Laparoscopic management of prolapse using a mesh in the recto vaginal and in the vesico vaginal spaces.

Seance of wednesday 23 november 2005 (CHIRURGIE GYNECOLOGIQUE : PRISE EN CHARGE DES PROLAPSUS GENITAUX)

Abstract

In the management of genital prolapse, the laparoscopic approachallows all the procedures previously achieved by laparotomy, andthe treatment of the posterior part of the defect which was previouslyimpossible by an abdominal route. Our technique involves asupracervical hysterectomy, the insertion of a mesh posteriorlysutured to the levator ani and to the vagina and anteriorly in thevesico vaginal space and to the uterine cervix. The mesh is thenfixed to the promontorium. In the Retzius space a Burch procedureand a paravaginal repair are performed.The preliminary results of this approach are presented in a series of138 patients with a mean follow-up of 30 months. The anatomicalresults are satisfactory in 90% of the cases. The intra and postoperativecomplication rates were respectively 5%, 8% and 2,9%. Ninecomplications related to the mesh occurred. In 7 cases a vaginalerosion was treated by vaginal excision and suture. Two mesheshad to be removed, one because of vesico vaginal fistula, successfullytreated by laparoscopy, and one for spondylodiscitis.These promising results will have to be confirmed with a longerfollow-up and by results obtained in other groups using similarendoscopic approaches.