Abdominal sacrocolpopexy and sacrohysteropexy with synthetic mesh safe for vault /prolapse repair: Study
Pelvic organ Prolapse (POP) is relatively a common condition among parous women. Uterine prolapse is defined as downward displacement of the uterus from its normal anatomical position usually associated with prolapse of the vaginal wall. Post-hysterectomy, vaginal vault slips down from anatomical position into or beyond vaginal introitus called vault prolapse. Uterine prolapse not associated with vaginal wall prolapse usually seen in nulliparous women is called nulliparous prolapse.
With increasing life span of women, POP incidence increases and it adversely affects the quality of life of the women. The most important cause of vault prolapse is failure to identify and repair an enterocele during hysterectomy. The management of vault prolapse depends upon age, parity, associated comorbidities, duration of anesthesia; desire to preserve sexual function and expertise of the surgeon. Conservative managements like vaginal ring pessary, pelvic floor exercise have limited role in management of vault prolapse. Many surgical procedures both vaginal and abdominal have been described over the years however abdominal sacrocolpopexy has better anatomical outcome. It has been shown to be a reliable and durable procedure with a success rate of 78-100%. In this procedure, the vaginal apex is fixed to the anterior ligament of the sacrum with a synthetic mesh. It restores the vaginal apex close to the normal anatomical position.
There are many retrospective studies on sacrocolpopexy and sacrohysteropexy where objective anatomical and surgical outcomes have been dealt with. The functional components (vaginal symptoms, sexual life) of the procedure have been neglected. In the present study short term (12 months) anatomical and subjective (vaginal symptoms, sexual well-being and impact on quality of life of the patients) outcomes has been studied.
Aim of the present study was to determine the effectiveness of the abdominal sacrocolpopexy / sacrohysteropexy with synthetic mesh for repair of vault prolapse and nulliparous prolapse respectively. The primary objectives were to describe the outcomes in the form of anatomical correction, symptomatic improvement and women’s satisfaction and the secondary objective was to describe the complications of the procedure in peri-operative and in follow-up period.
This prospective observational study was carried out in the department of Obstetric and Gynaecology, at a tertiary care center. The present study included 22 women with vault prolapse (n=18) and nulliparous prolapse (n=4), underwent abdominal sacrocolpopexy /sacrohysteropexy respectively for 2 years from 1st February 2021 to 31st January 2023 and follow up for 12 months.
Most of the women had preoperative apical prolapse in stages-3 (59%), mean age in abdominal sacrocolpopexy/ sacrohysteropexy group was 53.6 years and 26.5 years respectively. Perioperative complications were bladder injury (n=1), paralytic ileus (n=1), wound dehiscence (n=1) and UTI (n=1). In post-operative reassessment of pelvic organ prolapse, vault/uterus was well supported (100%), 100% symptomatic relief. During follow up dyspareunia (n=1), lower backache (n=1) were present, no mesh erosion and no recurrence of Pelvic organ prolapse observed.
Abdominal sacrocolpopexy for vault prolapse and sacrohysteropexy for nulliparous uterine prolapse have high and consistent success rate with minimal perioperative complications. Along with this, these procedures are highly significant for patients satisfaction for vaginal symptoms and overall impact on their quality of life.
