Case series of abdominal sacral colpopexy

Abstract

INTRODUCTIONAbdominal sacral colpopexy was introduced in early 1960s, it become a widely accepted trans abdominal procedure that suspends the vaginal vault to the sacrum using natural or synthetic grafts.1 Abdominal sacral colpopexy attaches the vaginal vault to the sacral promentary and restores the physiological position of the vagina According to the International continence society, descent of the vaginalapex/ cuff /vaginal vault below a point that is 2 cm less than the total vaginal length above the plane of hymen is known as vaginal vault proplapse. 2Post hysterectomy vault prolapse risk increases with time after hysterectomy and in patients having pelvic organ prolapse previously. 3,4 Abdominal approach to sacrocolpopexy is associated with a lower incidence of vault prolapse compared to the vaginal sacrospinous fixation.5 Studies show success rates of abdominal sacrocolpopexy to be more than 90%.6,7 Primary indication of this procedure is to resuspend a prolapsed vaginal apex. Secondary indications include repair of the anterior vaginal wall (cystocele), posterior vaginal wall and apical segment descent (enterocele and rectocele). vaginal vault proplapse affects quality of women by its local symptoms like bulging, heaviness, pressure ,effects on urinary symptoms like urinary retention and incomplete emptying, bowel symptoms like constipation and sexual functions like dyspareunia. ABSTRACT Background:Abdominal sacral colpopexy is a transabdominal procedure that suspends vaginal vault to the sacrum using natural or synthetic graft material. We can perform this procedure in patients who have Post hysterectomy vault prolapse. Primary indication of this procedure is to resuspend a prolapsed vaginal apex. Secondary indications include repair of the cystocele, posterior vaginal wall and apical segment descent. The goal of this study was to assess the complications of repair of post hysterectomy vaginal vault proplase with polypropylene mesh. Methods: This study was conducted on 8 patients scheduled to undergo abdominal sacral colpopexy in SVBP Hospital associated to LLRM Medical College, Meerut, UP, India from March 2011 to March 2016 who had vault prolapse after hysterectomy. When patients complained of something coming out of vagina, pelvic examination was done by consultant in OPD during valsalva manoeuvre and per speculum examination. Pelvic organ prolapse quantification classification was used to classify prolapse. Two consultants performed all operations based on a standardized surgical technique. Results: In our study, all patients were followed for up to one year (at 3 months, 6 months, one year) after surgery for following observations-recurrence of prolapse, mesh erosion, dyspareunia, lower abdominal pain, constipation. None of the patient had above complaints in the follow up period. Conclusions: Abdominal sacral colpopexy with polypropylene mesh is a safe, effective treatment in patients having post hysterectomy vaginal vault proplase. When done by experienced gynecologist, major post-operative comp...

The effectiveness of the abdominal sacrocolpopexy / sacrohysteropexy with synthetic mesh for repair of apical prolapse

“…14 Similar finding also seen in Monika Anant et al, Dhama et al in their respective studies. 11,15 Nygaard et al concluded that sacrocolpopexy is a reliable procedure that effectively and consistently resolves vaginal vault prolapse. Patients should be counseled about the low, but present risk, of reopening for prolapse, stress incontinence, and complications.…”