Laparoscopic sacropexy: a retrospective analysis of perioperative complications and anatomical outcomes

Abstract

Background and objective: The aim of this study was to evaluate the surgical outcomes and complications of laparoscopic sacropexy with regard to 3 varying mesh attachment points: the vaginal stump, the cervical stump, and the posterior side of the cervix in the case of uterus preservation.

Method: A retrospective study was conducted among 310 women treated for descensus with laparoscopic sacropexy between January 2000 and December 2007. Information was obtained from medical files and follow-up examinations.

Results: Sacropexies with mesh attachment to the cervical stump, to the vaginal stump, and with uterus preservation were performed in 213, 67, and 30 cases, respectively. In 40 cases, no concomitant interventions were necessary. One perioperative conversion and 2 terminations occurred. Short-term complications included fever in 15 cases and urinary incontinence in 7 cases. Average follow-up was 7.9 mo with 211 patients completing followup. Prolapse recurrence rate was 10.4%; the reoperation rate was 4%. No significant differences between groups were detected for cystocele recurrence. Rectocele recurrence was significantly higher (P < .05) for sacropexy with vaginal mesh attachment. A reduction of incontinence was observed, which was significant (P < .05) for those patients treated with simultaneous or previous hysterectomy.

Conclusion: Laparoscopic sacropexy shows good short-term results with low reprolapse and complication rates.

Figure 1.

Trocar placement with patient in horizontal position with stretched legs (three 5-mm trocars).

Figure 2.

Illustration of the anatomical structures.

Figure 3.

Blunt preparation with a blunt probe.

Figure 4.

Mesh fixation with a Z-suture on the ligamentum longitudinale.

Figure 5.

Mesh fixation on the cervical stump and ligamentum longitudinale.

Figure 6.

Mesh peritonealization.