Laparoscopical and vaginal approaches in correction of POP – pros and cons

In a period from 2005 till present at the Department of Operative Gynecology there were performed 29 laparoscopic MESH-promontofixations (1st group) and 200 operations on the vaginal wall reconstructions (2nd group) in patients with various stages of pelvic organs prolapse (POP-Q classification).

During the dynamic observation the vaginal wall erosion was observed in 1 patient of the 1st group (3.45%) after 3 years and in 8 patients of the second group (4.9%) after 1–3 month after the surgery (p>0.05). In 13 patients (44.8%) of the 1st group in conjunction with sacrovaginopexia was performed hysterectomy (9– STLH, 4– TLH), and in 5 patient (17.2%) – promontofixation was performed as treatment of the vaginal vault prolapse, in 11 (37.9%) patients sacrohysteropexia was performed.

In the 2nd group in 89 (44.5%) cases vaginal hysterectomy as a treatment of concomitant uterine pathology (uterine myoma, adenomyosis, endometrial hyperplasia in post menopause) was performed, in 22 (11%) women as a treatment of the cervix elongation with intact uterus, was done the cervix amputation without hysterectomy and in 1 (0.5%) patient vaginal hysterectomy necessitated laparoscopic assistance (LAVH) as a result of multiple adhesive processes. It should be noted that in 5 (17.2%) patients of the 1st group and in 91 patients (45.5%) of the 2nd group stress urinary incontinence was discovered during preoperative investigation. In connection with that in the 1st group the promontofixation was combined with Burch operation in 4 (13.8%) women, and in 1 (3.45%) – TVT-Obturator operation. In the second group in all cases the pelvic reconstruction was combined with TVT-Obturator operation.

The experience gained by us allows to draw conclusions on high efficiency laparoscopic and vaginal colpopexy for surgical treatment of POP. Preferences to a method of choice in our opinion are defined by proficiency of the surgeon and age of the patients.