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13.13: Apical Support Procedures Post Hysterectomy

  • Page ID
    18624
  • Transabdominal procedures

    Sacrocolpopexy is durable with level 1 evidence supporting its use, and several workers have reported that concomitant hysterectomy is safe without any increase in surgical risks. Mesh erosions range from 3% to 40%. There is at present no data to clarify the use of routine culdoplasty with the procedure, and there are no standardized outcome measures to assess sacrocolpopexy success.

    Level 1 evidence suggests an apical prolapse cure in 85% - 90% of cases, but quality of life data in these cases is very limited. Surgery may result in a dysfunctional vagina with dyspareunia, and so anatomical support does not necessarily equate to patient satisfaction. The risk of prolapse at other sites subsequently has not been sufficiently studied.

    Abdominal sacrocolpopexy may also be approached by means of the laparoscopic route, but vast experience and patience is required to achieve good results within reasonable time frames. At present little published data evaluates laparoscopic vault support procedures.

    In this country, Cronje has performed perineo – colposacrosuspension (PCSS) in many hundreds of cases, when women have stage 3 or stage 4 prolapse, or stage 2 symptomatic prolapse - particularly with obstructive defecation (sometimes combined with a STARR procedure). This comprehensive repair represents major surgery, and is beyond the scope of the “generalist” gynaecologist. The recurrent prolapse rate is 10%, with a 5% occurrence of de – novo dyspareunia.

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