The Problem of Recurrent Anterior Wall Prolapse after Supracervical Hysterectomy with Sacrocolpopexy.

Abstract

This video details a step-by-step approach to sacrocolpopexy for recurrent anterior vaginal vault prolapse following a sacrocolpopexy at the time of supracervical hysterectomy. An explanation regarding the etiology of increased incidence of recurrent pelvic organ prolapse in supracervical hysterectomy with concomitant sacrocolpopexy as compared to total hysterectomy is provided. Minimally invasive sacrocolpopexy is a feasible and safe option for the treatment of recurrent vaginal vault prolapse. Recurrence of prolapse following pelvic reconstruction most commonly occurs in the anterior compartment. Studies have shown that supracervical hysterectomy at the time of sacrocolpopexy increases the risk of recurrent prolapse compared to total hysterectomy. While supracervical hysterectomy at time of sacrocolpopexy decreases incidence of mesh exposure, careful consideration should be given to patients with redundant anterior vaginal prolapse and patients who have more advanced pelvic organ prolapse preoperatively. This may entail performing a total hysterectomy in lieu of a supracervical hysterectomy or plicating the anterior vaginal wall to decrease redundancy and potentially recurrence of prolapse of the anterior compartment.