Abdominální sakrokolpopexe v léčběprolapsu poševního pahýlu po hysterektomii

Overview

Objective:
To evaluate the safety and effi cacy of the abdominal sacral colpopexy in the treatmentof posthysterectomy vault prolapse.Design: Retrospective clinical trial.Setting: Obstetric and Gynecologic Department, The Charles University 2nd Medical School andFaculty Hospital Motol, Prague.Methods: A group of 18 patients with vaginal vault prolapse after hysterectomy who underwentabdominal sacral colpopexy between July 2001 and June 2003 was studied. Ten women had undergoneprevious abdominal and 8 previous vaginal hysterectomy. All patients were operatedon by one surgeon. Preoperative evaluation consisted of physical examination, age, parity, bodymass index, history of previous pelvic surgery and hormonal status. The cure rate and complicationswere evaluated in follow-up.Results: The mean age was 59.5 (41-72) years, the median parity was 2.05 (1-5). Seven (38.9%) patientswere slightly overweight (BMI 25-30 kg/m2), one (5.6%) patient was obese (BMI 33.4 kg/m2) and10 (55.5%) had normal weight (20-25 kg/m2). The average period of follow-up was 14.9 months (6-24). The cure rate was 94.4% (17 of 18 patients). No serious intraoperative complications occured.Postoperative complications occured in 2 (11.2%) cases (one urgent and one stress urinary incontinence).The complications were resolved and the patients were free of negative postoperativesymptoms in the time of the last follow-up visit.Conclusions: Vaginal vault prolapse is an infrequent complication after both vaginal and abdominalhysterectomy. The study shows that abdominal sacral colpopexy is an effective and safesurgical procedure in the treatment of posthysterectomy vault prolapse. The operative techniqueis simple but the surgery should be performed by experienced pelvic surgeons able to resolveintraoperative complications.

Klíčová slova:
abdominal sacral colpopexy, vaginal vault prolapse, hysterectomy, cure rate, safety