feito com
V19-05
J. B. Mendes1, M. T. Tanaka1, M. J. B. C. Girão2, O. E. H. Fugita3, J . L. Amaro3, E. F. Pacagnan4, M. R. S. S. B. Mendes4, A. S. Tanaka1
1Master Clínica, Cascavel, Brazil, 2Unifesp, São Paulo, Brazil, 3Unesp, Botucatu, Brasil, 4Unioeste, Cascavel, Brasil
Introduction: The sacrocolpopexy using different mesh in an open intrabdominal surgery approach has successfully been reported as one of the most effective long term technique to repair vaginal vault prolapse. The reproduction of this classical technique by laparoscopy seems to be a very good option due to its advantages of minimal invasion with no lowering in the effectiveness.
Method: a 69-year-old patient with prior hysterectomy developed a total vaginal vault prolapse with enterocele and underwent a transperitoneal laparoscopic surgery, at Trendelenburg with the vagina easily accessible, using three port-sites. Keeping the vaginal vault prolapse reduced by a gauze wad and the bladder catheterized, an anterior and posterior dissection of the vaginal vault carried out. The posterior peritoneum was opened downward to fully expose the promontory and the anterior aspect of the sacrum. A Y-shape prolene mesh previously fashioned outside, was sutured in the anterior and posterior walls of the vaginal vault, and then anchored to the promontory periosteum with non-absorbable sutures. A rigorous closure of the peritoneum opening was performed in order to fully cover the prolene mesh. To repair an associated enterocele, the cul-de-sac was reduced by interrupted sutures between the sigmoid anterior taenia and the parietal peritoneum, right before performing the promontory anchoring.
Result: The operation was uneventful, lasting 150 minutes. The hospital stay was 2 days with minimal pain complaint. At a two-year follow-up, no recurrence was observed.
Conclusion: Laparoscopy is a good and advantageous approach for such a kind of pathology enabling associated pathology repairs.