Digital Presentation AGES XXVIII Annual Scientific Meeting 2018

Comparison between vaginal and laparoscopic sacrocolpopexy – clinical outcomes. (5424)

Nili Raz 1 2 3 , Alexander Condrea 1 4 , Shimon Ginath 1 4
  1. Department of Obstetrics and Gynecology, Edith Wolfson Medical Center, Holon, Israel
  2. Department of Obstetrics and Gynecology, Hillel Yaffe Medical Center, Hadera, Israel
  3. The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Haifa, Israel
  4. Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv , Israel

Hypothesis

Sacrocolpopexy (SCP) is the operation of choice for apical vault prolapse (1). Initially described as an open abdominal procedure (2), followed by laparoscopic and robotic approaches with equal anatomical outcomes, but longer operating time (1). Further described is a combined approach (3). Based on this, it seemed logical to continue and explore the possibility of performing SCP exclusively trans-vaginally. The objective of the study is to present the technique of this new operation and compare it with laparoscopic SCP

materials and methods

Our retrospective cohort study compared surgery results of 25 patients who underwent vaginal sacrocolpopexy (VSCP) and 18 patients who underwent laparoscopic sacrocolpopexy (LSCP) for either post hysterectomy vault prolapse or at the same session of hysterectomy for prolapse. VSCP was performed as follows: after transversely incising the vaginal apex without opening the peritoneal cavity, the posterior peritoneum was bluntly dissected over the rectum, up to the sacrum.  A 3*15 cm polypropylene mesh was sutured to the posterior vaginal wall leaving the excess length of the mesh proximally. The rectum was displaced to the left through the anus. The mesh was inverted into the dissected space, and attached to the anterior surface of the sacrum at the level of S3-5 under digital control with 2-3 endoscopic tackers (ProTack™ 5mm Fixation Device). Tension was gauged by leaving a 1st degree apical prolapse to avoid excess tension and back pain. Vaginal cuff was closed and additional correction of anterior wall\TOT were made as indicated.

Results

Demographic characteristics, clinical characteristics and concomitant hysterectomies were similar in both surgical approaches. More concomitant vaginal wall repairs was performed in VSCP group. The length of VSCP procedure was shorter than LSCP (104 min, 84 min respectively).

The immediate complications following VSCP were post-operative anemia in one woman treated with blood transfusion and rectal lacerations in two patients, which was identified and sutured during primary operation without further sequella. The immediate complications following LSCP were post-operative fever in one patient, which resolved by antibiotic treatment and ileus due to trocar site herniation in another patient witch was successfully treated by repeated laparoscopy by repositioning the bowel and suturing the hernia sac.

In a follow-up of eight months, the recurrence of prolapse, de-novo urgency and mesh erosions rate were similar in both groups.

Concluding message

We present a novel vaginal approach for sacrocolpopexy. Both LSCP and VSCP are safe and effective options for SCP.

 

 

  1. 1. Paraiso M, Jelovsek J, Frick A, Chen CC, Barber MD. Laparoscopic compared with robotic sacrocolpopexy for vaginal prolapse: a randomized controlled trial. Obstet Gynecol 2011;118(5):1005–13.
  2. 2. Gutman R, Maher C. Uterine-preserving prolapse surgery. Int Urogynecol J 2013;24(11):1803–13.  
  3. 3. Nygaard IE, McCreery R, Brubaker L, Connolly A, Cundiff G, Weber AM, Zyczynski H; Pelvic Floor Disorders Network. Abdominal sacrocolpopexy: a comprehensive review. Obstet Gynecol. 2004 Oct;104(4):805-23.  
  • Have you presented oral, video or DCS at an AGES meeting before?: No
  • Are you a trainee and if so at what level?: Not a trainee
  • Are you a subspecialists or AGES member?: No