Objective: To evaluate the safety and efficacy of posterior intravaginal slingplasty (IVS) as a minimally invasive surgical procedure for treatment of vaginal vault prolapse and to determine its effect on the posterior fornix syndrome symptoms.
Patients & Methods: A prospective clinical study that was conducted at Department of Obstetrics & Gynecology, Benha University Hospital and in private practice hospitals between December 2005 and August 2008, on 30 patients with vaginal vault prolapse (Grade 2-4). All patients underwent preoperative assessment by thorough history taking, physical and gynecological examinations and preoperative investigations that included urine analysis and abdominal and pelvic ultrasonography. The aim of the procedure was to insert an 8 mm Polypropylene tape between the perineum and the vaginal vault to reinforces the atrophied uterosacral ligaments. Associated anterior and posterior compartments defects were also treated by anterior and posterior repairs with insertion of tension-free vaginal mesh (TVM). All patients were followed-up at 1, 3, 6 and 12 months postoperatively.
Results: The symptomatic cure rates were 93.3% for vaginal vault prolapse, 85% for pelvic pain, 84.6% for urgency, 81.8% for nocturia, and 90.9% for obstructive micturition feeling. The mean operative time for posterior IVS itself was 52 ± 3.6 min (range 40-55min). The mean blood loss was 140 ± 57.8 ml (range 100 – 400 ml). All patients were discharged home within 24 hours with a mean hospital stay of 20 ± 3.8 h (range 12-24 h). There were no intraoperative complications and no blood transfusions were required.
Conclusion: The posterior IVS is a simple, safe and minimally invasive surgical procedure that delivered satisfactory results for treatment of vault prolapse and the associated symptoms of posterior fornix syndrome.
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