Complete laparoscopic treatment of genital prolapse with meshes including vaginal promontofixation and anterior repair: a series of 138 patients

Abstract

Study objective: To evaluate feasibility and anatomic and functional results of complete laparoscopic treatment of genital prolapse with meshes.

Design: Retrospective monocentric study (Canadian Task Force classification II-2).

Setting: Centre Hospitalier Universitaire de Clermont-Ferrand, Polyclinique Hôtel Dieu, France.

Patients: One hundred thirty-eight consecutive patients operated from January 1, 1998, through December 31, 2003.

Interventions: Laparoscopic promontofixation using meshes placed anteriorly in the vesicovaginal space and posteriorly to the levator ani muscles and in the prerectal space. In the space of Retzius, the anterior compartment was treated with paravaginal repair, Burch colposuspension, or both.

Measurements and main results: Mean follow-up was 33.7 months, with 7 patients lost to follow-up. Mean operating time was 190 minutes without any conversion to laparotomy or major perioperative complications. In all, 98% of patients were satisfied with the operation. Anatomic recurrence rate was 11%, and functional recurrence rate was 12%, with maximum delay of 40 months. A total of 57 patients (46%) had postoperative stress urinary incontinence (grade 1 or 2 in most cases), including 9 who did not receive any perioperative treatment for stress urinary incontinence. Seven patients (5%) had vaginal erosion, and for 2 of them (1%), meshes had to be removed because of infectious complications.

Conclusion: Complete laparoscopic treatment of prolapse including promontofixation appears to be an efficient and viable technique. Treatment of stress urinary incontinence as a consequence of surgery should be improved. Laparoscopic placement of meshes induced few complications.