Laparoscopic Modified Halban Colpopexy Combined with LAVH in Treating Uterine Prolapse

Abstract

Traditionally, uterine prolapse is treated by vaginal hysterectomy with or without anterior or posterior colporrhaphy. However, in certain instances, such as coexisting ovarian pathologic conditions or pelvic adhesion, difficulties may be encountered in the transvaginal approach. We herein report our experience of laparoscopic modified Halban colpopexy as an adjunctive procedure to laparoscopic assisted vaginal hysterectomy (LAVH) in the treatment of uterine prolapse combined with indications for ovarian resection or concurrent intraabdominal procedures. Inclusion criteria were moderate to severe uterine prolapse combined with pelvic or adnexal pathology (4 patients), previous pelvic surgery or suspected pelvic adhesion (15 patients), concurrent intraabdominal procedure, for example, Burch colposuspension (4 patients), or postmenopausal women desiring oophorectomy (6 patients). After the hysterectomy, laparoscopic Halban colpopexy was performed. Two stitches are passed over the uterosacral ligament at each side to suspend the vaginal vault, which has been dissected during hysterectomy. Another two to three bites of redundant cul-de-sac are incorporated at regular intervals to obliterate the cul-de-sac. Instead of circumferential pursestring sutures or side-to-side sutures as described in the original Moschcowitz and McCall culdeplasties, we use parallel sagittal sutures from back to front to avoid compromising the position of the uterus. Twenty-seven patients have been treated without major intraoperative or postoperative complications. The follow-up intervals ranged from 10 to 23 months (mean interval 15.7 months), and no posthysterectomy vault prolapse occurred. Despite the limited follow-up period, our results suggest that laparoscopic modified Halban colpopexy in conjunction with LAVH may provide a safe and feasible alternative in the treatment of uterine prolapse, especially in cases requiring intraabdominal procedures. (J GYNECOL SURG 13:175, 1997)