Introduction. Sacrocolpopexy is a generally applied treatment for vault prolapse which can be performed laparoscopically or by open laparotomy. Methods. Between October 2007 and December 2012, we performed a multicenter prospective cohort study in 2 university and 4 teaching hospitals in the Netherlands. We included patients with symptomatic posthysterectomy vaginal vault prolapse requiring surgical treatment, who either had abdominal or laparoscopic sacrocolpopexy. We studied surgery related morbidity, which was divided in pre-, peri-, and postoperative characteristics. Results. We studied 85 patients, of whom 42 had open abdominal and 43 laparoscopic sacrocolpopexy. In the laparoscopic sacrocolpopexy group, estimated blood loss was significantly less compared to the abdominal group: 192？mL (±126) versus 77？mL (±182), respectively ( ). Furthermore, hospital stay was significantly shorter in the laparoscopic group (4.2 days) as compared to the abdominal group (2.4 days) ( ). The overall complication rate was not significantly different ( ). However there was a significant difference in favor of the laparoscopic group in peri- and postoperative complications requiring complementary (conservative) treatment and/or extended admittance (RR 0.24 (95%-CI 0.07–0.80), ). Conclusion. Laparoscopic sacrocolpopexy reduces blood loss and hospital stay as compared to abdominal sacrocolpopexy and generates less procedure related morbidity. 1. Introduction The incidence of posthysterectomy vault prolapse requiring surgery has been estimated at 36 per 10,000 women years [1]. The risk increases cumulatively with years after hysterectomy and increases significantly in women whose initial hysterectomy was performed for genital prolapse [1–3]. In an aging population, the number of women that will seek medical help for a vaginal vault prolapse will increase due to an improved life expectancy and due to the aging population. Surgery for pelvic organ prolapse, including vaginal vault prolapse, focuses on the restoration of the normal vaginal anatomy and normal bladder and bowel function. To date, a variety of different surgical procedures to correct vaginal vault prolapse have been reported [4]. These reconstructive techniques can principally be divided into vaginal or abdominal procedures. The abdominal approach can be performed open or laparoscopically. According to a Cochrane review on the subject, abdominal sacrocolpopexy is associated with a lower rate of recurrent vault prolapse compared to the vaginal sacrospinous fixation [5]. Success rates of abdominal sacrocolpopexy
References
[1]
J. Mant, R. Painter, and M. Vessey, “Epidemiology of genital prolapse: observations from the oxford family planning association study,” British Journal of Obstetrics and Gynaecology, vol. 104, no. 5, pp. 579–585, 1997.
[2]
S. E. Swift, “The distribution of pelvic organ support in a population of female subjects seen for routine gynecologic health care,” American Journal of Obstetrics and Gynecology, vol. 183, no. 2, pp. 277–285, 2000.
[3]
M. Marchionni, G. L. Bracco, V. Checcucci et al., “True incidence of vaginal vault prolapse: thirteen years of experience,” Journal of Reproductive Medicine for the Obstetrician and Gynecologist, vol. 44, no. 8, pp. 679–684, 1999.
[4]
P. Toozs-Hobson, K. Boos, and L. Cardozo, “Management of vaginal vault prolapse,” British Journal of Obstetrics and Gynaecology, vol. 105, no. 10, pp. 1127–1128, 1998.
[5]
M. F. R. Paraiso, M. D. Walters, R. R. Rackley, S. Melek, and C. Hugney, “Laparoscopic and abdominal sacral colpopexies: a comparative cohort study,” American Journal of Obstetrics and Gynecology, vol. 192, no. 5, pp. 1752–1758, 2005.
[6]
T. E. Snyder and K. E. Krantz, “Abdominal-retroperitoneal sacral colpopexy for the correction of vaginal prolapse,” Obstetrics and Gynecology, vol. 77, no. 6, pp. 944–949, 1991.
[7]
M. C. Timmons, W. A. Addison, S. B. Addison, and M. G. Cavenar, “Abdominal sacral colpopexy in 163 women with posthysterectomy vaginal vault prolapse and enterocele: evolution of operative techniques,” Journal of Reproductive Medicine for the Obstetrician and Gynecologist, vol. 37, no. 4, pp. 323–327, 1992.
[8]
C. H. Nezhat, F. Nezhat, and C. Nezhat, “Laparoscopic sacral colpopexy for vaginal vault prolapse,” Obstetrics and Gynecology, vol. 84, no. 5, pp. 885–888, 1994.
[9]
R. M. Freeman, K. Pantazis, A. Thomson et al., “A randomized controlled trial of abdominal versus laparoscopic sacrocolpopexy for the treatment of post-hysterectomy vaginal vault prolapse: LAS study,” International Urogynecology Journal, vol. 24, no. 3, pp. 377–384, 2013.
[10]
J. L. Klauschie, B. A. Suozzi, M. M. O'Brien, and A. W. McBride, “A comparison of laparoscopic and abdominal sacral colpopexy: objective outcome and perioperative differences,” International Urogynecology Journal and Pelvic Floor Dysfunction, vol. 20, no. 3, pp. 273–279, 2009.
[11]
“NVOG Complication registration form obstetrics and gynecology,” 2006, http://www.nvog.nl/.
[12]
C. Maher, K. Baessler, C. M. Glazener, E. J. Adams, and S. Hagen, “Surgical management of pelvic organ prolapse in women,” Cochrane Database of Systematic Reviews, no. 4, Article ID CD004014, 2010.
F. Claerhout, D. de Ridder, J. P. Roovers et al., “Medium-term anatomic and functional results of laparoscopic sacrocolpopexy beyond the learning curve,” European Urology, vol. 55, no. 6, pp. 1459–1468, 2009.
[15]
A. M. Ganatra, F. Rozet, R. Sanchez-Salas et al., “The current status of laparoscopic sacrocolpopexy: a review,” European Urology, vol. 55, no. 5, pp. 1089–1105, 2009.
[16]
N. Price, A. Slack, and S. R. Jackson, “Laparoscopic sacrocolpopexy: an observational study of functional and anatomical outcomes,” International Urogynecology Journal and Pelvic Floor Dysfunction, vol. 22, no. 1, pp. 77–82, 2011.
[17]
J. W. Ross and M. Preston, “Laparoscopic sacrocolpopexy for severe vaginal vault prolapse: five-year outcome,” Journal of Minimally Invasive Gynecology, vol. 12, no. 3, pp. 221–226, 2005.
[18]
R. Garry, J. Fountain, J. Brown et al., “Evaluate hysterectomy trial: a multicentre randomised trial comparing abdominal, vaginal and laparoscopic methods of hysterectomy,” Health Technology Assessment, vol. 8, no. 26, pp. 1–154, 2004.
[19]
M. J. A. Maresh, M. A. Metcalfe, K. McPherson et al., “The VALUE national hysterectomy study: description of the patients and their surgery,” BJOG: An International Journal of Obstetrics and Gynaecology, vol. 109, no. 3, pp. 302–312, 2002.
