Complete laparoscopic treatment of genital prolapse with meshes including vaginal promontofixation and anterior repair: a series of 138 patients.
OBJECTIVE
To evaluate feasibility and anatomic and functional results of complete laparoscopic treatment of genital prolapse with meshes.


METHODS
Retrospective monocentric study (Canadian Task Force classification II-2).


METHODS
Centre Hospitalier Universitaire de Clermont-Ferrand, Polyclinique Hôtel Dieu, France.


METHODS
One hundred thirty-eight consecutive patients operated from January 1, 1998, through December 31, 2003.


METHODS
Laparoscopic promontofixation using meshes placed anteriorly in the vesicovaginal space and posteriorly to the levator ani muscles and in the prerectal space. In the space of Retzius, the anterior compartment was treated with paravaginal repair, Burch colposuspension, or both.


RESULTS
Mean follow-up was 33.7 months, with 7 patients lost to follow-up. Mean operating time was 190 minutes without any conversion to laparotomy or major perioperative complications. In all, 98% of patients were satisfied with the operation. Anatomic recurrence rate was 11%, and functional recurrence rate was 12%, with maximum delay of 40 months. A total of 57 patients (46%) had postoperative stress urinary incontinence (grade 1 or 2 in most cases), including 9 who did not receive any perioperative treatment for stress urinary incontinence. Seven patients (5%) had vaginal erosion, and for 2 of them (1%), meshes had to be removed because of infectious complications.


CONCLUSIONS
Complete laparoscopic treatment of prolapse including promontofixation appears to be an efficient and viable technique. Treatment of stress urinary incontinence as a consequence of surgery should be improved. Laparoscopic placement of meshes induced few complications.
Rivoire
Cécile
C
Centre Hospitalier Universitaire de Clermont-Ferrand, Polyclinique Hôtel Dieu, Department of Obstetrics and Gynecology, Clermont-Ferrand cedex 1, France.
Botchorishvili
Revaz
R
Canis
Michel
M
Jardon
Kris
K
Rabischong
Benoit
B
Wattiez
Arnaud
A
Mage
Gérard
G
D000368:Aged; D052858:Cystocele / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D020047:Rectocele / Q000601:surgery*; D012008:Recurrence; D012189:Retrospective Studies; D053825:Suburethral Slings; D013526:Surgical Mesh; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000601:surgery*