Sacrocolpopexy for posthysterectomy vaginal vault prolapse: long-term follow-up (original) (raw)
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Journal of the American College of Surgeons, 2002
BACKGROUND: 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. STUDY DESIGN: 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 H 2 O. All patients had abdominal sacral colpopexy associated with a Burch procedure and a posterior perineal repair. RESULTS: 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. CONCLUSIONS: 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.
American Journal of Obstetrics and Gynecology, 2012
The objective of the study was to compare recurrence and complication rates for sacrospinous fixation (SSF) and prolene mesh techniques for the primary treatment of posthysterectomy vaginal vault prolapse. STUDY DESIGN: Patients undergoing surgery for vault prolapse were included in a multicenter, randomized, controlled study comparing SSF or total mesh (Prolift; Gynecare/Ethicon, Somerville, NJ). The examination included pelvic organ prolapse quantification, urodynamics, ultrasound, and quality-of-life (QoL) questionnaires before and 3 and 12 months after surgery. RESULTS: Of 168 randomized patients, 83 underwent SSF and 85 mesh repair. Prolapse recurrence after 12 months occurred in 39.4% of the SSF group and in 16.9% of the mesh group (P ϭ .003). The mesh exposure rate was 20.8%. No difference in QoL improvement as well as of de novo stress urinary incontinence and overactive bladder onset was found. CONCLUSION: Mesh exposure occurrence was balanced against a lower prolapse recurrence rate in the patients undergoing mesh surgery compared with those undergoing SSF.
Bjog: An International Journal Of Obstetrics And Gynaecology, 2023
Background: Hysterectomy is one of the most performed surgical procedures during lifetime. Almost 10 % of women who have had a hysterectomy because of prolapse symptoms, will visit a gynaecologist for a surgical correction of a vaginal vault prolapse thereafter. Vaginal vault prolapse can be corrected by many different surgical procedures. A Cochrane review comparing abdominal sacrocolpopexy to vaginal sacrospinous fixation considered the open abdominal procedure as the treatment of first choice for prolapse of the vaginal vault, although operation time and hospital stay is longer. Literature also shows that hospital stay and blood loss are less after a laparoscopic sacrocolpopexy compared to the abdominal technique. To date, it is unclear which of these techniques leads to the best operative result and the highest patient satisfaction. Prospective trials comparing vaginal sacrospinous fixation and laparoscopic sacrocolpopexy are lacking. The aim of this randomized trial is to compare the disease specific quality of life of the vaginal sacrospinous fixation and laparoscopic sacrocolpopexy as the treatment of vaginal vault prolapse. Methods: We will perform a multicentre prospective randomized controlled trial. Women with a post-hysterectomy symptomatic, POP-Q stage ≥2, vaginal vault prolapse will be included. Participants will be randomized to the vaginal sacrospinous fixation group or the laparoscopic sacrocolpopexy group. Primary outcome is disease specific quality of life at 12 months follow-up. Secondary outcome will be the effect of the surgical treatment on prolapse related symptoms, sexual functioning, procedure related morbidity, hospital stay, postoperative recovery, anatomical results using the POP-Q classification after one and 5 years follow-up, type and number of re-interventions, costs and cost-effectiveness. Analysis will be performed according to the intention to treat principle and not as a per protocol analysis. With a power of 90% and a level of 0.05, the calculated sample size necessary is 96 patients. Taking into account 10% attrition, a number of 106 patients (53 in each arm) will be included. Discussion: The SALTO-2 trial is a randomized controlled multicentre trial to evaluate whether the laparoscopic sacrocolpopexy or vaginal sacrospinous fixation is the first-choice surgical treatment in patients with a stage ≥2 vault prolapse.
BMC Women's Health
Background: Hysterectomy is one of the most performed surgical procedures during lifetime. Almost 10 % of women who have had a hysterectomy because of prolapse symptoms, will visit a gynaecologist for a surgical correction of a vaginal vault prolapse thereafter. Vaginal vault prolapse can be corrected by many different surgical procedures. A Cochrane review comparing abdominal sacrocolpopexy to vaginal sacrospinous fixation considered the open abdominal procedure as the treatment of first choice for prolapse of the vaginal vault, although operation time and hospital stay is longer. Literature also shows that hospital stay and blood loss are less after a laparoscopic sacrocolpopexy compared to the abdominal technique. To date, it is unclear which of these techniques leads to the best operative result and the highest patient satisfaction. Prospective trials comparing vaginal sacrospinous fixation and laparoscopic sacrocolpopexy are lacking. The aim of this randomized trial is to compare the disease specific quality of life of the vaginal sacrospinous fixation and laparoscopic sacrocolpopexy as the treatment of vaginal vault prolapse. Methods: We will perform a multicentre prospective randomized controlled trial. Women with a post-hysterectomy symptomatic, POP-Q stage ≥2, vaginal vault prolapse will be included. Participants will be randomized to the vaginal sacrospinous fixation group or the laparoscopic sacrocolpopexy group. Primary outcome is disease specific quality of life at 12 months follow-up. Secondary outcome will be the effect of the surgical treatment on prolapse related symptoms, sexual functioning, procedure related morbidity, hospital stay, postoperative recovery, anatomical results using the POP-Q classification after one and 5 years follow-up, type and number of re-interventions, costs and cost-effectiveness. Analysis will be performed according to the intention to treat principle and not as a per protocol analysis. With a power of 90% and a level of 0.05, the calculated sample size necessary is 96 patients. Taking into account 10% attrition, a number of 106 patients (53 in each arm) will be included. Discussion: The SALTO-2 trial is a randomized controlled multicentre trial to evaluate whether the laparoscopic sacrocolpopexy or vaginal sacrospinous fixation is the first-choice surgical treatment in patients with a stage ≥2 vault prolapse.
Asian Journal of Medical Sciences
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 gr...
The World Clinics Journal of Medical Sciences, 2017
he surgical repair of apical pelvic organ prolapse (POP) includes vaginal and abdominal approaches. 1 The vaginal approaches are lessmorbid than abdominal approaches.However, abdominal approaches provides lower recurrence rates and less dysparenuia than vaginal approaches. 2 Today, sacrocolpopexy is the gold standard procedure for apical POP repair. 1,2 The procedure that can be performed by abdominally (ASC), or minimally invasively (MISC), provides excellent anatomical and functional outcomes. 2 Since vaginal vault prolapses occured more rarely, the number of studies including MISCs are rare. 3 Herein we report our experience with abdominal and minimally invasive approaches of the sacrocolpopexy. In addition, we present the demographic, peri-and postoperative outcomes of abdominal and minimally invasive approaches. MATERIAL AND METHODS SUBJECTS A total of 41 consecutive women who were diagnosed with POP and underwent a sacrocolpopexy operation (21 ASC, 20 MISC) were included in
Laparosopic sacrocolpopexy in the management of vaginal vault prolapse
Gynaecological Endoscopy, 1996
There are many procedures described for the treatment of vaginal vault prolapse. This paper describes the use of minimal access surgical techniques, in the form of laparoscopic sacrocolpopexy, for the treatment of this condition. The outcomes for the first 29 women to have undergone this procedure are described. Of the operations, 26 were completed without any intra-operative problems. On two occasions the bladder was perforated during the procedure, and in one case the inferior epigastric artery was injured. One patient had a urinary tract infection postoperatively. The remaining patients had uneventful postoperative courses. Most patients were discharged home on the 2nd postoperative day. All patients were reviewed at 2 weeks and at 6 weeks, and 28 have been reviewed at 3 months and at 6 months, and 14 for greater than 6 months, following surgery. All patients have been able to return to their normal lifestyle very rapidly and there were no reports of dyspareunia. There were eight cases of rectocoele at the 6-month review, and one patient had a recurrence of vault prolapse. Four patients have required a further surgical procedure, namely posterior repair. All except one patient had good support of the vaginal vault.
Journal of Robotic Surgery, 2007
Transabdominal sacrocolpopexy has been shown, in multiple long-term studies of its success and durability, to be the deWnitive treatment option for posthysterectomy vaginal vault prolapse. It is, however, associated with greater morbidity than vaginal repair. We describe a minimally invasive technique for vaginal vault prolapse repair and present our experience with a minimum of one-year follow-up. The surgical technique involves Wve laparoscopic ports-three for the da Vinci robot and two for the assistant. After appropriate dissection a polypropylene mesh is attached to the sacral promontory and to the vaginal apex by use of Gore-Tex sutures. The mesh material is then covered by the peritoneum. Patient analysis focused on complications, urinary continence, patient satisfaction, and morbidity, with a minimum of 12 months follow-up. Forty-two patients with post-hysterectomy vaginal vault prolapse underwent robot-assisted laparoscopic sacrocolpopexy at our institute and 35 have a minimum of 12 months follow-up, with a mean follow-up of 36 months (range 12-48) in the group. Mean age was 67 (47-83) years and mean operating time was 3.1 (2.15-4.75) h for the entire cohort. All but one patient were discharged home on postoperative day one; one patient left on postoperative day two. One developed recurrent grade three rectocele, one had recurrent vault prolapse, and two suVered from vaginal extrusion of mesh. All patients were satisWed with their outcome. The robot-assisted laparoscopic sacrocolpopexy is a minimally invasive technique for vaginal vault prolapse repair, combining the advantages of open sacrocolpopexy with the reduced morbidity of laparoscopy. We observed reduced hospital stay, low occurrence of complications, and high patient satisfaction, with a minimum of 1-year followup. Most importantly, the long-term results of the robotic repair are similar to those of open repair, but with signiWcantly less morbidity.