Question 6

A 45 yo presents with symptomatic stage III pelvic organ prolapse. She has been using a pessary for 5 years, but now she would like surgery. She is an avid triathlete. She does not have any urinary or bowel symptoms. She is sexually active. Her apex and anterior vaginal wall are 5 cm outside the hymen. She wants the most durable repair with the fastest recovery time. What is the best surgery for her?

Answer Choices:

Sacrospinous ligament suspension

Laparoscopic sacrocolpopexy

Uterosacral ligament suspension

Colpocleisis

Iliococcygeus suspension

Correct Answer:

Laparoscopic sacrocolpopexy

Explanation:

  • Apical prolapse = descent of uterus, cervix or vaginal vault

  • Sacrocolpopexy has lower rates of recurrence and reoperation than sacrospinous ligament suspension

  • Laparoscopic sacrocolpopexy- secure anterior and posterior vaginal walls via surgical mesh to the anterior longitudinal sacral ligament just below the sacral promotory

  • Prolapse outcomes similar with open and laparoscopic sacrocolpopexy but blood loss and length of stay lessened with laparoscopic approach