[EFFICACY OF VAGINAL AND LAPAROSCOPIC SACROCOLPOPEXY, A DUAL APPROACH TO UTERO-VAGINAL PROLAPSE, COMPARED WITH LAPAROSCOPIC SACROCOLPOPEXY ALONE].

Introduction: Sacrocolpopexy (SCP) is one of the most successful operations for correcting utero-vaginal prolapse and achieving a functional vaginal reconstruction. The operation, which classically calls for an open abdominal approach, can be performed laparoscopically, but it is time-consuming and requires experienced laparoscopists. A few years ago, we introduced a dual vaginal-laparoscopic technique, in which we combined the ease of vaginal suturing with the advantages of laparoscopic SCP. We now evaluate the efficacy of this dual approach in comparison to the primary laparoscopic operation.

Methods: We compared the efficacy and short-term results of 68 patients who had the dual operation to that of 28 classical Laparoscopic SCP patients. The study was retrospective and included analysis of patients' records. We also called the patients and encouraged them to come for a follow-up examination. We managed to examine 11 of the 28 Laparoscopic SCP patients (39%), 3-7 years after the operation, and 40 of the 68 patients who had the dual operation (59%), 1-5 years after the procedure.

Results: The short-term results of the dual operation showed that it was faster, without compromising the wellbeing of the patients. For the long term results we examined the patients available and found that the subjective cure rate was 73% for the Laparoscopic SCP patients and 87% for the dual operation. However, we observed some degree of vaginal prolapse in 82% (9/11) of the Laparoscopic SCP operations, mainly cystocele or rectocele grade 1 or 2, but only 30% of the patients with the dual operation had such prolapse. There were no mesh erosions or exposures in any of the groups.

Conclusions: The dual operation combined the ease and accuracy of a vaginal operation with the benefits to the patient from a laparoscopic approach. It also enabled a convenient approach to add vaginal procedures that improved the surgical results, or complied with the patients' wishes.