251 patients were identified.
There were 7 LSCP cases between 2002-2006, 7 in 2007-2011, 37 in 2012-2016, and 53 cases in 2017-2018.
The majority of patients 160 (64%) were post-menopausal.
In OSCP, the age range was 27-77years, with a mean age of 56 years. The Body Mass Index (BMI) in this group ranged 23-38 (mean=28).
In LSCP, the age range was 24- 88 years, with a mean age of 50years. The BMI range in this group was 22-40 (mean=25).
112 patients (45%) had pelvic surgery for prolapse previously, including 47 patients (42%) who had surgery for vault prolapse. These included 2patients (4%) who had a previous laparoscopic sacrohysteropexy and 3patients (6%) who had previous open sacrocolpopexy. The remainder of patients had sacrospinous fixation (SSF)19 (40%), and 23 patients who had vaginal hysterectomy without SSF(53%).
Twenty-six patients (10%) had a total hysterectomy previously.
204(81%) had SCP for primary vault prolapse and 47 (19%) had surgery for recurrent vault prolapse (table1).
Table 1. OSCP vs LSCP assessing nature of prolapse, surgery and complications
Multi-compartment Prolapse (Table1): Overall 43(24%) had rectocele and vault, 70(39%) cystocele and vault, and 69(38%) cystocele, rectocele and vault.
Although 73% had multi-compartment prolapse, only a third of patients in both groups required concomitant pelvic floor repair at the time of vault surgery. In the majority of patients, a Y-mesh implant was used to address multi-compartment prolapse with less patients requiring concomitant PFR.
112 (45%) has concomitant sub-total hysterectomy to aid mesh placement.
Visceral injury: In LSCP group, 3(3%) patients had bladder injury and 1patient (1%) had bowel injury which were managed intra-operatively. There were no visceral injuries in OSCP group.
Return to theatre: In LSCP, 2(2%) patients had port site small bowel herniation in immediate post-operative period and returned to theatre to repair the defect. One patient (0.7%) in OSCP returned to theatre, due to bleeding from the vaginal vault.
Wound Infection: In LSCP 5 (5%) had wound infection and 11 (7%) in OSCP developed wound infection.
Medium/Long term complications
Mesh related complications:
• Vaginal exposure: 1patient in LSCP and 3 in OSCP group. All had trimming of the exposed mesh. The patient in the LSCP group had a vaginal assisted laparoscopic SCP.
• Mesh Perforation into bladder. 1(1%) patient in the LSCP group, which was treated with cystoscopic laser mesh excision.
25 patients (10%) complained of pain (7 backache, 4 abdominal, 6 bladder, 6 vaginal; 2 patients complained of generalised pain that they attributed to the mesh). The pain rate comparable in both groups. Patients with backache were investigated with MRI scan, with no positive findings related to mesh, and were managed conservatively.
Table 2. Outcomes (Short, medium and long-term) of OSCP and LSCP
Overall 209 (95%) reported success at short term with 100% OSCP and 94% in LSCP. At medium-term (94 patients), overall success was 87%, with 85% OSCP and 90% in LSCP. 14 patients with long-term follow up had 87% success overall with 85% OSCP and 90% LSCP.
Overall, 9(6%) patients in OSCP and 6 (6%) in LSCP had recurrent vault prolapse. 9 opted for further vault surgery, including 6 open SCP, 1 redo SHP and 2 SSF.
There were 10(5%) recurrences of non-vault POP in OSCP and 6(3%) in LSCP. Five of these opted for further surgery and had vaginal repair of POP.
There were 2cases in OSCP and 5 in LSCP, of new non-vault POP, 3 of whom opted for vaginal POP repair.
The maximum failure rates for vault prolapse were identified at medium-term. Similarly, failed non-vault prolapse and new onset non-vault were identified mainly at medium-term.