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Surgical management of recurrent upper vaginal prolapse following sacral colpopexy

Abstract

Introduction and hypothesis

As sacral colpopexy (SC) is increasingly utilised in the surgical management of apical prolapse, we will undoubtedly be asked to manage recurrent prolapse after SC. We present a four-step technique of performing a repeated laparoscopic sacral colpopexy (LSC) for the surgical management of recurrent upper vaginal prolapse after SC surgery.

Methods

Between July 2012 and July 2013 women presenting with symptomatic post-SC vault prolapse were prospectively evaluated. Peri-operative morbidity and short-term complications were recorded. Surgical outcomes were objectively assessed utilising the Pelvic Organ Prolapse Quantification (POP-Q) system, the Australian Pelvic Floor Questionnaire (APFQ) and the Patient Global Impression of Improvement (PGI-I).

Results

Five women underwent LSC. Extensive adhesiolysis was required in three patients and the dissection was characterised by marked fibrosis. The mesh remained attached to the sacrum and had limited contact with the anterior vagina and vault in all cases. At a mean follow-up of 8.5 months all women had resolution of the awareness of prolapse, less than stage 2 prolapse on examination and high levels of satisfaction on PGI-I.

Conclusions

While the repeat LSC is feasible, safe and effective, adhesions and marked fibrosis make this a challenging intervention. Further evaluation is required.

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References

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    Maher C, Feiner B, Baessler K, Schmid C (2013) Surgical management of pelvic organ prolapse in women. Cochrane Database Syst Rev 4:CD004014

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Consent

Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

Financial disclaimer/conflict of interest

None.

Authors’ contributions

N. Haya: project development, data collection, manuscript writing; M. Maher: manuscript editing, video and audio editing; E. Ballard: management data analysis, manuscript editing.

Author information

Correspondence to Nir Haya.

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Haya, N., Maher, M. & Ballard, E. Surgical management of recurrent upper vaginal prolapse following sacral colpopexy. Int Urogynecol J 26, 1243–1245 (2015) doi:10.1007/s00192-015-2633-9

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Keywords

  • Laparoscopic sacral colpopexy
  • Apical prolapse
  • Mesh