Laparoscopic hysteropexy: the initial results of a uterine suspension procedure for uterovaginal prolapse

Abstract

Objective The aim of this study was to evaluate the outcome of laparoscopic hysteropexy, a surgical technique for the management of uterine prolapse, involving suspension of the uterus from the sacral promontory using bifurcated polypropylene mesh.Design The investigation was designed as a prospective observational study (clinical audit).Setting The study was undertaken at a tertiary referral urogynaecology unit in the UK.Population The participants comprised 51 consecutive women with uterovaginal prolapse, who chose laparoscopic hysteropexy as one of the available surgical options.Methods The hysteropexy was conducted laparoscopically in all cases. A bifurcated polypropylene mesh was used to suspend the uterus from the sacral promontory. The two arms of the mesh were introduced through bilateral windows created in the broad ligaments, and were sutured to the anterior cervix; the mesh was then fixed to the anterior longitudinal ligament over the sacral promontory, to elevate the uterus.Main outcome measures Cure of the uterine prolapse was evaluated subjectively using the International Consultation on Incontinence Questionnaire for vaginal symptoms (ICIQ-VS), and objectively by vaginal examination using the Baden-Walker halfway system and the pelvic organ prolapse quantification (POP-Q) scale. Operative and postoperative complications were also assessed.Results The mean age of the 51 women was 52.5 years (range 19-71 years). All were sexually active, and at least three of them expressed a strong desire to have children in the future. All were available for follow-up in clinic at 10 weeks, and 38 have completed the questionnaires. In 50 out of 51 women the procedure was successful, with no objective evidence of uterine prolapse on examination at follow-up; there was one failure. Significant subjective improvements in prolapse symptoms, sexual wellbeing and related quality of life were observed, as detected by substantial reductions in the respective questionnaire scores.Conclusions Laparoscopic hysteropexy is both a feasible and an effective procedure for correcting uterine prolapse without recourse to hysterectomy. It allows restoration of the length of the vagina without compromising its calibre, and is therefore likely to have a favourable functional outcome.

Laparoscopic Sacral Uteropexy with Cravat Technique--Experience and Results

“…The suspension of uterus from round ligaments (ventrosuspension) is associated with high recurrence rate. In a case series of nine women, recurrence of prolapse in eight women was reported within 3 months of surgery (2,14). This technique causes significant change of normal vaginal axis, hence it results in transmission of abdominal pressure to the cul-de-sac increasing the formation of enterocele (13,14).…”

“…Several alternative operations for prolapse repair with uterine preservation, using either a vaginal or an abdominal approach, have been proposed (1,2,(12)(13)(14)(15)(16)(17)(18)(19)(20).…”

“…Peritoneal relaxing incision was made down into the pelvis, laterally to the rectum, medially to the right ureter, and also the peritoneum at the level of the insertion of uterosacral ligaments was mobilised to ease complete peritonisation of the mesh. Bifurcated polypropylene mesh was sutured anteriorly to the anterior cervical wall, posteriorly to the anterior longitudinal ligament over the sacral promontorium and then, complete peritonisation of mesh was performed (2). The difference from the bifurcated mesh described by Price et al and our mesh was the 25x1.5cm 2 tape.…”

“…Furthermore, many women do not seek medical attention despite of symptomatic POP. Population based studies report a 11 to 19 percent lifetime risk in women undergoing surgery for prolapse or incontinence (1,2).…”

“…The increasing desire for uterine preservation provoked the development of new techniques with less morbidity and more patients' satisfaction. Several conservative (pessary) or surgical treatment options were defined to preserve uterus in patients with POP (1,2). Surgical approach could be either vaginal or abdominal route.…”