Failed abdominal sacral colpopexy: observations and recommendations.

Abdominal sacral colpopexy provides effective surgical management of the vagina that has prolapsed after hysterectomy. Recurrences of prolapse after this operation are rare. Three patients are presented who did exhibit recurrent prolapse necessitating another operation. In two patients, the synthetic mesh used for colpopexy had separated from the vagina. In the remaining patient, the posterior vaginal wall had ruptured distal to the attachment of mesh to the vagina. In each patient, the mesh had become completely interpenetrated by tissue. We believe that failures can be minimized by suturing the suspensory mesh to the vagina over as extended an area as possible. Reasons for this belief are addressed, and techniques for achieving such an attachment are described. A meticulous culdoplasty beneath the suspensory mesh is also considered important, as is the use of permanent sutures placed through the full thickness of the vagina in attaching the mesh.