Gynecological Surgery

, Volume 10, Issue 2, pp 143–150

Laparoscopic sacral colpopexy versus total vaginal mesh for vault prolapse; comparison of cohorts

  • Mariëlla I. J. Withagen
  • Mark E. Vierhout
  • Alfredo L. Milani
  • Guido H. H. Mannaerts
  • Kirsten B. Kluivers
  • Robin M. F. van der Weiden
Original Article

DOI: 10.1007/s10397-013-0786-4

Cite this article as:
Withagen, M.I.J., Vierhout, M.E., Milani, A.L. et al. Gynecol Surg (2013) 10: 143. doi:10.1007/s10397-013-0786-4

Abstract

The surgical treatment of vaginal vault prolapse can either be performed by the vaginal or the abdominal (laparoscopic) route. The objective of this study was to compare the laparoscopic sacral colpopexy (LSC) and total vaginal mesh (TVM) for vaginal vault prolapse. This study compared a prospective cohort of LSC with bone-anchor fixation and mesh limited to the apex to a prospective cohort of TVM as treatment modalities in patients with a symptomatic vaginal vault prolapse (pelvic organ prolapse-quantification (POP-Q) point C ≥ −3). Primary outcome was failure in the apical compartment after 6 month follow-up, defined as POP-Q stage ≥ II with prolapse complaints or re-treatment in apical compartment. Based on an overall failure in all compartments of 23 % in the LSC group and 57 % in the TVM group, 29 patients would be needed in each group with a power of 80 % and alpha 0.05. Ninety-seven women were included, 45 LSC and 52 TVM. The failure rate of symptomatic vault prolapse was 1 (2 %) in each group (p = 0.99). The failure rate (POP stage ≥ II) in any compartment was 23 (51 %) in the LSC group and 11 (21 %) in the TVM group (p = 0.002). Each technique had its own type of complications. Short-term failure rates in the apical compartment after TVM and LSC were similar. In case of anterior or posterior prolapsed, additional mesh insertion or additional vaginal colporrhaphy is indicated in LSC surgery.

Keywords

Bone anchorLaparoscopic sacral colpopexyPelvic organ prolapseVaginal meshVaginal vault

Copyright information

© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  • Mariëlla I. J. Withagen
    • 1
  • Mark E. Vierhout
    • 1
  • Alfredo L. Milani
    • 2
  • Guido H. H. Mannaerts
    • 3
  • Kirsten B. Kluivers
    • 1
  • Robin M. F. van der Weiden
    • 4
  1. 1.Department of Obstetrics and GynaecologyRadboud University Nijmegen Medical CentreNijmegenThe Netherlands
  2. 2.Department of Obstetrics and GynaecologyReinier de Graaf GroupDelftThe Netherlands
  3. 3.Department of SurgerySint Franciscus GasthuisRotterdamThe Netherlands
  4. 4.Department of Obstetrics and GynaecologySint Franciscus GasthuisRotterdamThe Netherlands