LAPAROSCOPIC SACROCOLPOPEXY IN THE TREATMENT OFVAGINAL VAULT PROLAPSE AND RECTOCELE. RETROSPECTIVE STUDYOF 64 CASES

Risultato della ricerca: Other contribution

Abstract

Objectives: To evaluate the results of the laparoscopic sacrocolpopexyusing a polypropylene mesh.Methods: We performed laparoscopic sacrocolpopexy on 64 ptswho presented a prolapse of the vaginal vault between the II and theIV degree according to HWS classification. The mean age was 65(range 58-76) with variable parity. The vaginal vault prolapse waspresent after abdominal hysterectomy in 33 pts.(51%) and aftervaginal hysterectomy in 24 pts. (38%). 7 pts. (11%) were affected byan isterocele of III -IV . 8pts(12%) presented a vault prolapse of I degree, 16pts.(25%) of II degree, 15pts.(23%) of III degree,18 pts.(%) of VI degree.They were also affected by different degreesof cystourethrocele and rectocele, respectively 45 pts. (70%) and 40pts. (60%).Moreover 40 pts.(62.5%) were also affected by SUI typeII. All the women underwent a complete urogynecological work up(Q tip test, Vaginal profile, Pad test, Stress test, Urodynamicinvestigation and Urethrocistoscopy). We used a polypropylenemesh modelled in a y shaped to repair a vaginal vault prolapse fixedwith a no reabsorbable suture (Ethibond) respectively to the anteriorand posterior vaginal wall, the tail of the y is fixed to the sacralligament. In patients with rectocele we positioned a mesh inrectovaginal space until to pubo- coccigeo muscle to substituterecto-vaginal septum. In those pts. with SUI we performedcolposospension according to Burch and in those ones with cystoceleand paravaginal defect we associated a paravaginal repair.Results: The mean operating time was 118 min. (range 90-150min.). Intraoperative complications were: 2 bladder injuries and 1sigma perforation (5%; all laparoscopicaly repaired). Post-operativecomplications were: 2 lumbosciatica, 2 de novo instability, 1vaginal haemathoma, 3 cases of minimal dispareunia. Mean hospitalstay was 3 days (2-7d). Our goal is to anaslyse the results witha (after) five year follow-up. In this moment we have reached a 30months follow-up (6-42 m.): the procedure was successefull in 59pts (92%). Failures were registred in 5 pts (8%): 3 of these weretreated(cured) with Vyprol mesh (so we stopped to use them). Noerosions were reported.Conclusions: Laparoscopic sacrocolpopexy is the first choiceprocedure for the treatment of vaginal vault prolapse. Is a feasiblemethod that allows to fully exploit of the advantages of laparoscopy
Lingua originaleEnglish
Numero di pagine0
Stato di pubblicazionePublished - 2003

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