Vault Prolapse II: Restoration of Dynamic Vaginal Supports by Infracoccygeal Sacropexy, an Axial Day-Case Vaginal Procedure

Abstract

Our objective was to present and critically analyze the first 75 infracoccygeal sacropexy (ICS) operations for cure of vault prolapse. Level 1 reconstruction was achieved by the insertion of a tension-free vaginal tape (nylon) via the ischiorectal fossa into a transversely incised posterior vaginal fornix. Level 2 defects were repaired by cutting a central 'bridge' in the posterior vaginal wall and suturing the lateral flaps to the bridge. Level 3 repair reconstituted the perineal body. Postoperative pain was minimized by avoiding excessive tightening of tissues and avoiding surgery on the distal 1 cm of the vagina. Total operating time varied between 30 and 60 minutes. Mean blood loss was 120 ml. All patients were discharged within 24 hours of surgery, with minimal pain and without indwelling catheters. Almost all returned to normal activities within 7-10 days. Of the 75 patients (mean age 54 years), 71 were prospectively followed up between 1 and 4.5 years after surgery. Vault prolapse recurred in 6%. The main complication was tape erosion (5.3%). Infracoccygeal sacropexy is a promising day-case alternative to conventional methods. It has built-in safety, as it avoids pudendal nerves and vessels and surface rectal veins. Areas of future development are identified.

Posterior intravaginal slingplasty for vault and uterovaginal prolapse: an initial experience

“…Previous studies have reported a high concomitant cure rate for bladder symptoms [2]. This study confirms previous reports of high rates of improvement in symptoms of prolapse, urgency, nocturia, pelvic pain, and difficulty voiding [6]. In our case series, the cure rates were We also compared the cure rates between the two groups of vault and uterovaginal prolapse ( Table 4).…”

Vaginal surgery for uterine descent; which options do we have? A review of the literature

“…In none of the studies were complications separately described for the subgroup of women in which the uterus was preserved. Therefore, for describing complications, we used data for women who underwent a posterior intravaginal slingplasty with and without preservation of the uterus [37][38][39][40][41][42][43][44][45][46][47].…”

“…In 2001, the posterior intravaginal slingplasty was introduced by Petros [41]. It was a minimally invasive, transperineal technique providing Level I support, as described by DeLancey, by making neo-sacrouterine ligaments using mesh [53].…”

Optimal repair of pelvic organ prolapse: the debate continues

“…The first kit, the posterior intravaginal slingplasty (PIVS; U.S. Surgical, Tyco Healthcare Group, Norwalk, CT), achieved Level I support by tunneling a nylon tape through the ischiorectal fossa into an incision in the posterior vaginal fornix. [28] The tunnelers exited through the iliococcygeus muscle near the ischial spines, and the deployed tape was sutured to the vaginal vault. After more than four years of follow-up, an apical recurrence was reported in only 6%, but mesh extrusion was observed in 5.3% and two intraoperative rectal perforations were reported.…”