gms | German Medical Science

Introduction: Laparoscopic sacrocolpopexy has been demonstrated to be the gold standard of prolapse surgery in cases with apical defect. According to our data, we have a result in a subjective cure rate of 95% after laparoscopic sacrocolpopexy. By patients with concomitant pelvic organ- and rectal-prolapse, we offer the option to combine laparoscopic sacrocolpopexy with rectopexy in order to solve the combined problem.

Methods: The video demonstrates the case of a 63 years old patient undergoing laparoscopic sacrocolporectopexy because of vaginal prolapse II° and rectal prolapse III°. The anterior dissection is started by opening the vesico-vaginal space. Lateral dissection is performed by opening the paravaginal space and exposing the lateral edge of the vagina. The distal part of both ureters is dissected from the anterior parametrium to the bladder to avoid ureteral damage. The transient fixation of sigma after loosening of adhesions to the pelvic wall with T-Lifts helps to have more space and a much better view of structures in the posterior compartment and gives an optimal approach to the rectovaginal space. We dissect the rectum gradually from the posterior wall of the vagina until the muscles of the pelvic floor for deep attachment of the mesh in the posterior compartment. The exposing of rectum is important in order to fix the mesh on it and to remove it in the right position. Posterior mesh is sutured on the levator ani muscle and additionally on the rectum with four non-absorbable sutures. Both meshes are fixed at the longitudinal ligament of the promontory. At the end a fully peritonealization is performed. The preparation is anatomically not much difficult comparing with sacrocolpopexy but the experience of gynecologist is decisive.

Results: The outcome of laparoscopic sacrocolporectopexy in our patient group is excellent. We made in the last 2 years five cases of recurrence after laparoscopic sacrocolpopexy. As we are following all our patients after laparoscopic sacrocolporectopexy, we have very good results at least in the short-term follow up.

Conclusion: Laparoscopic sacrocolporectopexy seem to be feasible and safe and is an option to correct laparoscopically concomitant pelvic organ- and rectal- prolapse in order to avoid laparotomy. This method can be performed by experienced gynecologists. Prospective anatomical and functional evaluation and data analysis must be done to scientifically verify these promising initial results.