Laparoscopic Sacrocolpopexy for Pelvic Organ Prolapse: Surgical Technique and Outcomes

Roberto Nucciotti1, Alessandro Bragaglia1, Fabrizio Viggiani1, Francesco Memgoni1, Giandomenico Passavanti1, Irene Farnetani1, Valerio Pizzuti1, Fabio Massimo Costantini1
  • 1 Ospedale Misericordia, U.O. Urologia (Grosseto)

Objective

The prevalence of pelvic organ prolapse (POP), defined as stage ≥2 prolapse using the Pelvic Organ Prolapse Quantification (POP-Q) examination, was reported to be 37% in the general population and increased to 64.8% in an older population of women with a mean age of 68 yr . Abdominal sacrocohysteropexy is the gold standard treatment for POP and can be performed laparoscopically. The aim of our study was to evaluate the surgical outcomes, complications and benefits of laparoscopic single promonto-fixation for patients with pelvic prolapse.

Materials and Methods

Between 2005 and 2015 a total of 243 patients affected by POP were submitted to laparoscopic single promonto-fixation in our Department of Urology, Misericordia Hospital in Grosseto. After an interrectovaginal dissection to free the whole posterior surface of the vagina we proceeded with the installation of a posterior polypropylene mesh pre-cut in a butterfly shape that we sutured with levator ani muscles than with uterosacral ligaments and finally with the posterior wall of vagina by a resorbable stitch. The anterior face of the promontory is then freed after incision of the posterior peritoneum. After intervescical vaginal dissection, the anterior prosthesis comprising a precut polypropylene mesh with a “single” end is fixed to promontory avoiding excess traction.

Results

Population median age was 63 (range 35–78); The median stage of POP, according to POP-Q, was 3 (range 2-4). The mean operating time was 102 minutes (range 70-122). There were 2 conversions to open surgery due to anesthetic or surgical difficulties. The average follow-up was 14.6 months. Follow up was done by a postal questionnaire and physical examination at 6 months and then every year. 233/243 (96%) were satisfied and no patients complained of sexual dysfunction. There was a 2% recurrence rate of prolapse and no vaginal erosions. Thare was an intraoperative vaginal effraction that we immediately repaired with a continue suture. The mean hospital stay was 3 days (2–5). We observed no retraction of the mesh and no dyspareunia. De novo urgency was observed in 10/243 patients (4.2%) who presented previous high-grade cystocele with concomitant prolapse of other compartments. In this case, symptoms were treated with short-term anticholinergic medications and always resolved in the first few weeks after surgery.

Conclusion

Laparoscopic single promonto-fixation is a feasible and highly effective technique that offers good long-term results with complication rates similar to open surgery, with the added benefits of minimally invasive surgery.
With this technique we performed a complete resolution of severe prolapse by a minimally invasive approach with a low rate of recurrence at this point. This technique with implant of polypropylene meshes is associated with low morbidity and good long-term results in the treatment of all types of POP.
With this type of “sigle-end” conformation of the anterior mesh and the fixation points of the posterior mesh we have significantly reduced the dischezia compared to double promonto-fixation.

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