Laparoscopic Sacrocolpopexy as Vaginal Vault Prolapse Treatment. Long-Term Outcomes

Context: Hysterectomies are one of the most common surgical procedures worldwide and post-hysterectomy vault prolapse ranges from 10 to 40%. Laparoscopic sacrocolpopexy has been considered the gold standard for the treatment of vaginal vault prolapse, with high success rates. Aim: To evaluate the feasibility, safety and long-term outcomes of laparoscopic sacrocolpopexy as vaginal vault prolapse treatment. Settings and Design: A prospective study. Methods: Between August 2008 and August 2016, laparoscopic sacrocolpopexy was performed in 45 patients with vaginal vault prolapse at the Department of Laparoscopic and Endoscopic Surgery, at the National Center for Minimally Invasive Surgery in Havana, Cuba. Results: The mean age of patients was 60 years (range 38–88). Previous surgical history included open hysterectomy in 23 (50%) patients, vaginal hysterectomy in 16 (34,8%) and laparoscopic hysterectomy in 7 (15,2%) patients. The success rate was 97,8% and one patient (2,2%) required conversion to vaginal surgery due to pelvic adhesions. Mean operative time was 129,2 min (range 90–240) and postoperative hospital stay was less than 1 day. One patient (2,2%) experienced an intraoperative complication (bladder injury) solved with laparoscopic treatment. There were five postoperative complications (11%): two stress urinary incontinence (4,4%), two osteomyelitis (4,4%) and one mesh erosion (2,2%). At a median follow-up of 32,3 months (range 3-96), recurrent vaginal vault prolapse was registered in five patients (11%). Conclusion: Laparoscopic sacrocolpopexy is a feasible and safe procedure for the treatment of post-hysterectomy vaginal vault prolapse and allows a long-term anatomical restoration.