To review the efficacy, safety, anatomical and functional outcomes of consecutive patients undergoing laparoscopic sacrocolpopexy (LSC) using Y mesh for post hysterectomy recurrent vaginal prolapse in a single unit.

Retrospective study of patients that had LSC using Y-shaped mesh for recurrent post hysterectomy vaginal vault prolapse. The study period was between January 2010 and March 2016. Data was obtained from BSUG database and electronic patients records. Patients records were obtained and reviewed independently. 
Preoperatively, all patients were evaluated using the Prolapse Quality of Life Questionnaire (PQOL) and examined using the Pelvic Organ Prolapse Quantification System (POP-Q). 
The LSC was perfomed under GA with patients in semi-lithotomy position. After skin preparation, and draping, a pneumoperitoneum was created and three laparoscopic ports were placed, 11-mm umbilical and 5-mm left and right lateral ports. The lateral ports were placed 1 cm below the level of the umbilicus under direct vision. The rectovaginal fascia was opened using monopolar diathermy scissors with dissection to the level of the perineal body and rectovaginal reflection. The bladder was then dissected from the anterior vaginal wall laparoscopically over a vaginal probe. Dissection was carried out to the level of the trigone. The sacral promontory was subsequently visualized and the presacral peritoneum opened with monopolar diathermy and laparoscopic scissors and dissected all the way down to the right side of the rectosigmoid. 
A polypropylene mesh was sutured to the vaginal walls including the posterior, anterior and vaginal vault using 20-30 cm mesh, The folded end of the mesh was then tacked to the sacral promontory with 5-mm helical fasteners (Protack, United States Surgical, Tyco Healthcare, Norwalk, CT, USA). Finally, the mesh was completely covered with peritoneum, gas was expelled and ports withdrawn under vision. The urinary catheter was removed the following morning. 
 Presentation symptomology, intraoperative complications and recurrence of symptoms were recorded. Post operatively all patients underwent evaluation using  POP-Q scoring and patient quality of life was assessed using the Prolapse Quality of Life Questionnaire (PQOL). Post-operative improvement was measured using the global impression of improvement score.
Analysis of the data has been expressed in terms of mean, frequency and percentage change. Where appropriate individual parameters have been discussed separately.

Data was available for 147 consecutive patients who underwent laparoscopic sacrocolpopexy. Patients age ranged from 35 to 86 years old with an average BMI of 28.8. The most common presenting symptoms were vaginal bulge (95%), vaginal heaviness (73%) and urinary urgency (46%). The average time between primary surgery to LSC was 10.5 years (5months – 42 years). Complications reported were 0.6% small bowel injury, 2.7% bladder injury, 0.6% risk of major haemorrhage and 1% risk of vaginal mesh extrusion. 12% patients developed de novo stress urinary incontinence and 2.7% new onset urinary urgency. Patient global impression of improvement showed that 76% reported feeling “much better” or “very much better”, POP-Q assessment was done pre and post operatively. Pre operative point C ranged from -3 to +4cm. Mean post operative point C was -7.6cm (need a range). Point C improved by 7 cm in the majority of patients postoperatively. There was also improvements in point Ba of 5 cm in the majority of patients. Point Bp on the other hand showed the least anatomical improvement, with 21 women showing a change of 2 cm. 
Twenty one women (14.2%) presented with recurrent prolapse symptoms, out of which 16 went on to have further surgery, where the majority of women had repeat prolapse surgery within 2 years of the LSC.

Post hysterectomy vault prolapse can be difficult to manage, especially if recurrent. Sacrocolpopexy is the gold standard for repair in these situations but has higher morbidty than a vaginal approach. In this consecutive review of patients we have shown that a laparoscopic approach to SCP can achieve excellent results with low morbidity and short length of stay.

LSC using Y mesh is a safe and effective method of managing recurrent post hysterectomy vaginal prolapse.