Laparoscopic Sacrocolpopexy with Two Separate Meshes along the Anterior and Posterior Vaginal Walls for Multicompartment Pelvic Organ Prolapse

Study Objective. To assess the feasibility and results of laparoscopic sacrocolpopexy (LSC) with two separate meshes along the anterior and posterior vaginal walls in correcting multicompartment pelvic organ prolapse (POP). Design. Prospective study (Canadian Task Force classification I). Setting. Tertiary care university-affiliated teaching hospital. Patients. Forty-six consecutive women with radiologic diagnosis of multicompartment POP with or without genuine stress urinary incontinence and no history of surgery for either disorder. Intervention. LSC with or without laparoscopic Burch colposuspension or tension-free vaginal tape procedure. Measurements and Main Results. LSC was performed in 89% of patients. Mean operating and hospitalization times were 171 ± 37 minutes and 4.0 ± 2.1 days, respectively. Intraoperative complications were 7% of bladder injuries successfully treated by laparoscopic suture. The success rate for POP was 83%. The main recurrence was rectocele (12%), which occurred only among women undergoing LSC plus laparoscopic Burch colposuspension (P = 0.036). The LSC was effective in treating symptoms in 95% of women. Because of excessive mesh tension, one patient (2%) developed obstructed defecation, and two (5%) had de novo urinary incontinence. In no patient did occlusion or mesh infection and/or erosion in adjacent organs occur. Conclusion. LSC appears to be feasible and effective in treatment of multicompartment POP. Performing concomitant Burch colposuspension significantly enhances the risk of rectocele recurrence or development.