Page 52 - WJOLS - Surgery Journal

World Journal of Laparoscopic Surgery, January-April 2009;2(1):53-54
Treatment of Vault Prolapse: Laparoscopic versus Open Sarcocolpopexy
Treatment of Vault Prolapse: Laparoscopic

versus Open Sarcocolpopexy

Million Teshome
Obstetrician and Gynecologist, Hawassa University, Hawassa, Ethiopia

Abstract organ prolapse is multifactorial and result in weakening of the
Pelvic organ prolapse is one of the common problems for parous women. pelvic support connective tissue and muscles as well as nerve
A literature review of published articles was done to determine the best damage. It is estimated about 50% of parous population may
method of treatment for pelvic prolapse mainly laparoscopic and open encounter pelvic organ prolapse. Patients may be asymptomatic
laparotomy methods. Electronic search made via medline, google and or have significant symptoms such as those relating to the
springer link using the keywords laparoscopic/open sarcocolpopexy
and vault/organ prolapse and relevant articles were reviewed. More than lower urinary tract, pelvic pain, defecatory problems, fecal
2000 patients included in this review and the results showed incontinence, back pain, and dyspareunia. To correct this
that laparoscopic sacrocolpopexy has shorter hospital stay 1-1.8 problem different abdominal and vaginal surgical techniques
days in the as compared to the laparotomy group which is 4-5.8 days have been used. The abdominal approach can be laparoscopic
(p < 0.005). Regarding estimated blood loss laparoscopy has less bleeding or open method to restore pelvic anatomy and sexual function. 1
compared to laparotomy (172 +/– 166 mL vs 234 +/– 149 mL; P = .04). The open technique is performed through abdominal
But the operation time is longer with this method, mean operation time incision and involves suspending the prolapsed vaginal vault
is 223(+/–24) minutes for the laparoscopic group and 195 (+/–45) to the sacral promontory using a synthetic mesh (polypropylene,
minutes for the abdominal sarcocolpopexy group. Other complications ® ®
like mesh erosion up to 5% is the same for both procedures. The chance Gore-tex, Mersilene ). It is associated with a risk of hemorrhage
of recurrence10-20% after sarcocolpopexy is a possibility for both from presacral vessels and around 4.3% of women may require
methods with short and long-term period of follow-up 3 months to 13 a blood transfusion. The chance of mesh erosion is 5%. The
years. In conclusion laparoscopic approach has favorable outcome if subjective success rate following an abdominal sacrocolpopexy
properly done by skilled surgeon especially with decreased hospital in a randomized study was 94% and the associated objective
time and operation time. success rate was 76%. 2
Keywords: Laparoscopic sarcocolpopexy, pelvic prolapse, vault Laparoscopic sacrocolpopexy which is relatively new
prolapse, open sarcocolpopexy. technique is an alternative to open method although operative
Aims and objectives: The aim of the study was to compare the time tends to be slightly longer, intraoperative complications
effectiveness and safety of laparoscopic and conventional open are related to the surgeon’s experience and remain comparable
abdominal sarcocolpopexy in the treatment of pelvic organ prolapse. to those noted in laparotomy however, it requires a high degree
Parameters evaluated for both methods include patient selection, of laparoscopic skill to perform the procedure via this route.
operative technique, and operative time, intraoperative and Even though there are a number of procedures to correct
postoperative complications. Evaluation was also done for post-
operative morbidity, hospital stay, cost effectiveness and short-term this problem the two most widely methods are being used by
and long-term quality of life. different surgeons worldwide. This paper tries to asses which
method is more appropriate to treat with the least complication
Materials and methods: A literature search was performed using
Medline and search engines’, Google, Springer link and Highwire press. and with long lasting favorable functional anatomical outcome.
The following search terms were used laparoscopic sacrocolpopexy,
pelvic organ prolapse, vault prolapse, suspension treatment.1640 CONTENT
citations were found in total and selected papers were screened for More than 2000 patients were included in this study, all the
further references. Criteria for selection of literature were the number comparison done only on laparoscopic and abdominal
of cases (excluded if less than 20), method of analysis (statistical or
nonstatistical), operative procedure (only universally accepted sacrocolpopexy cases. Patients with additional procedures at
procedures were selected) and the institution where the study was the time of surgery and variations of pelvic organ prolapse
done (specialized institution for laparoscopy surgery). surgery were excluded from the study to avoid biases.
Operation time: Mean operation time is 223(+/–24) minutes
INTRODUCTION for the laparoscopic group and 195(+/–45) minutes for the
With the aging of the population, pelvic organ prolapse is an abdominal sarcocolpopexy group. This is slightly greater in the
increasingly common condition seen in women. Cause of pelvic laparoscopic approach, and is evident on all studies included

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