Laparoscopic management of genital prolapse: lateral suspension with two meshes

Abstract

Objective To report our experience with a new laparoscopic technique to treat genital prolapse. Subjects Prospective longitudinal case study of 35 women with genital prolapse treated between June 1997 and January 1999. Intervention The technique involves the use of two composite meshes, one of which is applied to the upper portion of the anterior wall of the vagina and the other to the upper portion of the posterior vaginal wall and posterior aspect of the cervix if present. The lateral ends of the two meshes are pulled trough a retroperitoneal tunnel and fixed to the aponeurosis of the external oblique muscle above the iliac crest. Depending on the patient's symptoms and clinical findings, ancillary procedures (i.e. urethropexy, repair of the pouch of Douglas) may be necessary. Results The average operating time was 254 ± 45 min (range 180–360). The total rate of complications was 20% (seven cases). The mean duration of hospital stay was 4.8 ± 1.2 days (range 3–8). With regard to the anatomical results: the mean postoperative follow up was 5 ± 4.6 months; results were excellent in 80% of cases. The remaining 20% had moderate posterior vaginal wall defect. With regard to the functional results: the mean follow‐up was 10.5 ± 4.6 months; 90.9% of the patients were satisfied; the functional defects were persistent urinary stress incontinence in 6.6% cases, urgency in 6.6% cases, frequency in 6.6% cases, constipation in 9.1% cases; the rate of dyspareunia in patients who were sexually active was 10.3%. Conclusion This technique presents the advantage of providing complete treatment for prolapse using laparoscopic surgery without having to approach the promontory or having to carry out extensive reperitonealization.

Réparation cœlioscopique des prolapsus des organes pelviens par suspension prothétique latérale : une série continue de 218 patientes

“…Toutefois, certaines techniques n'utilisent pas de prothè se, en particulier, les procé dé s de Moscovitz et Mac Coy [4,5], ainsi que la ré paration paravaginale par l'espace de Retzius (paravaginal repair) [6]. La technique coelioscopique que nous avons publié e en1998 est la suspension uté rine laté rale avec prothè se [7,8], inspiré e du procé dé de Kapandji qui é tait ré alisé par laparotomie [9]. Notre technique a pré senté plusieurs modifications depuis les publications initiales [10].…”

Cure de cystocèle par voie vaginale. Prothèse de polypropylène sous-vésicale transversale libre. Technique et résultats

“…L'utilisation de prothèses par voie coelioscopique semble avoir une meilleure tolérance vaginale puisque le taux d'éro-sion vaginale s'élève à 1,2 % pour Cosson [4] et 6,4 % pour Dubuisson [21] après utilisation de prothèses non résorba-bles.…”

“…La durée moyenne d'intervention par voie coelioscopique s'élève à 231 minutes (120-360) dans la série de Dubuisson [21] et 276 minutes (120-360) dans la série de Cosson [4].…”

Sacrospinous ligament fixation for massive genital prolapse in women aged over 80 years

“…Incidental patients aged over 80 years have successfully been treated with this operation 14,15 . Abdominal hysteropexy, either open or laparoscopic procedure, is also an alternative in some cases 16,17 . With the vaginal approach general anaesthesia and laparotomy or laparoscopy can be avoided, which is a bene®t for elderly, often medically compromised patients.…”