2 The condition, current treatments and procedure
2.1 Apical prolapse is the descent of the uterus, cervix, or vaginal vault. Vaginal vault prolapse is when the upper part of the vagina descends from its usual position, sometimes out through the vaginal opening. It is common after hysterectomy. Apical prolapse can affect quality of life by causing pressure and discomfort, and by its effect on urinary, bowel and sexual function.
2.2 Treatment is rarely indicated if there are no symptoms. Mild-to-moderate prolapse may be treated with conservative measures such as pelvic floor muscle training, electrical stimulation and biofeedback. Topical oestrogens and mechanical measures such as pessaries may also be used. Surgery may be needed when the prolapse is severe. Several surgical procedures are available including hysterectomy, mesh sacrocolpopexy, uterine suspension sling (including sacrohysteropexy) and uterine or vault suspension (without sling). Some procedures involve using mesh to provide additional support.
2.3 Laparoscopic mesh pectopexy is done with the patient under general anaesthesia. Using a laparoscopic approach, a polyvinylidene fluoride (PVDF) monofilament mesh is inserted into the abdominal cavity. The ends of the mesh are attached to the iliopectineal ligaments on each side of the pelvis, using nonabsorbable suture material. The cervical stump or vaginal apex is elevated to the intended tension-free position and sutured to the central part of the mesh. The mesh is then completely covered with peritoneum, secured using absorbable suture material, so that no mesh is visible in the abdominal cavity.
2.4 This procedure may offer an alternative to laparoscopic sacrohysteropexy when access to the sacral promontory is limited, for example because of abnormal anatomy, obesity, adhesions, or previous surgery.