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. 2013 Apr-Jun;17(2):235-44.
doi: 10.4293/108680813X13654754535115.

Efficacy of laparoscopic sacrocervicopexy for apical support of pelvic organ prolapse

Maurizio Rosati  1 , Silvia Bramante, Umberto Bracale, Giusto Pignata, Guglielmo Azioni
Affiliations

Efficacy of laparoscopic sacrocervicopexy for apical support of pelvic organ prolapse

Maurizio Rosati et al. JSLS. 2013 Apr-Jun.

Abstract

Background and objectives: To evaluate the efficacy of laparoscopic sacrocervicopexy for apical support in sexually active patients with pelvic organ prolapse.

Methods: One-hundred thirty-five women with symptomatic prolapse of the central compartment (Pelvic Organ Prolapse Quantitative [POP-Q] stage 2) underwent laparoscopic sacrocervicopexy. The operating physicians used synthetic mesh to attach the anterior endopelvic fascia to the anterior longitudinal ligament of the sacral promontory with subtotal hysterectomy. Anterior and posterior colporrhaphy was performed when necessary. The patients returned for follow-up examinations 1 month after surgery and then over subsequent years. On follow-up a physician evaluated each patient for the recurrence of genital prolapse and for recurrent or de novo development of urinary or bowel symptoms. We define "surgical failure" as any grade of recurrent prolapse of stage II or more of the POP-Q test. Patients also gave feedback about their satisfaction with the procedure.

Results: The mean follow-up period was 33 months. The success rate was 98.4% for the central compartment, 94.2% for the anterior compartment, and 99.2% for the posterior compartment. Postoperatively, the percentage of asymptomatic patients (51.6%) increased significantly (P < .01), and we observed a statistically significant reduction (P < .05) of urinary urge incontinence, recurrent cystitis, pelvic pain, dyspareunia, and discomfort. The present study showed 70.5% of patients stated they were very satisfied with the operation and 18.8% stated high satisfaction.

Conclusion: Laparoscopic sacrocervicopexy is an effective option for sexually active women with pelvic organ prolapse.

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Figures

Figure 1.
Figure 1.
A diagrammatic representation of Pelvic Organ Prolapse-Quantitative (POP-Q) staging.
Figure 2.
Figure 2.
Pelvic Organ Prolapse-Quantitative (POP-Q) staging.
Figure 3.
Figure 3.
The anterior longitudinal ligament in the presacral space.
Figure 4.
Figure 4.
The pelvic peritoneum is opened up to lay the mesh.
Figure 5.
Figure 5.
The mesh is secured to the cervix.
Figure 6.
Figure 6.
The mesh is secured to the sacral promontory.
Figure 7.
Figure 7.
No undue tension in the mesh is noted.
Figure 8.
Figure 8.
The pelvic peritoneum is reapproximated.
Figure 9.
Figure 9.
Guidelines. SLH = subtotal laparoscopic hysterectomy; AC = anterior colporrhaphy; PC = posterior colporrhaphy; VH = vaginal hysterectomy.
See this image and copyright information in PMC

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