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Deffieux, X., Fiavre, E., Gervaise, A., Frydman, R., & Fernandez, H. (2007). Posterior infracoccygeal sacropexy procedure for vaginal vault prolapse: anatomical and functional results on a series of 86 patients. Int Urogynecol J, 18 Suppl 1, S107-S244.

OBJECTIVE: To evaluate the results of infracoccygeal sacropexy procedure for cure of vaginal vault prolapse.

MATERIALS AND METHODS: A descriptive retrospective study concerning a continuous series of 86 women, mean age 63 years (+11), who have undergone infracoccygeal sacropexy procedure for the treatment of vaginal vault prolapse. Surgical approach was as follows: after opening the ischiorectal fossa into a transversely incised posterior vaginal fornix, a sling is inserted by trans-gluteal approach: IVS© (n=53) or I-STOP© (n=33). Bilateral gluteal skin incisions were made 3 cm lateral and below the external anal sphincter. The IVS© or I-STOP© tunneller was placed into the ischiorectal fossa, and then turned inwards for passage through the rectovaginal fascia, so as to reach the transverse vaginal incision. The procedure is repeated on the contralateral side. The tape is secured to the vaginal vault and also to the remnants of the uterosacral ligaments. Mean follow-up was 15 months (+10). All subjects were asked to complete the PFDI and PFIQ questionnaires.

RESULTS: There was no rectal perforation. One per-operative ischiorectal fossa hemorrhage was observed and a postoperative gluteal hematoma occurred, but this did not required re-intervention. No perineal abscess or cellulitis has been observed. Postoperative perineal pain was reported by 4 (4%) women. Two of them required sling removal: one case of pudendal nerve damage and one case of mesh shrinkage. Vaginal extrusion of the sling occurred in 5 women, but this complication was observed only with IVS© sling (vaginal extrusion rate with IVS© sling: 9%). None vaginal extrusion has been observed with I-STOP© sling. Recurrent vaginal vault prolapse, ICS grade 3 or 4, developed in 2 patients (2%) but this recurrence did not required re-intervention. Only five patients were unsatisfied at last follow-up, with no or few improvement of symptoms and quality of life.

CONCLUSION: The current study shows good functional results and low rate of vaginal vault prolapse recurrence following this 'mini-invasive' procedure. However, patients and surgeons must be aware of the risk of complications such as perineal or gluteal pain. New polypropylene meshes, such as I-STOP© device, seem to sharply diminish the risk of vaginal extrusion of the sling.

Source: Original Abstract

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