Laparoscopic sacrocolpopexy for severe vaginal vault prolapse: five-year outcome.

STUDY OBJECTIVE: To assess the efficacy of the laparoscopic sacrocolpopexy in the treatment of severe vaginal prolapse.

DESIGN: (Canadian Task Force classification II-1).

SETTING: Private clinic.

PATIENTS: Fifty-one consecutive posthysterectomy patients with severe vaginal prolapse (Baden-Walker Grade 3 or 4).

INTERVENTIONS: The patients were treated by laparoscopic sacrocolpopexy in conjunction with other laparoscopic and/or vaginal procedures, as indicated.

MEASUREMENTS AND MAIN RESULTS: Of the 43 patients seen at 5-year follow-up, 3 had recurrent vaginal prolapse (objective cure rate 93%). In the patients with recurrence, the polypropylene mesh had torn partially or completely from the vaginal apex. When the posterior strip of mesh was extended to the perineal body, there were fewer recurrences of posterior compartment defects. Postoperatively, two patients had a partial small bowel obstruction secondary to bowel adherence to the mesh. Four patients had mesh erosion at the vaginal apex: two responded to local treatment, and two required vaginal flaps to cover the defect.

CONCLUSION: Laparoscopic sacrocolpopexy can be used safely with cure rates similar to abdominal sacrocolpopexy. Extending the mesh to the perineum appears to decrease posterior vault defects. There is a protracted learning curve. Patient recovery is greatly enhanced, in most cases requiring only an overnight hospitalization.