Surgical management of relapse of multicompartment pelvic organ prolapse after laparoscopic lateral POP suspension

Giuseppe Loverro, mdª,Gianluca Raffaello Damiani, mdªe ,Matteo Loverro, mdª, Luca Maria Schönauer ,mda,Giuseppe Muzzupapa,mdª, Enrico Coluccia, Carmine Carriero, Teresa Capursi,Edoardo Dinaro

ª Department of Biomedical Sciences and Human Oncology, 1th Gynecologic and Obstetrics Clinic, Policlinic of BARI, UNIVERSITY OF BARI ,Piazza Aldo Moro ,BARI ,70100, ITALY


Aim: To demonstrate our surgical repair of multicompartment pelvic organ prolapse relapse after lateral POP suspension with mesh fixation technique, due to the lack of reference in literature (1-4).
Material and methods:
A step-by-step explanation of the surgery using video (instructive video),at 1st Obstetric and Gynecological Unit, University Hospital Policlinico of Bari. The patient was a 54-year-old woman with multicompartment POP arose after a previous laparoscopic lateral POPs performed 4 years before.
In the first step, adheliolysis, previous mesh visualization in the anterior vaginal compartment, and a subtotal hysterectomy was performed. The central part of previous mesh appeared completely detached from vaginal wall. Uterine manipulator, left in place, offers an appropriate exposure of the posterior vaginal fornix and Douglas pouch, before recto-sigmoid detachment from posterior vaginal wall. The vesico-vaginal space was then identified between the bladder and the anterior vaginal wall. The rectovaginal septum was deeply dissected, until the exposition of puborectalis muscle on each side. A vaginal y tailored propylene mesh was then place on anterior and posterior vaginal wall as well on the cervical stump and finally fixed on the promontorium as in promontory sacropexy technique.
At the three years follow up the vagina and cervical profile was perfectly corrected. The previous mesh was completely detached from anterior and cervical suspension requiring a completely dissection of previous surgical plane so as a complete new planning of a new suspension technique by sacrocolpexy.
We have provided an adequate surgical management of relapse of multicompartment pelvic organ prolapse after previous lateral POPS, due to a no well defined surgical technique repair (5). The main difficulty of the present procedure consisted in surgical dissection requiring a very expertise surgeon.
1. Dubuisson J, Eperon I, Dällenbach P, Dubuisson JB. Laparoscopic repair of vaginal vault prolapse by lateral suspension with mesh.Arch Gynecol Obstet.;287(2):307-12. doi: 10.1007/s00404-012-2574-1.
2. Ceci F, Spaziani E, Corelli S, Casciaro G, Martellucci A, Costantino A, Napoleoni A, Cipriani B, Nicodemi S, Di Grazia C, Avallone M, Orsini S, Tudisco A, Aiuti F, Stagnitti F. Technique and outcomes about a new laparoscopic procedure: the Pelvic Organ Prolapse Suspension (POPS). G Chir. 2013;34(5-6):141-4.
3. Dubuisson JB1, Eperon I, Jacob S, Dubuisson J, Wenger JM, Dallenbach P, Kaelin-Gambirasio I. Laparoscopic repair of pelvic organ prolapse by lateral suspension with mesh: a continuous series of 218 patients Gynecol Obstet Fertil. 2011;39(3):127-31. doi: 10.1016/j.gyobfe.2010.12.007. Epub 2011.
4. Granese R, Candiani M, Perino A, Romano F, Cucinella G. Laparoscopic sacrocolpopexy in the treatment of vaginal vault prolapse: 8 years experience. Eur J Obstet Gynecol Reprod Biol. 2009 ;146(2):227-31. doi: 10.1016/j.ejogrb.2009.06.013. Epub 2009 . 5. Dubuisson JB, Dubuisson J Epub 2012 .How I do... laparoscopic repair of vaginal vault prolapse by lateral suspension. . Gynecol Obstet Fertil. 2012 ;40(10):617-9. doi: 10.1016/j.gyobfe.2012.07.030.