Laparoscopic sacral colpopexy with Gynemesh as graft material - Experience and results

STUDY OBJECTIVE: To evaluate the safety and efficacy of Prolene (Ethicon, Inc., Johnson and Johnson, Somerville, NJ) graft for sacral colpopexy and ease of use laparoscopically. DESIGN: Retrospective analysis (Canadian Task Force classification II-1). SETTING: Academic university hospital. PATIENTS: Seventy-four patients with recurrent prolapse of the apex or severe uterine prolapse (stage II-IV). INTERVENTIONS: Seventy-four patients with recurrent prolapse of the apex or severe uterine prolapse (stage II-IV) underwent laparoscopic sacral colpopexy or cervicopexy with Gynemesh (Ethicon, Inc.) used as the graft material. MEASUREMENTS AND MAIN RESULTS: Seventy-four patients, from March 2003 through March 2006, underwent a sacropexy. Fifty-one patients had recurrent apical prolapse, 22 patients had uterovaginal prolapse stage III or IV, and I patient had uterovaginal prolapse stage II and insisted on retaining the uterus. Fifty-two patients also had a concurrent sling procedure performed for incontinence. Intraoperative and postoperative complications included 1 middle sacral bleed managed by suturing in the middle sacral region and I postoperative cervical abscess requiring reoperation and removal of the graft at 10 days. All patients were evaluated at 2 weeks and 6 weeks after surgery, and pelvic examination was performed. They were then followed up biannually. Median age was 63 years (range 48-76 years), and median body mass index was 35 (range 24-41). Laparoscopic sacral colpopexy or cervico or uteropexy was performed successfully in 72 patients. Median blood loss was less than 25 mL (range 25-150 mL), and the median hospital stay was 7 day (range 1-2 days). One surgery was terminated because of dense rectosigmoid adhesions to the cuff requiring a laparotomy and partial sigmoid resection because of redundancy and postdissection trauma to the sigmoid. Another procedure was completed as a Prolift (Johnson and Johnson) procedure because of finding of a prior Mersilene (Phillips Sumika Polypropylene Co., Houston, TX) mesh that was densely adherent to the pelvic contents. Seventy patients are extremely happy and satisfied with the surgery. Postoperative recovery has been uneventful, and subjective and objective cure is 97% and 100%, respectively. One patient with sacrouteropexy still has stage I prolapse of her cervix, but it feels well supported. There have been no cases of colpopexy graft exposure or recurrence with a median follow-up of 24 months (range 9-36 months). The patient with cervical abscess and graft removal has also healed with no recurrance of her prolapse. CONCLUSIONS: Laparoscopic sacral colpopexy or cervicopexy is a safe and effective procedure with excellent results. Gynemesh (Ethicon, Inc.), a wide-pore polypropelene mesh seems to be an excellent graft material with low risk for graft infection (1.4%) or erosion. (C) 2007 AAGL. All rights reserved.