LAPAROSCOPIC MODIFIED HALBAN COLPOPEXY COMBINED WITH LAVH IN TREATINGUTERINE PROLAPSE

Traditionally, uterine prolapse is treated by vaginal hysterectomy wit h or without anterior or posterior colporrhaphy. However, in certain i nstances, such as coexisting ovarian pathologic conditions or pelvic a dhesion, difficulties may be encountered in the transvaginal approach. We herein report our experience of laparoscopic modified Halban colpo pexy as an adjunctive procedure to laparoscopic assisted vaginal hyste rectomy (LAVH) in the treatment of uterine prolapse combined with indi cations for ovarian resection or concurrent intraabdominal procedures. Inclusion criteria were moderate to severe uterine prolapse combined with pelvic or adnexal pathology (4 patients), previous pelvic surgery or suspected pelvic adhesion (15 patients), concurrent intraabdominal procedure, for example, Burch colposuspension (4 patients), or postme nopausal women desiring oophorectomy (6 patients). After the hysterect omy, laparoscopic Halban colpopexy was performed. Two stitches are pas sed over the uterosacral ligament at each side to suspend the vaginal vault, which has been dissected during hysterectomy. Another two to th ree bites of redundant cul-de-sac are incorporated at regular interval s to obliterate the cul-de-sac. Instead of circumferential pursestring sutures or side-to-side sutures as described in the original Moschcow itz and McCall culdeplasties, we use parallel sagittal sutures from ba ck to front to avoid compromising the position of the uterus. Twenty-s even patients have been treated without major intraoperative or postop erative complications. The follow-up intervals ranged from 10 to 23 mo nths (mean interval 15.7 months), and no posthysterectomy vault prolap se occurred. Despite the limited follow-up period, our results suggest that laparoscopic modified Halban colpopexy in conjunction with LAVH may provide a safe and feasible alternative in the treatment of uterin e prolapse, especially in cases requiring intraabdominal procedures.