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Salvage pectopexy using detached lateral suspension mesh arms.

Patrícia Pereira Amaral¹, Revaz Botchorichvili²

¹Department of Obstetrics and Gynaecology, Unidade Local de Saúde de Amadora/Sintra, Lisboa, Portugal.

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Summary

Recurrent pelvic organ prolapse after laparoscopic lateral suspension can be effectively managed with a salvage surgery. This technique refixes detached mesh arms to Cooper's ligament, reinforcing the fascia and avoiding risky sacral promontory dissection.

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Area of Science:

Urogynecology
Minimally Invasive Surgery
Pelvic Floor Reconstruction

Background:

Laparoscopic lateral suspension is an alternative to sacrocolpopexy for pelvic organ prolapse (POP) when sacral promontory access is limited.
Recurrence can occur due to mesh detachment or fascial weakening.
Pectineal fixation offers a potentially stronger anchoring method.

Purpose of the Study:

To present a minimally invasive salvage surgical strategy for recurrent anterior compartment prolapse.
The patient had a history of laparoscopic lateral suspension with an inaccessible sacral promontory.

Main Methods:

A salvage laparoscopic anterior colporrhaphy was performed to reinforce the pubocervical fascia.
Detached mesh arms were refixed to Cooper's ligament using non-absorbable sutures, applying tension-free pectopexy principles.

Keywords:

Fascia laparoscopy ligament mesh pelvic organ prolapse surgery

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Peritonisation was completed to cover the mesh.

Main Results:

The described salvage technique successfully managed recurrent anterior prolapse in a patient with prior laparoscopic lateral suspension.
Mesh arms were securely refixed to Cooper's ligament, reinforcing the native fascia.

Conclusions:

Recurrent anterior prolapse with an inaccessible sacral promontory can be treated by reusing detached mesh arms.
Refixing mesh to Cooper's ligament provides a stable, anatomically sound solution.
This approach avoids the complications associated with sacral promontory dissection.