Laparoscopic sacral uteropexy with cravat technique--experience and results.

Abstract

OBJECTIVE:

The aim of the present study was to evaluate the safety and efficacy of a ″Cravat″ technique for the management of uterine prolapse in patients who want to preserve uterus, involving suspension of the uterus from the sacral promontory by using polypropylene mesh.

MATERIALS AND METHODS:

A prospective observational study between January 2011 and September 2013 was conducted. Prior to surgery, prolapse assessment was undertaken with Baden-Walker halfway system to grade the degree of prolapse at all sites. Patients with severe uterine prolapse (stage II-IV) who want to preserve uterus, were operated with Cravat technique. All patients were evaluated at 2 weeks and 6 weeks after surgery and followed for 6 months. Outcomes were evaluated objectively by vaginal examination using Baden-Walker halfway classification, and subjectively classifying patients as 'very satisfied', 'satisfied' and 'not satisfied' at the 6th month postoperatively.

RESULTS:

Sacral uteropexy was successfully performed by laparoscopy in 32/33 patients (one needed to be converted to laparotomy). Nine patients also had a concurrent procedure as colporaphy anterior, colporaphy posterior or transobturator tape. Postoperative recovery has been uneventful with subjective and objective cure rates were 96.9% and 93.9%, respectively at six month. One recurrence of total prolapse needed to be reoperated and two patients with sacrouteropexy still remained at stage 2 prolapse. There have been no cases of graft exposure, rejection or infection with a median follow-up of 23.9 months.

CONCLUSIONS:

Laparoscopic sacral uteropexy with "Cravat technique" was found to be safe and simple procedure.

• Authors: Murat Api, Semra Kayatas, Aysen Boza, Hakan Nazik, Hakan Aytan
• Journal: International braz j urol : official journal of the Brazilian Society of Urology (Int Braz J Urol) 2014 Jul-Aug Vol. 40 Issue 4 Pg. 526-32 ISSN: 1677-6119 [Electronic] Brazil
• PMID: 25251957 (Publication Type: Evaluation Study, Journal Article, Observational Study)

Chemical References

• Polypropylenes

Topics

• Adult
• Female
• Humans
• Laparoscopy (methods)
• Middle Aged
• Operative Time
• Organ Sparing Treatments (methods)
• Patient Satisfaction
• Peritoneum (surgery)
• Polypropylenes (therapeutic use)
• Prospective Studies
• Reproducibility of Results
• Suburethral Slings
• Surgical Mesh
• Time Factors
• Treatment Outcome
• Uterine Prolapse (surgery)
• Uterus (surgery)