Sacrocolpopexy For Vaginal Vault Prolapse Research Articles

Evaluation of laparoscopic versus open sacrocolpopexy for vaginal vault prolapse – A study from a tertiary care center

Background: Post hysterectomy vault prolapse is a progressive herniation of the vaginal vault through the urogenital diaphragm and commonly leads to per vaginal bulge. Surgically, vault prolapse is corrected by sacrocolpopexy which can be done both as an open abdominal surgery and as a laparoscopic repair. Aims and Objectives: This study was performed to compare the therapeutic efficacies of laparoscopic and abdominal sacrocolpopexy. Materials and Methods: This study includes 50 cases of vault prolapsed who underwent hysterectomy previously, admitted in our institution and operated during January 2021–June 2022 for a period of 18 months with both open abdominal and laparoscopic sacrocolpopexy. We compared the basic characteristics, duration of surgery, post-operative stay, post-operative complications, and patient satisfaction between open and laparoscopic groups. Results: No significant difference was observed between the characteristics of the patients in the abdominal-approach group and the laparoscopic-approach group. The laparoscopic-approach group had a lower intraoperative estimated blood loss (187.8 vs. 90.3 mL, P<0.001) and a shorter operative time (148.0 vs. 115.3 min, P<0.001) than the abdominal-approach group. The complication rates of the two groups were not significantly different. Conclusion: Our Study is favorable for the use of laparoscopic approach over open abdominal surgery for treating cases of vault prolapse for sacrocolpopexy. The less invasive method leads to less blood loss and a shorter operative time than an open approach.

Laparoscopic sacrocolpopexy versus abdominal sacrocolpopexy for vaginal vault prolapse: long-term follow-up of a randomized controlled trial

Introduction and hypothesisThe objective of this study was to evaluate long-term outcomes of laparoscopic sacrocolpopexy (LSC) versus abdominal sacrocolpopexy (ASC) for vaginal vault prolapse (VVP).MethodsLong-term follow-up of a multicenter randomized controlled trial (SALTO trial). A total of 74 women were randomly assigned to LSC (n=37) or ASC (n=37). Primary outcome was disease-specific quality of life, measured with validated questionnaires. Secondary outcomes included anatomical outcome, composite outcome of success, complications, and retreatment.ResultsWe analyzed 22 patients in the LSC group and 19 patients in the ASC group for long-term follow-up, with a median follow-up of 109 months (9.1 years). Disease-specific quality of life did not differ after long-term follow-up with median scores of 0.0 (LSC: IQR 0–17; ASC: IQR 0–0) on the “genital prolapse” domain of the Urogenital Distress Inventory in both groups (p = 0.175). Anatomical outcomes were the same for both groups on all points of the POP-Q. The composite outcome of success for the apical compartment is 78.6% (n = 11) in the LSC group and 84.6% (n = 11) in the ASC group (p = 0.686). Mesh exposures occurred in 2 patients (12.5%) in the LSC group and 1 patient (7.7%) in the ASC group. There were 5 surgical reinterventions in both groups (LSC: 22.7%; ASC: 26.3%, p = 0.729).ConclusionsAt long-term follow-up no substantial differences in quality of life, anatomical results, complications, or reinterventions between LSC and ASC were observed. Therefore, the laparoscopic approach is preferable, considering the short-term advantages.Trial registrationDutch Trial Register NTR6330, 18 January 2017, https://www.trialregister.nl/trial/5964

Surgical traps in laparoscopic sacrocolpopexy for vaginal vault prolapse.

To describe the possible difficulties encountered in the event of laparoscopic sacrocolpopexy for vaginal vault prolapse and corresponding avoidance strategies. Video recordings of different laparoscopic sacrocolpopexies for vaginal vault prolapse showing various situations and difficulties. University Teaching Hospital of Strasbourg. Although laparoscopic sacrocolpopexy for vaginal vault prolapse is becoming more common, achieving a good outcome remains challenging, especially with the vesicovaginal dissection. Bladder injuries are not rare and occur in about 2 to 6% of cases. Vaginal perforation is less common, but remains a risk. This video illustrates possible difficulties encountered and presents various strategies to avoid them. Several tips on exposing structures and following anatomical landmarks are described. Knowing how to avoid these surgical traps will help trainee urogynecologic surgeons to perform laparoscopic sacrocolpopexy for vaginal vault prolapse.

Anal incontinence and bowel dysfunction after sacrocolpopexy for vaginal vault prolapse

This study aimed to determine the prevalence of bowel dysfunction and anal incontinence in relation to vaginal vault prolapse surgery in women hysterectomized on benign indications. This is a case-control study where women having had sacrocolpopexy (n = 78) were compared with hysterectomized women without sacrocolpopexy (n = 233) using a bowel function questionnaire and the Cleveland Clinic Incontinence Score (CCIS). Sacrocolpopexy was performed on average 13.7 years (+/-11.1 SD) after the hysterectomy. Sacrocolpopexy was associated with an increased prevalence of rectal emptying difficulties (p = 0.04), incomplete rectal evacuation (p < 0.001), digitally assisted rectal emptying (p < 0.001), and use of enemas (p = 0.001). There was no overall significant difference in mean CCIS when comparing women having had vaginal vault prolapse surgery (CCIS = 2.78 +/- 4.1 SD) with those without (CCIS = 2.1 +/- 3.3 SD, p = 0.1) Abdominal sacrocolpopexy is associated with obstructed defecation but not anal incontinence when compared to hysterectomized controls without vaginal vault prolapse surgery.

Long‐term quality‐of‐life outcome after mesh sacrocolpopexy for vaginal vault prolapse

To evaluate the long-term outcome of mesh sacrocolpopexy (MSC, which aims to restore normal pelvic floor anatomy to alleviate prolapse related symptoms) and its effect on patient's quality of life, as women with vaginal vault prolapse commonly have various pelvic floor symptoms that can affect urinary, rectal and sexual function. From January 2000 to June 2006, consecutive patients with confirmed stage 2-4 vaginal vault prolapse subsequently had a MSC. Detailed telephone interviews using the Cleveland Clinic Short Form-20 Pelvic Floor Distress Inventory (PFDI) questionnaire, with Urinary Distress Inventory (UDI), Pelvic Organ Prolapse Distress Inventory (POPDI) and Colorectal-Anal Distress Inventory (CRADI) subscales was completed by all patients to assess symptoms before and after MSC, improvement in sexual function and overall satisfaction. In all, 21 patients had abdominal MSC; the median (range) follow-up was 52.2 (21-99) months. Total PFDI scores were significantly better after MSC (mean 44.0/300) than before (mean 113.9/300; P < 0.001). Analysis of the subscale scores showed that all patients reported a significant improvement of symptoms in the POPDI category (P < 0.001). CRADI subscale scores showed no significant change after MSC (before, mean 7.43/100 vs after 8.47/100; P = 0.542). There was an improvement of urinary symptoms on the UDI subscale after MSC but it was not statistically significant (P = 0.08). Analysis of score differences over time after MSC showed an insignificant decreasing slope (P = 0.227), suggesting long-term stability of symptoms after surgery; 90% of patients reported a significant improvement in sexual function and excellent long-term overall satisfaction with MSC. Our results suggest that MSC is a safe and effective surgical option for treating vaginal vault prolapse, providing symptom improvement and stability in the long term.

Laparoscopic sacrocolpopexy: A comparison of Prolene® and Tutoplast® mesh

A retrospective study was carried out to evaluate which mesh (cadaveric fascia lata (Tutoplast or Prolene mesh) is associated with the best outcome of laparoscopic sacrocolpopexy for vaginal vault prolapse. Nineteen women who had surgery with Tutoplast and 20 who underwent surgery with Prolene were followed and asked to complete the Urogenital Distress Inventory and Defecation Distress Inventory to measure disease-specific quality of life. The women were invited for a follow-up visit for pelvic examination at a mean time of 45 months. There were no significant differences in operating time, blood loss or hospital stay between the groups. The risk of re-intervention because of recurrent prolapse was higher in the Tutoplast group than in the Prolene group (relative risk 2.9 (95% Confidence interval 0.9-9.5)). Women in the Prolene group were significantly more satisfied with the operative result.

Short-Term Outcomes of Robotic Sacrocolpopexy Compared With Abdominal Sacrocolpopexy

To compare short-term outcomes of robotic sacrocolpopexy with abdominal sacrocolpopexy for vaginal vault prolapse. We conducted a retrospective cohort study comparing robotic to abdominal sacrocolpopexy with placement of permanent mesh. The primary outcome was vaginal vault support on 6-week postoperative pelvic organ prolapse quantification (POP-Q) system examination. Secondary outcomes included blood loss, operative time, length of stay, blood transfusion, pulmonary embolus, gastrointestinal or genitourinary tract injury, ileus, bowel obstruction, postoperative fever, pneumonia, wound infection, and urinary retention. The analysis included 178 patients (73 robotic and 105 abdominal sacrocolpopexy). There were no differences in age, race, or body mass index. Robotic sacrocolpopexy showed slight improvement on POP-Q "C" point (-9 compared with -8, P=.008) when compared with abdominal sacrocolpopexy and was associated with less blood loss (103+/-96 mL compared with 255+/-155 mL, P<.001), longer total operative time (328+/-55 minutes compared with 225+/-61 minutes, P<.001), shorter length of stay (1.3+/-0.8 days compared with 2.7+/-1.4 days, P<.001), and a higher incidence of postoperative fever (4.1% compared with 0.0%, P=.04). There were no differences in other secondary outcomes. Operative time remained significantly greater in the robotic group (P<.001), and estimated blood loss remained lower (P<.001) when controlling for possible confounders. Robotic sacrocolpopexy demonstrated similar short-term vaginal vault support compared with abdominal sacrocolpopexy, with longer operative time, less blood loss, and shorter length of stay. Long-term data are needed to assess the durability of this new minimally invasive procedure. II.

Long-Term Results of Robotic Assisted Laparoscopic Sacrocolpopexy for the Treatment of High Grade Vaginal Vault Prolapse

Transabdominal sacrocolpopexy is a definitive treatment option for vaginal vault prolapse with durable success rates. However, it is associated with increased morbidity compared with vaginal repairs. We describe a minimally invasive technique of vaginal vault prolapse repair and present our experience with a minimum of 1 year followup. The surgical technique involves 5 laparoscopic ports: 3 for the da Vinci robot and 2 for the assistant. A polypropylene mesh is attached to the sacral promontory and vaginal apex using polytetrafluoroethylene sutures. The mesh material is then covered by peritoneum. Patient analysis focused on complications, urinary continence, patient satisfaction and morbidity with a minimum of 12 months followup. A total of 30 patients with post-hysterectomy vaginal vault prolapse underwent robotic assisted laparoscopic sacrocolpopexy at our institution and 21 have a minimum of 12 months followup. Mean followup was 24 months (range 12 to 36) and mean age was 67 years (range 47 to 83). Mean operative time was 3.1 hours (range 2.15 to 4.75). All but 1 patient were discharged home on postoperative day 1 and the 1 patient left on postoperative day 2. Recurrent grade 3 rectocele developed in 1 patient, 1 had recurrent vault prolapse and 2 had vaginal extrusion of mesh. All patients were satisfied with outcome. The robotic assisted laparoscopic sacrocolpopexy is a minimally invasive technique for vaginal vault prolapse repair, combining the advantages of open sacrocolpopexy with the decreased morbidity of laparoscopy. We found a decreased hospital stay, low complication rates and high patient satisfaction with a minimum of 1 year followup.

The use of submucosal small intestinal mesh in laparoscopic sacrocolpopexy and posterior vaginal repair

Sacrocolpopexy for vaginal vault prolapse changes the mechanical axis of the vagina and can result in prolapse of the anterior or posterior vaginal walls. Thirteen consecutive patients were examined before and after surgery using the POP-Q International Continence Society scoring system for genital prolapse. One patient had an intact cervix and therefore underwent sacrocervicopexy, whereas two patients had sacrohysteropexy. The other patients had sacrocolpopexy. Porcine small intestinal submucosal (SIS) absorbable mesh (Surgisis, Cook) was fixed to the posterior vaginal wall. The posterior wall remained well supported following SIS mesh interposition between the posterior vaginal wall and the rectum. Meshes can provide the much-needed support in pelvic reconstruction.

Sacrocolpopexy for vaginal vault prolapse: a combined vaginal and laparoscopic approach

ABSTRACTObjective To report the short‐term effectiveness and safety of a combined vaginal and laparoscopic approach to sacrocolpopexy in the management of vaginal vault prolapse.Design A retrospective analysis of 22 patients.Results The mean operating time was 105 min. The only significant intraoperative complication was a rectal injury. The mean length of hospital stay was 3.18 days. Erosion of the Prolene mesh occurred in two women. The vaginal vault remained well supported in all 22 patients, over a mean follow‐up time of 12.5 months. Three women have required further surgery for a symptomatic cystocele.Conclusion A combined vaginal/laparoscopic approach to sacrocolpopexy appears to be effective and associated with a low risk of intraoperative and postoperative morbidity. Its principal advantage over a completely laparoscopic approach is in removing the technical demands of laparoscopic suturing.

Short-term and long-term follow-up of abdominal sacrocolpopexy for vaginal vault prolapse: initial experience in a district general hospital

The aim of this study was to evaluate the short-term and long-term outcome with patients' satisfaction of abdominal sacrocolpopexy performed on our initial 11 patients for vaginal vault prolapse. All patients included in this study underwent surgery at a district general hospital and was performed by one experienced clinician (co-author). A retrospective analysis was performed on all 11 consecutive women who underwent abdominal sacrocolpopexy for vaginal vault prolapse between September 1996 and January 1997 and were followed-up at 6 months and at 5-year intervals. Our initial experience reveals that abdominal sacrocolpopexy is a safe and effective method in the treatment of posthysterectomy prolapse of the vaginal vault. It is associated with a low incidence of intraoperative and immediate postoperative complications and recurrent vault prolapse. Latent stress incontinence may be unmasked and preoperative urodynamic evaluation is therefore recommended. Our study also agrees with the other studies in that co-existent cystocoele, rectocoele and enterocoele should be corrected at the same setting. Following this series we have modified our technique to reduce postoperative complications such as graft erosion, which is being analysed separately. It finally concludes that this operation should be considered by every gynaecologist and that it can be performed in any district general hospital.