Laparoscopic Sacrocolpopexy for Treatment of Vaginal Vault Prolapse in a Patient with Severe Pelvic Adhesions: A Case Report

Abstract

Aims: Pelvic organ prolapse (POP) regards an increasing number of women. The gold standard procedure for the POP is abdominal sacrocolpopexy. Adhesions often occur after pelvic surgery, with a lower incidence after laparoscopy. We present a laparoscopic sacrocolpopexy in a patient with severe pelvic adhesions. Presentation of Case: A 52-years-old woman presented to our hospital with fourth degree vaginal vault prolapse after hysterectomy. Laparoscopic bilateral oophorectomy and sacrocolpopexy were proposed to woman. During operation multiple pelvic adhesions were observed; and left ovary, affected by a cyst detected during preoperative assessment, was not visible. The adhesions were removed and bilateral oophorectomy and sacrocolpopexy were performed. Discussion: POP is often a multicompartmental disorder. Some authors recommended abdominal sacrocolpopexy with mesh as optimal surgical treatment for vaginal vault prolapse. Recent literature showed significant improvements about symptoms using minimally invasive techniques and it reported 78.26% of patients with improvement in defecatory function, 55% in urinary symptomatology and 93.75% in symptoms related to the first compartment. The incidence of intraoperative complications is low and the most common complication is bladder injury with an occurrence of 2%. In the literature a preponderance of evidence (7 of 12 studies) sustained benefits of laparoscopy in reducing adhesions. Conclusion: Laparoscopic surgical procedures for the treatment of POP are effective and safe techniques and prevent the formation of adhesions, but complex adhesions cases can increase the difficult of surgical procedures.