Combined vaginal and laparoscopic sacrofixation for genital prolapse usinga tacking technique: a series of 45 cases

Objective To determine the efficacy and the safety of a combined laparoscop ic and vaginal approach to the management of genital prolapse. Design,A retrospective case series. Setting Gynaecological unit of a university hospital. Subjects 45 women with total genital, cervical or vaginal prolapse examined between November 1995 and November 1997. Interventions All the patients underwent a simple combined vaginal and lapa roscopic technique. A polypropylene mesh was attached to the posterior part of the cervix: or the vaginal vault and the body of the first sacral or fi fth lumbar vertebra. A tacking device (Origin Tacker System) was used. Results Follow up ranged from 6 to 30 months. Combined vaginal and laparosc opic surgery was faster than laparotomy and use of the tacking technique pr ovided an easy, quick and effective fixation of the mesh to the vertebra in all cases but one. There was one recurrence due to inappropriate fixation of the mesh to the cervix. In another case, the vault was well fixed but an enterocele appeared 1 month later and required classical vaginal managemen t. One serious complication (sciatic nerve compression) was caused by inapp ropriate tacking of one coil. Conclusion Our results suggest that a combined vaginal and laparoscopic sac rofixation approach can be an effective and quick alternative for prolapse therapy.