Laparoscopic paravaginal mesh fixation during laparoscopic sacrocolpopexy – an important step to avoid anterior recurrence. A surgical Video

Laparoscopic sacrocolpopexy has been demonstrated to be the gold standard of prolapse surgery. Isolated anterior compartment failure can occur especially if paravaginal defect has initially been present. Anterior recurrence can occur in up to 10%, additional surgery is needed in about 6%. In the last 2 years we adapted our technique of lateral fixation of anterior mesh to reduce the risk of anterior recurrences; the first results are very encouraging.

The Video demonstrates the case of a 67 years old patient undergoing laparoscopic sacrocolpopexy because of combined prolapse. After accomplishing supracervical hysterectomy and posterior dissection, the anterior dissection is started by opening the vesicovaginal space and separating the bladder from the vagina. Lateral dissection is performed by opening the paravaginal space and exposing the lateral edge of vagina. The distal part of ureters is dissected from anterior parametrium to avoid damage. The anterior mesh is sutured to distal the vaginal in the midline and laterally to vaginal edge. The posterior mesh is sutured on levator ani and cervix. Both meshes are fixed at longitudinal Ligament.

Perioperative results with deep and lateral mesh fixation are excellent. As we are following all our patients we can report a significant improvement of anatomical outcome in the anterior compartment at least in short term follow up.

Lateral dissection and mesh fixation in anterior compartment seem to be feasible and safe and could help to significantly reduce the risk of anterior recurrences. Prospective anatomical evaluation must be performed to scientifically verify these promising initial results.

Publication History

Article published online:
07 October 2020