Maurizio Rosati, Silvia Bramante, Giorgio Febo, Annamaria Stammitti, Ilaria Colagrande.
Department of Obstetrics and Gynecology, Santo Spirito Hospital, Pescara, Italy
Aim of the Study: To evaluate efficacy of laparoscopic sacrocervicopexy for apical support in sexually active patients with pelvic organ prolapse.
Materials and methods: 135 women with symptomatic prolapse of central compartment (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 or without subtotal hysterectomy. Anterior and posterior colporrhaphy was performed when necessary. The patients returned for follow up exams one 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 the de-novo development of urinary or bowel symptoms.
Results: The mean follow up period was 33 months. Success rate was 98.4 % for central compartment, 94.2% for anterior and 99.2% for posterior compartment. Postoperatively, the percentage of asymptomatic patients (51.6%) increased significantly (p<0.01), and we observed a statistically significant reduction (p<0.05) of urinary urge incontinence, recurrent cystitis, pelvic pain, dyspareunia and discomfort. The present study showed 89.3% of patients who stated to have high or very high satisfaction about the operation.
Conclusion: Laparoscopic sacrocervicopexy is an effective option for sexually active women with pelvic organ prolapse.
Figure 1:Anterior longitudinal ligament in the presacral space
Figure 2: Pelvic peritoneum opened up to lay the mesh.
Figure 3: Mesh secured to the cervix.
Figure 4: Mesh secured to the sacral promontory.
Figure 5: No undue tension in the mesh noted
Figure 6: Pelvic peritoneum reapproximated.
Figure 7: Guide-lines
(SLH: subtotal laparoscopic hysterectomy; AC: anterior colporrhaphy; PC: posterior colporrhaphy; VH: vaginal hysterectomy).