Vaginal vault suspension by abdominal sacral colpopexy for prolapse:: a follow up study of 40 patients

Objectives: Vaginal vault prolapse is a rare event after hysterectomy. Vaginal repair often results in a narrowed and shortened vagina with diminished function. Abdominal sacral colpopexy attaches the vaginal apex to the sacral promontory and restores the physiological position of the vagina. The: objective of the study was to evaluate follow up results of the abdominal sacral colpopexy in 40 patients by a questionnaire and a gynaecologic examination. Methods: we performed a cohort study. Between 1992 and 1998. 45 consecutive patients with a vaginal vault prolapse treated with an abdominal sacral 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 resulted in a condition without any complaint, related to the vaginal prolapse. If initially a combination of complaints (vaginal protrusion. urinary incontinence, defecation problems, sexual dysfunction) was the creation for surgery. 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 before 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 after surgery. However. in five patients de novo constipation developed after surgery. There were no cases of de novo urinary incontinence. At gynaecological examination in three patients, the vaginal vault prolapse recurred within the follow-up period. accounting for a success rate of 93%. In ten more patients a moderate enterorectocele developed or persisted. No reoperations 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. Peritonisation of. the graft seems not to be necessary. The use of banked ct,collagen tissue as graft material is promising and needs further investigation. (C) 2001 Elsevier Science Ireland Ltd. All rights reserved.