Laparoscopic posterior vaginal plication plus sacral colpopexy for severe posterior vaginal prolapse: A randomized clinical trial

Abstract

Aim: A randomized clinical trial proposing a new laparoscopic prosthetic and fascial approach to severe posterior vaginal prolapse. The primary endpoint was to evaluate the objective and subjective outcomes of our laparoscopic posterior plication (LPP) combined to "two-mesh" sacral colpopexy (laparoscopic sacral colpopexy [LSC]) in severe posterior vaginal prolapse, with a 1-year follow-up. The secondary endpoint was to evaluate the safety of this surgical procedure.Methods: This is single-center prospective randomized double-blinded clinical trial. A total of 130 consecutive patients with anterior and/or apical pelvic organ prolapse (POP) (POP-Q stage ≥II) and severe posterior vaginal prolapse (posterior POP-Q stage ≥III) were prospectively assessed for inclusion into the study from November 2018 to January 2020. Patients underwent "two-meshes" LSC and were randomized in Group A (LSC plus LPP) and Group A (LSC alone). Of the 130 included subjects, 8 were excluded, not meeting inclusion criteria. Cure rate was evaluated objectively, using POP-Q study, and subjectively using PGI-I, POPDI-6, and FSDS questionnaires. Complications were assessed intra-, peri-, and postoperatively. Twelve-month follow-ups were analyzed for the study.Results: We found in LSC plus LPP Group a significant improvement of Ap and genital hiatus POP-Q points. Our subjective study showed, at 12 months, a statistical difference in PGI-I successful outcomes rate in favor of LPP. Also the Neurourol Urodyn.

Laparoscopic Posterior Vaginal Plication plus Sacral Colpopexy for Severe Posterior Vaginal Prolapse: a Step-by-Step Video- Article

“…This surgical approach, unlike previous studies on laparoscopic anterior single-mesh sacral colpopexy or pectopexy suspension and combined native tissue repair, specifically analysing apical anatomy ( Noé et al, 2019 ), was expressly validated for anterior/ apical prolapse associated with severe posterior colpocele, demonstrating significant results in terms of anatomical posterior repair ( Morciano et al, 2023 ).…”

“…To show a step-by-step demonstration of a surgical approach to pelvic organ prolapse (POP) patients with concomitant severe posterior colpocele, using a laparoscopic posterior vaginal fascial plication (LPP) ( Morciano et al, 2023 ) combined with standard sacral colpopexy.…”

“…Recent studies proposed, in addition, a laparoscopic approach to anterior or posterior native tissue repair combined with apical sacral colpopexy or pectopexy suspension ( Noé et al, 2019 ). In the light of these observations, in 2023 we validated a surgical approach to patients with anterior/ apical prolapse associated with severe posterior colpocele, using a Laparoscopic Posterior Vaginal Plication (LPP) combined with a standard LSC, demonstrating significant beneficial results in terms of anatomical repair ( Morciano et al, 2023 ). This video-article is a step-by-step video demonstration of this combined fascial/prosthetic laparoscopic technique.…”

Modified Oxford technique of colpopexy for the treatment of uterine and vaginal vault prolapse: a retrospective pilot cohort study

“…Laparoscopic sacrocolpopexy remains the golden standard for POP surgery ( 30 ), as it was reported to carry favorable results in terms of restoring the anterior and middle compartments ( 31 ). In their study, Campagna et al reported that patients undergoing high uterosacral ligament suspension are at 6 times higher risk of prolapse recurrence compared to those who had laparoscopic sacrocolpopexy ( 8 ).…”

Spondylodiscitis after sacral colpopexy: diagnose early to treat earlier

“…The LSC is performed suspending vagina to sacral promontory, by using a surgical mesh. Although surgical techniques for LSC vary widely between surgeons [2,3], the two-meshes technique better prevents against de novo posterior colpocele after vaginal axis verticalization [4].…”