Abdominal sacrocolpopexy--standardized surgical technique, perioperative management and outcome in women with posthysterectomy vaginal vault prolapse.

AIMS: To provide a detailed description of abdominal sacrocolpopexy and to present a retrospective evaluation of the outcomes.

METHODS: 78 patients underwent sacrocolpopexy between January 2004 and July 2006; 72% had concomitant procedures; 53 patients participated in the follow-up. Anatomical success was defined as any leading point of the vaginal wall remaining >1 cm above the hymen. Failures were split into 3 groups: (1) asymptomatic, no further treatment; (2) symptomatic, conservative treatment; (3) symptomatic, requiring repeat surgery. The key points of the surgical technique were standardized mesh shape, reasonable choice of fixation of the mesh to the anterior and posterior vaginal walls as well as to the longitudinal ligament at S(2), and short operating time.

RESULTS: Standardization kept the mean operating time short (72.7 +/- 14.5 min for sacrocolpopexy only, 86.4 +/- 21.0 min if combined with the Burch procedure; p = 0.03). At the follow-up, none of the 53 patients (100%) presented with a recurrent apical prolapse; 17% (n = 9) had stage II anterior wall prolapse, and 69.8% (n = 37) did not show symptoms specific to anterior wall prolapse. Regarding the posterior compartment, 38% (n = 20) had stage II and 1 stage III posterior wall prolapse; 86.8% (n = 46) did not show symptoms specific to posterior wall prolapse. Questionnaire items showed improvement of quality of life. Nine patients required reinterventions: suburethral sling (3), excision due to erosion (2), anterior (1) and posterior (1) repair, stapled transanal rectal resection (1), botulinum toxin injection (1). Every fourth woman presented with symptoms requiring further treatment.

CONCLUSIONS: Sacrocolpopexy is a valid technique to treat apical and anterior vaginal wall prolapse.