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. Although recurrence can occur in up to 10% of cases and additional surgery is needed in about 6%. Recurrence of apex is very rare but recurrence of anterior compartment is about 6%. Isolated anterior compartment failure can occur especially if paravaginal defect has initially been present. A recurrence in anterior compartment is difficult to correct: an option is a vaginal anterior Mesh with high rates of dyspareunia and pain. In the last 2.5 years, we went in recurrences after laparoscopic through re-sacrocolpopexy and the first results are very encouraging.

Methods: The Video demonstrates the cases of 3 patients between 45 and 75 years old undergoing laparoscopic re-sacrocolpopexy because of combined re-prolapse after laparoscopic sacrocolpopexy. The main problem is a recurrence of anterior compartment with paravaginal defect, the apex descends just a little. The old mesh will be left; trying to remove has risks without benefits. The preparation is anatomically more difficult but the old mesh does not bother the placement of the new one. 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 posterior mesh is sutured to the levator ani or the posterior vagina and the cervix. Both meshes are fixed at the longitudinal ligament. This can be challenging after sacrocolpopexy because of the anatomical restriction and scarring by previous mesh fixation.

Results: The outcome of laparoscopic re-sacrocolpopexy in our patient group is excellent. We made in the last 2.5 years about twelve cases of recurrence after laparoscopic sacrocolpopexy. As we are following all our patients after laparoscopic re-sacrocolpopexy, we have very good results at least in the short-term follow up.

Conclusion: Laparoscopic re-sacrocolpopexy seem to be feasible and safe and is an option to correct laparoscopically prolapse-recurrences in order to avoid vaginal surgery after primary laparoscopic sacrocolpopexy. Prospective anatomical and functional evaluation and data analysis must be done to scientifically verify these promising initial results.