Research
Urogynecology
Laparoscopic sacral colpopexy versus total vaginal mesh for vaginal vault prolapse: a randomized trial

Presented at the 34th Annual Meeting of the International Urogynecological Association, Lake Como, Italy, June 16-20, 2009.
https://doi.org/10.1016/j.ajog.2010.11.016Get rights and content

Objective

To compare the laparoscopic sacral colpopexy and total vaginal mesh for vaginal vault prolapse.

Study Design

Women with symptomatic stage ≥2 vault prolapse were randomly allocated the laparoscopic sacral colpopexy (53) or total vaginal mesh (55). Primary outcome measures were objective success rates at pelvic organ prolapse quantification sites individually and collectively. Secondary outcome measures included perioperative outcomes, patient satisfaction, quality of life outcomes, complications, and reoperations.

Results

The laparoscopic sacral colpopexy group had a longer operating time, reduced inpatient days, and quicker return to activities of daily living as compared with the total vaginal mesh group. At the 2-year review, the total objective success rate at all vaginal sites was 41 of 53 (77%) for laparoscopic sacral colpopexy as compared with 23 of 55 (43%) in total vaginal mesh (P < .001). Reoperation rate was significantly higher after the vaginal mesh surgery 12 of 55 (22%) as compared with laparoscopic sacral colpopexy 3 of 53 (5%) (P = .006).

Conclusion

At 2 years, the laparoscopic sacral colpopexy had a higher satisfaction rate and objective success rate than the total vaginal mesh with lower perioperative morbidity and reoperation rate.

Section snippets

Materials and Methods

From the end of 2005, consecutive women referred to Wesley, Royal Brisbane's and Mater tertiary referral Urogynaecology unit with symptomatic stage 2 or greater (point C ≥ −1 pelvic organ prolapse quantification [POP-Q]) vaginal vault prolapse were eligible for inclusion. Recruitment was completed at the end of 2007. Exclusion criteria included those younger than 18 years of age, inability to comprehend questionnaires, to give informed consent or to return for review, vault prolapse < stage 2,

Results

The Figure details patients' progress through the study with 108 women of 142 potentially eligible, consenting to randomization and participation with 53 allocated LSC and 55 vaginal mesh repair. All completed at least 6 months follow-up. The randomization process was adequate with no differences between the 2 groups in demographics and preoperative variables as seen in Table 1. Wilcoxon test indicate no significant difference between treatment groups for preoperative POP-Q measurements except

Comment

The results indicate that both procedures had acceptable perioperative outcomes with the longer operating time being a disadvantage of the LSC that was offset by small but statistically significant reduction in blood loss, inpatient stay, catheter days, and return to activities of daily living in the LSC group as compared with the TVM group.

At mean 2 year review, the anatomic outcome saw a significant reduction in Aa, Ba, C, Ap, and Bp in both groups as compared with the preoperative

References (19)

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The study was supported by competitive research grants from the Australian Gynaecological Endoscopy Society, 2007 and 2008, Sydney, Australia.

Cite this article as: Maher CF, Feiner B, DeCuyper EM, et al. Laparoscopic sacral colpopexy versus total vaginal mesh for vaginal vault prolapse: a randomized trial. Am J Obstet Gynecol 2011;204:360.e1-7.

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