Pmaj. Geomini et al., Vaginal vault suspension by abdominal sacral colpopexy for prolapse: a follow up study of 40 patients, EUR J OB GY, 94(2), 2001, pp. 234-238
Citations number
28
Categorie Soggetti
Reproductive Medicine
Journal title
EUROPEAN JOURNAL OF OBSTETRICS GYNECOLOGY AND REPRODUCTIVE BIOLOGY
Objectives: Vaginal vault prolapse is a rare event after hysterectomy. Vagi
nal repair often results in a narrowed and shortened vagina with diminished
function. Abdominal sacral colpopexy attaches the vaginal apex to the sacr
al promontory and restores the physiological position of the vagina. The: o
bjective of the study was to evaluate follow up results of the abdominal sa
cral colpopexy in 40 patients by a questionnaire and a gynaecologic examina
tion. Methods: we performed a cohort study. Between 1992 and 1998. 45 conse
cutive patients with a vaginal vault prolapse treated with an abdominal sac
ral colposcopy were included. Results: Forty patients were included in the
study. No serious complications occurred during surgery. Two patients per-
or postoperative hemorrhage required blood transfusion. In 'protrusion' was
the only preoperative complaint, in 93% (13/14) of the cases, surgery resu
lted in a condition without any complaint, related to the vaginal prolapse.
If initially a combination of complaints (vaginal protrusion. urinary inco
ntinence, defecation problems, sexual dysfunction) was the creation for sur
gery. only ten of 27 (37%) patients were symptom-free at follow up (P=0.002
. Yates corrected). In the whole whole group 34 (85%) patients noticed befo
re the operation a feeling of vaginal protrusion. At follow-up, 23 patients
(56%) had no symptoms at all that could he related to the vaginal prolapse
. Problems concerning defecation, like constipation were present hc before
surgery in eight patients. In six of them. these complaints well resolved a
fter surgery. However. in five patients de novo constipation developed afte
r surgery. There were no cases of de novo urinary incontinence. At gynaecol
ogical examination in three patients, the vaginal vault prolapse recurred w
ithin the follow-up period. accounting for a success rate of 93%. In ten mo
re patients a moderate enterorectocele developed or persisted. No reoperati
ons were performed for that reason. Conclusions: Abdominal sacral colpopexy
is a safe and efficacious treatment of the: posthyserectomy vaginal vault
prolapse. To prevent the persistence or development of an enterorectocele.
a culdoplasty according to Halban or McCall might possibly be helpful. Peri
tonisation of. the graft seems not to be necessary. The use of banked ct,co
llagen tissue as graft material is promising and needs further investigatio
n. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.