Abdominal sacrocolpopexy and sacrohysteropexy with synthetic mesh safe for vault /prolapse repair: Study
Pelvic organ Prolapse (POP) is relatively a common condition
among parous women. Uterine prolapse is defined as downward displacement of the
uterus from its normal anatomical position usually associated with prolapse of
the vaginal wall. Post-hysterectomy, vaginal vault slips down from anatomical
position into or beyond vaginal introitus called vault prolapse. Uterine
prolapse not associated with vaginal wall prolapse usually seen in nulliparous
women is called nulliparous prolapse.
With increasing life span of women, POP incidence increases
and it adversely affects the quality of life of the women. The most important
cause of vault prolapse is failure to identify and repair an enterocele during
hysterectomy. The management of vault prolapse depends upon age, parity,
associated comorbidities, duration of anesthesia; desire to preserve sexual
function and expertise of the surgeon. Conservative managements like vaginal
ring pessary, pelvic floor exercise have limited role in management of vault
prolapse. Many surgical procedures both vaginal and abdominal have been
described over the years however abdominal sacrocolpopexy has better anatomical
outcome. It has been shown to be a reliable and durable procedure with a
success rate of 78-100%. In this procedure, the vaginal apex is fixed to the
anterior ligament of the sacrum with a synthetic mesh. It restores the vaginal
apex close to the normal anatomical position.
There are many retrospective studies on sacrocolpopexy and
sacrohysteropexy where objective anatomical and surgical outcomes have been
dealt with. The functional components (vaginal symptoms, sexual life) of the
procedure have been neglected. In the present study short term (12 months)
anatomical and subjective (vaginal symptoms, sexual well-being and impact on
quality of life of the patients) outcomes has been studied.
Aim of the present study was to determine the effectiveness
of the abdominal sacrocolpopexy / sacrohysteropexy with synthetic mesh for
repair of vault prolapse and nulliparous prolapse respectively. The primary
objectives were to describe the outcomes in the form of anatomical correction,
symptomatic improvement and women’s satisfaction and the secondary objective
was to describe the complications of the procedure in peri-operative and in follow-up
period.
This prospective observational study was carried out in the
department of Obstetric and Gynaecology, at a tertiary care center. The present
study included 22 women with vault prolapse (n=18) and nulliparous prolapse
(n=4), underwent abdominal sacrocolpopexy /sacrohysteropexy respectively for 2
years from 1st February 2021 to 31st January 2023 and follow up for 12 months.
Most of the women had preoperative apical prolapse in
stages-3 (59%), mean age in abdominal sacrocolpopexy/ sacrohysteropexy group
was 53.6 years and 26.5 years respectively. Perioperative complications were
bladder injury (n=1), paralytic ileus (n=1), wound dehiscence (n=1) and UTI
(n=1). In post-operative reassessment of pelvic organ prolapse, vault/uterus
was well supported (100%), 100% symptomatic relief. During follow up
dyspareunia (n=1), lower backache (n=1) were present, no mesh erosion and no
recurrence of Pelvic organ prolapse observed.
Abdominal sacrocolpopexy for vault prolapse and
sacrohysteropexy for nulliparous uterine prolapse have high and consistent
success rate with minimal perioperative complications. Along with this, these
procedures are highly significant for patients satisfaction for vaginal
symptoms and overall impact on their quality of life.
Obstetrics and Gynecology Research 2024;11(2):270–275
