Laparoscopic management of pelvic organ prolapse recurrence after open sacrocervicopexy

In this narrated video we present a case of pelvic organ prolapse (POP) recurrence 12 years after sacrocervicopexy, outline our management and suggest an optimal laparoscopic surgical technique that may reduce the risk of future recurrence. A 71-year-old patient, who had undergone an open sub-total hysterectomy with sacrocervicopexy 12 years previously, complained of a bulging sensation in her vagina, of 12 months' duration. On physical examination, a Pelvic Organ Prolapse Quantification (POP-Q) stage III prolapse was diagnosed, with marked apical, anterior and posterior compartment prolapse. On laparoscopy we identified the old mesh attached to the promontory and to the vaginal apex, without any fixation of the vaginal walls. Complete mesh excision was performed, followed by vaginal dissection to facilitate implantation of two new meshes and performing a new sacrocolpopexy. No postoperative complications occurred. Over 6 weeks of post-operative follow-up, there was no pelvic pain, dysuria or dyschezia. A good anatomical result was noted without any prolapse. Laparoscopy appears to be an effective approach to complete mesh excision. For the treatment of prolapse recurrence, complete excision of the old mesh with new pelvic mesh-augmented reconstruction is recommended. Thorough dissection of the vesico-vaginal and recto-vaginal spaces followed by mesh fixation to the relevant vaginal walls may reduce recurrence.