparoscopic removal of the mesh has been reported (6) but with a long operative time. Timmons and Kholi described in detail their experience with partial transvaginal mesh resection in 16 and seven patients, respectively (1, 2). However, Timmons et al. underlined that some of the patients required multiple surgical procedures related to a partial mesh excision (1). Our case report pointed out about the late occurrence of vaginal mesh erosion. Vaginal mesh erosions begin as a local disease of the vagina and can be complicated by osteomyelitis or systemic infection. In the case of a severe infection the mesh should be entirely removed and a laparotomy or laparoscopy should be performed. In the absence of any systemic signs of infection a partial removal of the mesh can be efficient. The presence or urinary symptoms can justify a cystoscopy to rule out concomitant bladder involvement. The exclusive vaginal approach has low morbidity and seems to be a real alternative to more invasive surgery. However the risk factors for mesh erosion such as vaginal chronic infection or atrophic vaginal mucosa should be identified and treated before surgery. Address for correspondence: Bruno Deval Service de Gynécologie Hôpital Beaujon 100 Avenue du Général Leclerc 92000 Clichy France e-mail: bruno.deval@bjn.ap-hop-paris.fr

Longterm followup of posthysterectomy vaginal vault prolapse abdominal repair: a report of 85 cases.

There are many surgical procedures to treat posthysterectomy vaginal vault prolapse. Abdominal sacral colpopexy is one of these procedures. The aim of this study was to review the cases of 85 consecutive patients treated by this technique since 1978 by the same surgical team using the same procedure. Our surgical procedure will be explained. Eighty-five patients were treated in our department between 1978 and 1998 for posthysterectomy vaginal vault prolapse. The mean age was 55.42 years. The mean weight was 63.37 kg. Their parity ranged from 0 to 5 (mean, 2.54). The interval of time between hysterectomy and vaginal vault prolapse repair ranged from 1 to 37 years (mean, 17.92 years). The main indication for hysterectomy was uterine leiomyomas. Of these patients, 67.05% had stress urinary incontinence, and mean urethral closure pressure was 48.7 cm H2O. All patients had abdominal sacral colpopexy associated with a Burch procedure and a posterior perineal repair. Seventeen patients had postoperative fever. Twenty-two had urinary tract infections. Two patients had to undergo blood transfusion. Three patients had postoperative urinary retention. The median longterm followup was 10.5 years; 27.05% of patients had relapsing stress urinary incontinence. Two patients had a relapse of the vaginal vault prolapse. The abdominal sacral colpopexy is a safe operation with low morbidity and long-standing good results. It can be recommended for sexually active women. Nevertheless, the Burch procedure performed with this operation failed to prevent recurrence of urinary incontinence.

Abdominal colporectopexy with pelvic cul-de-sac closure.

Rectal prolapse and posthysterectomy vaginal vault prolapse often occur together and constitute a management problem. This article describes a combined colorectal and gynecologic approach to surgical management and reports the follow-up results of treatment. Patients who presented with both rectal and gynecologic symptoms of prolapse subsequent to hysterectomy and were found on clinical examination to have overt and/or occult prolapse of both the rectum and the vaginal vault were considered suitable for a combined operative procedure. This consisted of an abdominal "mesh" rectopexy, abdominal closure of the pelvic cul-de-sac (enhanced by intravaginal endoscopic transillumination), and a colpopexy attaching forward extensions of the same mesh to the apex of the anatomically restored and reinforced vaginal vault. The operation was also accompanied by a colporrhaphy if prolapse of the lower one-third of the vagina was still evident on completion of the abdominal procedures. Eighty-nine patients underwent combined surgery. Sixty of these patients had a concurrent vaginal repair. The mean follow-up time was approximately five years. There were no perioperative deaths, and the morbidity rate was 9 percent. No injury occurred to the urinary tract, and no wound or pelvic infections were evident. There was no recurrence of either the rectal or vaginal vault prolapse. Improvement occurred in all major symptoms, especially in pelvic pain. The problem of coexisting rectal and posthysterectomy vaginal vault prolapse can be corrected by combined abdominal colporectopexy and closure of the pelvic cul-de-sac. For 89 patients this operation provided considerable relief of symptoms, with no evidence of recurrence of rectal or vaginal vault prolapse at follow-up.

Sacrospinous ligament fixation for massive genital prolapse in women aged over 80 years

Objective To assess the feasibility of vaginal sacrospinous ligament fixation for women over 80 years of age with massive vaginal vault or uterovaginal prolapse. Design Retrospective observational study with long term follow up. Setting Department of Obstetrics and Gynaecology, Tampere University Hospital, Finland. Sample and Methods The study group consisted of 25 women with a mean (SD) [range] age of 83 (3) [80-93] years: 13 had posthysterectomy vaginal vault prolapse and 12 had massive uterovaginal prolapse. All underwent vaginal sacrospinous ligament fixation with repair of pelvic floor relaxation. Women with uterovaginal prolapse also underwent concomitant vaginal hysterectomy. The long term outcome was assessed in 19 women. The mean follow up period was 33 (31) [2-113] months. Main outcome measures Intra- and post-operative morbidity, mortality and recurrence of prolapse. Results Sixteen of the 25 women (64 %) had no major intra- or post-operative complications. The mean estimated blood loss was 400 (280) mL, and seven women received blood transfusions. Four women (16%) had cardiovascular complications, and one died of pulmonary embolism. All four had a history of vascular disease. One woman had symptomatic recurrence of vault prolapse treated with a vaginal pessary; two women had asymptomatic cystocele and one had an enterocele requiring no treatment. The outcomes were similar for women with or without concurrent vaginal hysterectomy. Conclusion Transvaginal sacrospinous ligament fixation is an effective treatment for massive vaginal vault or uterovaginal prolapse in aged women. Increased blood loss may elevate the risk of cardiovascular complications especially in elderly patients with a history of vascular disease, thus indicating the importance of intraoperative bleeding control.

Sacrospinous ligament fixation for massive genital prolapse in women aged over 80 years.

To assess the feasibility of vaginal sacrospinous ligament fixation for women over 80 years of age with massive vaginal vault or uterovaginal prolapse. Retrospective observational study with long term follow up. Department of Obstetrics and Gynaecology, Tampere University Hospital, Finland. and Methods The study group consisted of 25 women with a mean (SD) [range] age of 83 (3) [80-93] years: 13 had posthysterectomy vaginal vault prolapse and 12 had massive uterovaginal prolapse. All underwent vaginal sacrospinous ligament fixation with repair of pelvic floor relaxation. Women with uterovaginal prolapse also underwent concomitant vaginal hysterectomy. The long term outcome was assessed in 19 women. The mean follow up period was 33 (31) [2-113] months. Intra- and post-operative morbidity, mortality and recurrence of prolapse. Sixteen of the 25 women (64 %) had no major intra- or post-operative complications. The mean estimated blood loss was 400 (280) mL, and seven women received blood transfusions. Four women (16%) had cardiovascular complications, and one died of pulmonary embolism. All four had a history of vascular disease. One woman had symptomatic recurrence of vault prolapse treated with a vaginal pessary; two women had asymptomatic cystocele and one had an enterocele requiring no treatment. The outcomes were similar for women with or without concurrent vaginal hysterectomy. Transvaginal sacrospinous ligament fixation is an effective treatment for massive vaginal vault or uterovaginal prolapse in aged women. Increased blood loss may elevate the risk of cardiovascular complications especially in elderly patients with a history of vascular disease, thus indicating the importance of intraoperative bleeding control.

Vaginal vault suspension by abdominal sacral colpopexy for prolapse: a follow up study of 40 patients

Objectives: Vaginal vault prolapse is a rare event after hysterectomy. Vaginal repair often results in a narrowed and shortened vagina with diminished function. Abdominal sacral colpopexy attaches the vaginal apex to the sacral promontory and restores the physiological position of the vagina. The objective of the study was to evaluate follow up results of the abdominal sacral colpopexy in 40 patients by a questionnaire and a gynaecologic examination. Methods: We performed a cohort study. Between 1992 and 1998, 45 consecutive patients with a vaginal vault prolapse treated with an abdominal sacral colposcopy were included. Results: Forty patients were included in the study. No serious complications occurred during surgery. Two patients per- or postoperative hemorrhage required blood transfusion. In two patients, one with a concomittant hysterectomy, the Gore-tex ® graft infected within 3 months after the operation. If vaginal ‘protrusion’ was the only preoperative complaint, in 93% (13/14) of the cases, surgery resulted in a condition without any complaint, related to the vaginal prolapse. If initially a combination of complaints (vaginal protrusion, urinary incontinence, defecation problems, sexual dysfunction) was the reason for surgery, only ten of 27 (37%) patients were symptom-free at follow up ( P=0.002, Yates corrected). In the whole group 34 (85%) patients noticed before the operation a feeling of vaginal protrusion. At follow-up, 23 patients (56%) had no symptoms at all that could be related to the vaginal prolapse. Problems concerning defecation, like constipation were present before surgery in eight patients. In six of them, these complaints were resolved after surgery. However, in five patients de novo constipation developed after surgery. There were no cases of de novo urinary incontinence. At gynaecological examination in three patients, the vaginal vault prolapse recurred within the follow-up period, accounting for a success rate of 93%. In ten more patients a moderate enterorectocele developed or persisted. No reoperations were performed for that reason. Conclusions: Abdominal sacral colpopexy is a safe and efficacious treatment of the posthysterectomy vaginal vault prolapse. To prevent the persistence or development of an enterorectocele, a culdoplasty according to Halban or McCall might possibly be helpful. Peritonisation of the graft seems not to be necessary. The use of banked collagen tissue as graft material is promising and needs further investigation.

Vaginal Vault Prolapse Following Hysterectomy

Abstract: in the last century many different operations were described to correct post hysterectomy vaginal vault prolapse. We analyzed the results of post hysterectomy vaginal vault prolapse repair at our centre, to compare the results of the abdominal colposacropexy to a vaginal approach using the Mayo culdoplasty technique. We also present a literature review of other surgical techniques to correct prolapse of the vagina.Methods: the charts of 78 patients with posthysterectomy vaginal vault prolapse presenting for surgical correction between February 1993 to November 1998 were reviewed. Follow-up phone interview and/or clinical examinations were performed to evaluate patient satisfaction and long-term outcome.Results: the mean age at operation was 67 years. Abdominal hysterectomy had been performed on 69 percent of the patients. The mean time elapsed from hysterectomy to vault prolapse repair was 19.93 years. Abdominal colposacropexy was performed on 24 percent of the patients. The Mayo culdoplasty technique was used in 76 percent of patients. There were few perioperative and postoperative complications. Follow-up ranged from one to 58 months.Conclusion: vaginal vault prolapse repair by the abdominal colposacropexy and the Mayo culdoplasty are safe and effective procedures. Anatomical restoration and patient satisfaction were achieved in the majority of patients.

Long-term results of abdominal sacral colpopexy with mersilene mesh in patients with posthysterectomy vaginal vault prolapse

International Journal of Gynecology & ObstetricsVolume 70, Issue S4 p. D80-D80 Video session: Miscellaneous topics Long-term results of abdominal sacral colpopexy with mersilene mesh in patients with posthysterectomy vaginal vault prolapse S. Kaleli, S. KaleliSearch for more papers by this authorK. Ayd_nl_, K. Ayd_nl_Search for more papers by this authorT. Erel, T. ErelSearch for more papers by this authorT. Atasü, T. AtasüSearch for more papers by this author S. Kaleli, S. KaleliSearch for more papers by this authorK. Ayd_nl_, K. Ayd_nl_Search for more papers by this authorT. Erel, T. ErelSearch for more papers by this authorT. Atasü, T. AtasüSearch for more papers by this author First published: 11 December 2003 https://doi.org/10.1016/S0020-7292(00)84396-9AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Volume70, IssueS42000Pages D80-D80 RelatedInformation

Results of Abdominal Sacral Colpopexy Using Polyester Mesh in the Treatment of Posthysterectomy Vaginal Vault Prolapse and Enterocele

Department of Obstetrics and Gynecology, Louisiana State University Medical Center, New Orleans, Louisiana J Pelvic Surg 1999;5:136-142

Posthysterectomy vaginal vault prolapse: Primary repair in 693 patients: Webb M.J.; Aronson M.P.; Ferguson L.K.; Lee R.A. USA Obstet Gynecol 1998 92/2 (281–285)

International Journal of Gynecology & ObstetricsVolume 63, Issue 3 p. 324-324 Citations from the literature gynecological surgery Posthysterectomy vaginal vault prolapse: Primary repair in 693 patients Webb M.J.; Aronson M.P.; Ferguson L.K.; Lee R.A. USA Obstet Gynecol 1998 92/2 (281–285) First published: 18 May 2004 https://doi.org/10.1016/S0020-7292(98)90182-5AboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat No abstract is available for this article. Volume63, Issue3December 1998Pages 324-324 RelatedInformation

Posthysterectomy vaginal vault prolapse: primary repair in 693 patients

Objective: To examine the results of primary repair of posthysterectomy vaginal vault prolapse in a current, large series of patients with long-term follow-up. Methods: From January 1976 to December 1987, 693 patients underwent primary repair of vault prolapse at the Mayo Clinic. The Mayo culdoplasty technique was used in 95% of these patients. Patients were followed up by reference to their Mayo Clinic medical records, a specifically designed questionnaire, and pelvic examination in a subgroup of patients. Results: The median age at operation was 66 years. Abdominal hysterectomy had been performed on 49.5% of patients and vaginal hysterectomy on 43.4% (hysterectomy type was not documented on 7.1%). The median number of years to vault prolapse repair after hysterectomy was 15.8 (range 0.4–48.4). Information about prolapse after primary repair was available for 504 patients (72.7%) and 80 had evidence or complaint (bulge, protrusion) of recurrent prolapse. Thirty-six of 693 patients (5.2%) had subsequent prolapse repair. Eighty-two percent of patients indicated satisfaction with the result. Complications of operation included entry into the bladder or rectum (2.3% of patients), vault hematoma (1.3%), cuff infection (0.6%), and ureteral complications (0.6%). The number of patients presenting for vault prolapse repair increased during the study interval. Conclusion: The Mayo culdoplasty can be performed with minimal morbidity. It achieved an anatomic restoration of upper vaginal support in a high percentage of patients with long-term follow-up.

Abdominal sacral colpopexy for massive genital prolapse

Objective: A retrospective study to determine the success and complications of abdominal sacral colpopexy in correcting massive genital prolapse over an 8-year period between September 1989 and January 1997. Methods: The charts were reviewed for 3 patients with massive procidentia and 15 patients with symptomatic posthysterectomy vaginal vault prolapse, who desired preservation of sexual function and underwent abdominal sacral colpopexy with Marlex mesh at two community teaching hospitals. Results: In 16 of the 18 patients, one or more concurrent procedures were performed at the same time, including three Burch colpocystourethropexies and one Raz bladder neck suspension, which successfully controlled urinary stress incontinence. In three cases, staging procedures were done for ovarian neoplasia. There were no intraoperative complications. One patient developed a superficial abdominal wound infection, one patient had a deep venous thrombosis in her left leg 7 days postoperatively, and one patient experienced a 1 cm area of graft erosion 10 months postoperative requiring partial resection. Duration of follow-up has varied from 8 months to 5 years. One patient died 43 months after surgery of unrelated causes. No patients developed recurrent prolapse. Conclusions: Abdominal sacral colpopexy is a successful operation for the correction of prolapse. Serious complications are infrequent. Photographs of the technique and a review of the literature are presented.

Colpopexy: a modification of Shaw's technique

Summary The efficacy of colpopexy using an autograft is assessed. The method was used in patients with post-hysterectomy vaginal vault prolapse and/or suffering from uterine prolapse complicated by ovarian pathology. Thirty-five patients were subjected to a modified operative procedure based on Shaw's original method and completed with a posterior colporrhaphy. All patients are now free of urinary and/or pelvic symptoms with a functional vagina, after a 48 to 60 months post-operative follow-up. Pelvic cellulitis was observed in two patients and low abdominal pain in three others for a period of 1 month.

Bilateral transvaginal sacrospinous colpopexy: Preliminary experience

OBJECTIVE: Our goal was to determine how often a transvaginal sacrospinous colpopexy procedure can be done bilaterally. STUDY DESIGN: Between August 1993 and July 1996, 66 patients were prospectively evaluated for uterine prolapse (19 patients) and posthysterectomy vaginal vault prolapse (47 patients). Twenty-six patients (25 with posthysterectomy vaginal vault prolapse) underwent an abdominal sacral colpopexy. The remaining 40 patients (18 with uterine prolapse, 22 with posthysterectomy vaginal vault prolapse) were preoperatively and intraoperatively assessed for a bilateral sacrospinous colpopexy. All patients with uterine prolapse underwent hysterectomy. RESULTS: In 10 of the 18 (56%) patients with uterine prolapse and in 16 of the 22 (73%) patients with posthysterectomy vaginal vault prolapse, bilateral suspension to the sacrospinous ligament was carried out. Follow-up has ranged from 6 to 40 months, and no recurrent vaginal cuff prolapses have been detected in any patients. In 3 patients, however, all in the bilateral fixation categories, distention cystoceles have developed; one patient has undergone a successful anterior colporrhaphy. CONCLUSIONS: The bilateral suspension is different from the unilateral suspension in that the former requires significant intraoperative judgment in its feasibility and in maintaining the width of the vaginal cuff to allow a bilateral suspension without tension. A bilateral fixation appears more attainable in a patient with posthysterectomy vaginal vault prolapse than in one with uterine prolapse.(Am J Obstet Gynecol 1997;177:62)

Laparoscopic sacral colpopexy for post-hysterectomy recurrent vaginal vault prolapse

SummaryRecurrent post-hysterectomy vaginal vault prolapse is a difficult surgical problem. Our experience of seven cases of such prolapse treated by laparoscopic sacral colpopexy is reported. In all, the vaginal vault was fixed to the presacral region using a prolene mesh, with the entire procedure being performed laparoscopically. Median follow-up is 6 months (range 2 to 18 months). All six patients with some follow-up reported excellent symptom-relief. The repairs were clinically assessed to be excellent in five and good in the remaining patient.