title: Laparoscopic sacral uteropexy with cravat technique--experience and results.
abstract: OBJECTIVE
  The aim of the present study was to evaluate the safety and efficacy of a ″Cravat″ technique for the management of uterine prolapse in patients who want to preserve uterus, involving suspension of the uterus from the sacral promontory by using polypropylene mesh.
  
  
  METHODS
  A prospective observational study between January 2011 and September 2013 was conducted. Prior to surgery, prolapse assessment was undertaken with Baden-Walker halfway system to grade the degree of prolapse at all sites. Patients with severe uterine prolapse (stage II-IV) who want to preserve uterus, were operated with Cravat technique. All patients were evaluated at 2 weeks and 6 weeks after surgery and followed for 6 months. Outcomes were evaluated objectively by vaginal examination using Baden-Walker halfway classification, and subjectively classifying patients as 'very satisfied', 'satisfied' and 'not satisfied' at the 6th month postoperatively.
  
  
  RESULTS
  Sacral uteropexy was successfully performed by laparoscopy in 32/33 patients (one needed to be converted to laparotomy). Nine patients also had a concurrent procedure as colporaphy anterior, colporaphy posterior or transobturator tape. Postoperative recovery has been uneventful with subjective and objective cure rates were 96.9% and 93.9%, respectively at six month. One recurrence of total prolapse needed to be reoperated and two patients with sacrouteropexy still remained at stage 2 prolapse. There have been no cases of graft exposure, rejection or infection with a median follow-up of 23.9 months.
  
  
  CONCLUSIONS
  Laparoscopic sacral uteropexy with "Cravat technique" was found to be safe and simple procedure.
authors.affiliation: Zeynep Kamil Maternity and Children's Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
authors.forename: Murat
authors.initials: M
authors.lastname: Api
authors.affiliation: Zeynep Kamil Maternity and Children's Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
authors.forename: Semra
authors.initials: S
authors.lastname: Kayatas
authors.affiliation: Zeynep Kamil Maternity and Children's Training and Research Hospital, Department of Obstetrics and Gynecology, Istanbul, Turkey.
authors.forename: Aysen
authors.initials: A
authors.lastname: Boza
authors.affiliation: Adana Numune Training and Research Hospital, Department of Obstetrics and Gynecology, Adana, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Nazik
authors.affiliation: Adana Numune Training and Research Hospital, Department of Obstetrics and Gynecology, Adana, Turkey.
authors.forename: Hakan
authors.initials: H
authors.lastname: Aytan
mesh_terms: D000328:Adult; D005260:Female; D006801:Humans; D010535:Laparoscopy / Q000379:methods*; D008875:Middle Aged; D061646:Operative Time; D059351:Organ Sparing Treatments / Q000379:methods; D017060:Patient Satisfaction; D010537:Peritoneum / Q000601:surgery; D011126:Polypropylenes / Q000627:therapeutic use; D011446:Prospective Studies; D015203:Reproducibility of Results; D053825:Suburethral Slings; D013526:Surgical Mesh; D013997:Time Factors; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000601:surgery*; D014599:Uterus / Q000601:surgery*
chemical_list: D011126:Polypropylenes