Abdominal sacrocolpopexy for vault prolapse without burial of mesh: a case series

Objectives To audit the clinical outcome of abdominal vault suspension (sacrocolpopexy, hysteropexy or cervicopexy) using non‐absorbable mesh, without burial by closure of the peritoneum. Design A case series. Setting Urogynaecology units of four hospitals. Population One hundred and twenty‐eight women having open or laparoscopic sacrocolpopexy (121), hysteropexy (6) or cervicopexy (1) using non‐absorbable mesh for vault prolapse. Methods Patients had suspension of the vault, uterus or cervix from the sacral promontory using a monofilament polypropylene mesh. The pelvic peritoneum was not closed over the mesh. Patients were followed up every six months. Main outcome measures Incidence of bowel complications as a consequence of the mesh; cure rate of prolapse and incidence of other post‐operative complications; rate of re‐operation for prolapse or incontinence. Result After a median follow up of 19 months (1.5–62), there were no bowel complications as a result of non‐burial of mesh. Three patients had asymptomatic vaginal mesh erosion, which required minor surgical intervention. Ninety percent of patients had good resolution of their prolapse symptoms while 10% of patients required further surgery. Conclusion Leaving the mesh uncovered by the pelvic peritoneum was not associated with complications. It appears safe to perform vault suspension without closing the peritoneum.