Author:

Keywords:

1114 Paediatrics and Reproductive Medicine, Obstetrics & Reproductive Medicine, 3215 Reproductive medicine, 4204 Midwifery

Abstract:

Objectives: Evaluation of the anatomical and functional outcome over long term in a series of 222 patients undergoing laparoscopic sacrocolpopexy (LS) for vaginal vault prolapse. Materials and methods: Preoperative and postoperative evaluation consisted of a structured interview by a standard questionnaire to assess prolapse symptoms, bladder, bowel and sexual function, clinical examination according to the Baden Walker vaginal profile and the POPQ-score, a multichannel urodynamic investigation and RX colpocystodefaecography. The primary approach was laparoscopy,unless if the latter was judged to be inappropriate (10%). Postoperative reviews were performed at 6 weeks, 6 months and annually after by a third person. Results: Two hundred twenty-two patients underwent 224 sacral colpopexies between May 1996 and October 2005. Ninety-five percent of the patients were followed-up for a mean of 37.8±29.1 months (range: 3–115). Thirty-one percent underwent a concomitant procedure (7.1% subtotal hysterectomy, 11.1%rectopexy, 4.5%anti-incontinence surgery). Eighty-four percent of all sacropexies were completed by laparoscopy; 6% were converted to laparotomy and 10% underwent primary laparotomy. There were 2% intraoperative complications (one bladder trauma, one ureteral trauma, two bleeding of epigastric artery). Major postoperative complications included one postoperative bleeding requiring reintervention, two pulmonary embolism and two small bowel strangulations, both requiring laparotomy. Subjective total cure rate of prolapse symptoms was 87.8% and another 8.5% improved. Of the patients not undergoing incontinence surgery, preoperative stress incontinence (35.3%) and urge incontinence (35%) improved postoperatively in respectively 51% and 56%. Fifteen percent of patients developed de novo stress incontinence and 7% underwent a secondary procedure because of urinary incontinence. Preoperative constipation (50%) improved in one third, worsened in 15 and 23% developed de novo constipation. In sexually active patients (45%), sexual function improved in 27%; 15%had worsening or de novo dyspareunia. The objective failure (≥ Stage II prolapse) in anterior, middle and posterior compartment was respectively 7, 3.7 and 9.3%; total reoperation rate because of prolapse was 4%. The vaginal mesh erosion rate was 2.6%. The Prolaps quality of life questionnaires demonstrated limited postoperative quality of life impairment (6 weeks,1 year) or a significant improvement of the quality of life. Conclusion: Sacrocolpopexy has a high objective and subjective cure rate of prolapse symptoms and limited intraoperative and postoperative complications. The majority of cases can be done by laparoscopy. Reoperation rate because of prolapse was 4%.