97: The Limitations of Laparoscopic Repair of Genital Prolapse Without Mesh

Oral Presentations repair post hysterectomy were compared with control subjects (n⫽236) who had only hysterectomy. Mean follow-up (interval between both operations) was 10.6 years (min 0.21; max 23.79 SD 6.35). Intervention: Between 1982-2002, in our department, hysterectomies were performed abdominally (n⫽ 4304; 69.3 %) vaginally (n⫽1749; 28.1 %) or by laparoscopy: LAVH (n⫽65; 1 %) and TLH (n⫽96; 1.5%). Measurements and Main Results: The incidence of patients requiring POP repair post hysterectomy was 1.27 per 1000 women-years of risk. If the initial hysterectomy was performed for indications other than POP, the incidence was 0.90 per 1000 women-years compared with 4.22 per 1000 women-years if initial hysterectomy was performed for POP (4.7 times higher). The risk was 8 times higher if preoperative POP was of grade 2 or higher. Significant risk factors are history of vaginal delivery, previous POP repair, surgery for urinary incontinence, as well as sexual activity. Conclusion: POP repair post hysterectomy can be prevented if during the initial operation pelvic floor defects are meticulously corrected. 97 The Limitations of Laparoscopic Repair of Genital Prolapse Without Mesh Dubuisson JB. Hopitaux Universitaires de Geneve, Geneve, Switzerland Study Objective: To demonstrate the efficacy, safety and low complication rate of laparoscopic treatment of genital prolapse without using mesh. Design: Prospective analysis of 66 consecutive cases of genital prolapse, with or without GSI, operated laparoscopically without using mesh, between 10/2003 and 6/2006. Setting: Geneva University Hospital, Geneva, Switzerland. Patients: Sixty-six women, mean age: 56⫹/⫺12.77 years, BMI: 27.65⫹/⫺5.19 with stage II, III and IV genital prolapse: 98.5 % had stage II, III and IV cystocele, 84.8 % had stage II, III and IV uterine prolapse and 92.4 %had stage II,III and IV rectocele. All candidates for laparoscopy were included. Follow up period was 15.56⫹/⫺10.07 months. Intervention: Two different laparoscopic procedures were performed: 1) Anterior colporrhaphy for midline cystocele and colposuspension to Cooper’s ligament for lateral cystocele, using nonabsorbable sutures. 2) Re-approximation of the uterosacral ligaments, posterior colporrhaphy and Douglas obliteration. Burch procedure was performed in 16 (24.2 %) patients with GSI. Hysterectomy was added in 13 patients (19.7 %). Measurements and Main Results: All procedures were accomplished through laparoscopy. The only intra-operative complication (1.5 %) was bladder perforation which was recognized and repaired immediately. Postoperatively, we report low-grade complications. Recurrence occurred in 12 patients (18.2 %), all stages and compartments included.

S37 Four patients (6 %) were re-operated. From a functional aspect, 86.3 % (n⫽57) of the patients were satisfied. Conclusion: Laparoscopic repair of genital prolapse without mesh offers less than optimal results, but with very few complications compared with repair using mesh. The indications for this operation should therefore be precise. 98 Is the Vagina Shortened in TLH Versus LAVH? Dulemba JF. North Texas Hospital, Denton, Texas Study Objective: To compare the length of the vaginal mucosa between a TLH and a LAVH. Design: A prospective study of 161 consecutive women undergoing a hysterectomy. Setting: A suburban southern Gynecologic private practice. Patients: One hundred sixty one women (ages 26-68) undergoing a LAVH from April 2005 to October 2007. Intervention: The distance between the incision on the cervix for the LAVH and the anterior fornix measured. The distance from the vaginal mucosal incision (the tissue dissected from the cervix to the anterior fornix varied from 0.75 to 4cm. The mean distance was 2.11cm. Measurements and Main Results: Shortened vagina syndrome has been reported as a complication of hysterectomy. When performing a LAVH, the vaginal mucosa is dissected from the cervix, and helps maintain vaginal length (in fact the length may be increased slightly). When a TLH is performed, the vaginal mucosa is dissected at the fornix. The average length of 2.11cm is a significiant shorter distance when compared to the average vaginal length of 10cm. Conclusion: Performing a TLH may be putting patients at risk for the shortened vagina syndrome. Further studies comparing the procedures, and longer follow-up may be needed. 99 Miscellaneous Uterine Malignancies Encountered During Hysteroscopic Surgery Edris F, Abu-Rafea B, Vilos G. The University of Western Ontario, London, Ontario, Canada; London, Canada Study Objective: To estimate the incidence of miscellaneous uterine malignancies, other than endometrial adenocarcinoma, encountered during routine resectoscopic surgery in women with abnormal uterine bleeding (AUB), and to determine the effect of hysteroscopic surgery on their long-term clinical outcome. Design: Prospective cohort study (Canadian Task Force Classification II-3). Setting: University-affiliated teaching hospital. Patients: From January 1990 through April 2007, the principal author (GAV) performed primary hysteroscopic surgery at St. Joseph’s Health Care, in 3641 women with AUB.