Pelvic organ prolapse resulting from the loss of  vaginal support is a common disorder that affects women as their age advances. An abdominal mesh sacral colpopexy is a more durable approach to manage prolapse and is known to be the gold standard treatment for advanced vaginal prolapse. However, a hostile sacral promontory can make the anchoring of mesh at the anterior longitudinal ligament overlying the sacral promontory during abdominal sacro-colpopexy (SCP) for apical prolapse treacherous. Furthermore rare complications including  lumbosacral  osteomyelitis and/or discitis have been described int he literature. In order to avoid injuring critical anatomical structures such as iliac veins, median sacral vessels and or the intervertebral disc, we present our experience and longer-term outcomes utilizing a modified new technique for mesh anchorage.

A prospective review of consecutive patients from an IRB approved sacro-colpopexy database was performed. Patients with symptomatic pelvic organ prolapse whom underwent a mesh peritoneo-colpopexy (PCP) were analyzed [1]. This technique anchors the apex of the vagina to the perirectal fat tissues in the right para rectal groove with 2/0 V-Loc sutures on either side. Optimal mesh anchorage is assessed by exerting traction at sutures pre-placed in the vaginal vault. Data assessed included demographic characteristics, prior anti-incontinence/ genitourinary surgery, complications, validated questionnaires, POP-Q examination and associated outcomes.

Twenty-three patients underwent PCP from January 2010 to December 2019 with at least 6 months follow up. Twenty-one patients (91%) had previous hysterectomy. Sixteen (70%) patients had previous surgery for pelvic organ prolapse (POP) and/or stress incontinence. Mean age and median follow up were 62 years (42-82) and 37.3 months (6-90.5) respectively. Mean preoperative C-point was -3.2 (+1 to -9) compared to -9.3 (-8 to -12) postoperatively (p < 0.001). Mean operative time and blood loss were 234 minutes (120-360) and 107 ml (20-900) respectively. No patients developed recurrent vault prolapse or required reoperations. Functional postoperative scores were QoL 2.8 (range 0-8), UDI-6 4 (range 0-15), and IIQ-7 3 (range 0-20).

The peritoneo-colpopexy technique aims to provide an alternative approach for mesh anchoring for hostile promontory anatomy. Solid restoration of level one support was noted at median follow up of 37.3 months without incurring devastating complications and compromising outcomes.

Peritoneo-colpopexy performed reliably to correct symptomatic POP with median follow up of 37.5 months. The use of strong unidirectional and delayed absorbable sutures to secure the mesh to the peritoneum and surrounding fat around the vaginal apex resulted in satisfactory anatomic outcomes with good permanent integration of the mesh. [1] J Urol. 2015 Jun;193(6):2089-93.

Abdominal mesh sacrocolpopexy without promontory fixation: initial results of the peritoneocolpopexy technique. J Urol. 2015 Jun;193(6):2089-93.