A TECHNIQUE FOR ABDOMINAL SACROCOLPOPEXY

Terry Dunn

Denver Health Medical Center, Denver, CO

OBJECTIVE: To describe a safe technique for abdominal sacrocolpopexy that does not dissect and place the graft in the retroperitoneal space.

MATERIALS AND METHODS:  All medical records of patients undergoing abdominal sacrocolpopexy with or without concomitant procedures between the period of January 1999 and December 2003 were reviewed after obtaining approval of the Institutional Review Board at the University of Colorado.  Thirty-two charts were completely available for review.  All procedures were performed by the same surgeon and a senior resident. The surgery in all cases utilized titanium bone tacks or permanent suture, polypropylene graft attached to the sacrum, the vaginal apex, and no dissection of the retroperitoneal space.  Extracted data included patient demographics, operating time, blood loss, mean hospital stay, and presence or absence of complications.  Follow-up time ranged from six months to three years.

RESULTS: The mean age of patients undergoing abdominal sacrocolpopexy was 62.4.  Race of the patients was 60% Hispanic, 30% Caucasian, 15% African American, and 5% other.  Eighteen patients had abdominal sacrocolpopexy with paravaginal repair; ten patients had abdominal sacrocolpopexy with paravaginal repair, and a procedure including suburethral sling, Burch procedure, or transobturator approach; of these patients, ten also underwent posterior colporrhaphy. Two patients underwent vaginal hysterectomy, and two had abdominal hysterectomies.  Hospital stay, blood loss, operating time and complications were analyzed in each group.  There was one case of post-operative ileus. There were no bowel obstructions, no peritonitis or any wound dehiscences in any of the patients.  Three abdominal wound infections were noted.  One patient who had undergone sacrocolpopexy paravaginal repair, hysterectomy and posterior repair had a graft erosion with sepsis at five month postoperatively. 

There have been no recurrent prolapse noted.

CONCLUSIONS:  While this is not a randomized trial comparing techniques, our technique compared with literature reports did not have a higher complication rate. Placement of the graft in the retroperitoneal space has a theoretical advantage; we found no complications related to bowel obstruction in any patients, and blood loss was minimal.  When performing abdominal sacrocolpopexy, placement of the graft intraperitoneal was not associated with increased complication rates.

Disclosure – Nothing to disclose.