Laparoscopic round ligament suspension for vault Prolapse: Early experience and results

Introduction & Objective:  Pelvic organ prolapse is a common complication after hysterectomy with an 11.6% requiring surgery.3 Laparoscopic Sacrocolpopexy has been a standard treatment option for the vault prolapse. The highest incidence peaks of vault prolapse surgeries are among women over 70 years.4,5 who also. have major comorbidities due to the old age and post-hysterectomy morbidities which may limit surgical options in these women. Usage of Round ligaments as an alternative native tissue repair has been described during hysterectomy for pelvic organ prolapse to prevent vault prolapse in the future.6 In our study, we employed this round ligament Colposuspension as a surgical management for high-risk patients presenting with post hysterectomy vault prolapse. Methods: This study is a prospective observational study to estimate the outcomes of this novel laparoscopic round ligament colposuspension as a surgical management option for post hysterectomy vault prolapse. We included vault prolapse patients following hysterectomy with age>60 years, classified as high risk by anesthesiologist and are willing for minimally invasive surgery and excluded patients with prior failed prolapse repair. The patients were followed up at at 7 days, 15 days and at 1, 3, 6, and 12 months postoperatively. Various parameters recorded include patients age, comorbidities, grade of prolapse, urinary symptoms, ASA physical risk grade, pre- and postoperative serum hemoglobin, packed cell volume, intraoperative duration(from port entry to closure), intraoperative and perioperative complications like bleeding requiring transfusion, perolonged intubation, need for intensive care, hospital stay, persistent pelvic pain/discomfort beyond postoperative day 7, time to return to normal activity, wound complications, recurrence of prolapse and onset of denovo urinary symptoms. Descriptive statistics were used to estimate the outcomes of this native tissue repair using round ligaments. Results: We enrolled three subjects with a mean age of 73.6 years and an Eastern Cooperative Oncology Group (ECOG) score of 2. All subjects presented with grade 4 vault prolapse and underwent laparoscopic native tissue repair using round ligaments. The mean intraoperative duration was 38.6 minutes with a minimal blood loss of 30 ml. No intraoperative drains were required, and the perioperative drop in hemoglobin was negligible at 0.1 mg/dl. At follow-up, none of the subjects experienced recurrent prolapse or developed new urinary symptoms. Additionally, no perioperative complications were observed. Conclusion: Laparoscopic colposuspension using round ligaments represents a minimally invasive, effective option for treating vault prolapse in women. It is especially feasible and recommended in elderly women with severe grades of vaginal prolapse. The ease of the procedure coupled with the short duration of surgery and quick recovery times make this an attractive alternative option in patients with multiple comorbidities.