Sutureless Sacrocolpopexy with Absorbable and Nonabsorbable Tacks for Mesh Fixation

Abstract

Introduction:

Sacrocolpopexy is the gold standard for high-stage pelvic organ prolapse and has attained this reputation from many successful years in achieving optimal success and duration of surgical results. Reducing the time and potential difficulties with this procedure would be a useful venture for the surgeon. We describe in this video our approach to the utilization of absorbable and nonabsorbable tacks for fixation of both anterior and posterior polypropylene mesh extensions to both the vaginal walls and sacrum.

Methods:

Between January 2008 and September 2009, 62 patients underwent sacrocolpopexy with absorbable and nonabsorbable tacks (Absorbatack and Protack; Covidien, Mansfield, MA) for repair of stage 2 or more pelvic organ prolapse of at least two pelvic compartments. All surgeries included a tension-free vaginal tape obturator or tension-free vaginal tape Secur (Gynecare, Southfield, NJ) for potential stress urinary incontinence (not demonstrated in video). The absorbable tacks (vaginal wall fixation) were copolymer based, whereas the nonabsorbable (sacral attachment) were titanium.

Results:

There was, with a minimum of 1 years' follow-up, no recurrent stage 2 vault prolapse, whereas recurrent cystocele's and rectocele's were 21% and 24%, respectively. Only four patients felt continued symptoms, resulting in the re-operation vaginally to repair their cystocele and/or rectocele. There were four of five patients with superficial tack erosions into the vagina that responded to time (dissolution of tack may take up to 1 year) and estrogen placement. Another patient's superficial tack erosion was removed vaginally at 6 months in lieu of waiting for its dissolution because of symptomatic dyspareunia. There were no episodes of bleeding or infection. Median blood loss and operative time were 150 mL and 54 min.

Conclusions:

The utilization of absorbable and nonabsorbable tacks for sacrocolpopexy may demonstrate good outcomes with a minimum of 1 years' follow-up. Continued study should be implemented to ascertain its continued applicability in open, laparoscopic, and robotic sacrocolpopexy.

No competing financial interests exist.

Runtime of video: 7 mins 54 secs