Laparoscopic management of genital prolapse: lateral suspension with two meshes

Objective To report our experience with a new laparoscopic technique to tre at genital prolapse. Subjects Prospective longitudinal case study of 35 women with genital prola pse treated between June 1997 and January 1999. Intervention The technique involves the use of two composite meshes, one of which is applied to the upper portion of the anterior wall of the vagina a nd the other to the upper portion of the posterior vaginal wall and posteri or aspect of the cenix if present. The later-al ends of the two meshes are pulled trough a retroperitoneal tunnel and fixed to the aponeurosis of the external oblique muscle above the iliac crest. Depending on the patient's s ymptoms and clinical findings, ancillary procedures (i.e. urethropexy, repa ir of the pouch of Douglas) may be necessary. Results The average operating time was 254 +/- 45 min (range 180-360). The total rate of complications was 20% (seven cases). The mean duration of hos pital stay was 4.8 +/- 1.2 days (range 3-8). With regard to the anatomical results: the mean postoperative follow up was 5 +/- 4.6 months; results wer e excellent in 80% of cases. The remaining 20% had moderate posterior vagin al wall defect. With regard to the functional results: the mean follow-up w as 10.5 +/- 4.6 months; 90.9% of the patients were satisfied; the functiona l defects were persistent urinary stress incontinence in 6.6% cases, urgenc y in 6.6% cases, frequency in 6.6% cases, constipation in 9.1% cases; the r ate of dyspareunia in patients who were sexually active was 10.3%. Conclusion This technique presents the advantage of providing complete trea tment for prolapse using laparoscopic surgery without having to approach th e promontory or having to carry out extensive reperitonealization.