title: Surgical management of recurrent upper vaginal prolapse following sacral colpopexy.
abstract: OBJECTIVE
  As sacral colpopexy (SC) is increasingly utilised in the surgical management of apical prolapse, we will undoubtedly be asked to manage recurrent prolapse after SC. We present a four-step technique of performing a repeated laparoscopic sacral colpopexy (LSC) for the surgical management of recurrent upper vaginal prolapse after SC surgery.
  
  
  METHODS
  Between July 2012 and July 2013 women presenting with symptomatic post-SC vault prolapse were prospectively evaluated. Peri-operative morbidity and short-term complications were recorded. Surgical outcomes were objectively assessed utilising the Pelvic Organ Prolapse Quantification (POP-Q) system, the Australian Pelvic Floor Questionnaire (APFQ) and the Patient Global Impression of Improvement (PGI-I).
  
  
  RESULTS
  Five women underwent LSC. Extensive adhesiolysis was required in three patients and the dissection was characterised by marked fibrosis. The mesh remained attached to the sacrum and had limited contact with the anterior vagina and vault in all cases. At a mean follow-up of 8.5 months all women had resolution of the awareness of prolapse, less than stage 2 prolapse on examination and high levels of satisfaction on PGI-I.
  
  
  CONCLUSIONS
  While the repeat LSC is feasible, safe and effective, adhesions and marked fibrosis make this a challenging intervention. Further evaluation is required.
authors.affiliation: The Royal Brisbane and Women's Hospital and Wesley Hospitals, Brisbane, Australia, nirhaya1@gmail.com.
authors.forename: Nir
authors.initials: N
authors.lastname: Haya
authors.forename: Malachy
authors.initials: M
authors.lastname: Maher
authors.forename: Emma
authors.initials: E
authors.lastname: Ballard
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D010535:Laparoscopy; D008875:Middle Aged; D017060:Patient Satisfaction; D012008:Recurrence; D012086:Reoperation; D012447:Sacrum / Q000601:surgery; D013526:Surgical Mesh; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery