V241: Rectus sheath colposuspension with polypropylene mesh for vaginal vault prolapse repair
VideoIntroduction and Objectives
Vaginal vault prolapse after previous hysterectomy is a challenging form of pelvic organ prolapse since 75% of affected women have a concomitant cysto-, recto- and/or enterocele. This video demonstrates transabdominal vaginal vault prolapse repair with rectus sheath colposuspension using polypropylene mesh.
Vaginal examination and cystoscopy are performed to evaluate the extent of cysto-, recto- and enterocele. Three tissue clamps are applied to the vaginal vault. Through a transverse suprapubic incision the plane between the detrusor and the peritoneum is opened. The tissue clamps in the vagina are pushed upwards, identifying the vaginal vault for dissection. Three sutures of polypropylene zero are placed through the vaginal vault. Cystoscopy is performed to assess the extent of elevation. A sheet of polypropylene mesh 10 x 15 cm is folded double and tied to the three vaginal vault sutures. The free end of the mesh is split in two, each half is pulled through an incision in the rectus sheath on either side, folded down and sutured to itself, and the sheath is closed with polypropylene zero.
We present the results at a minimum of 4 years followup in 40 women with vaginal vault prolapse after previous hysterectomy (mean patient age 60, range 42-82 years). Previous bladder suspension had been performed in 50% of the patients. Pre-operative symptoms included urinary incontinence in 55%, recurrent urinary tract infection in 38% and incomplete bladder emptying in 30%. Concomitant rectocele repair was performed in 30%, a midurethral sling was placed in 20% and Burch colpopexy was performed in 5%. The most common complication was occurrence of a secondary rectocele in 17.5% requiring subsequent posterior repair. Vaginal vault prolapse recurred in 5% and secondary stress incontinence occurred in 2.5% of cases.
Rectus sheath colposuspension with polypropylene mesh using an open extraperitoneal approach is a simple and cost-effective surgical technique for the treatment of severe vaginal vault prolapse. The main advantage, compared to transperitoneal open or laparoscopic sacrocolposuspension, is that it is an extraperitoneal procedure, with consequently lower morbidity.