Laparoscopic application of Mesh in the treatment of pelvic floor disorders: a review of the literature

Abstract

The use of laparoscopically introduced mesh was adopted in order to correct all pelvic floor disorders, however today laparoscopic prostheses tend to be used increasingly for patients with prevailing apical prolapse: III and IV degree hysterocele and/or post-hysterectomy prolapse of the vaginal vault. The co-existence of other defects, for example cystocele and/or III degree rectocele, urethral hypermobility and/or urethrocele with associated urinary incontinence and above all the presence of these defects in an isolated form, usually indicates a vaginal surgical approach. Therefore the operation in which the application of laparoscopically introduced prostheses prevails is indirect promontory colpopexy (or sacrocolpopexy) and hysterosacropexy. At the beginning of the ‘90s, Dorsey [1] and Nezhat [2] were the first authors to describe laparoscopic sacral colpopexy, with dissection of the vagina anterior to the bladder and posterior to the rectum, in order to apply the mesh to the anterior and posterior wall of the vagina. The method then became widely used and was perfected, and it tended increasingly to be performed together with the laparotomic approach. Wattiez [3] even claims that the laparoscopic approach is better than the vaginal and/or laparotomic approach for the treatment and/or prevention, not only of apical genital prolapse, but of the whole range of pelvic floor disorders. Therefore, considering the growing importance of the laparoscopic prosthetic correction of apical defects, the authors, on the basis of a revision of the literature, describe the following aspects: rational of the technique, type of prosthetic materials used, controversies regarding the method of application of the mesh and whether or not hysterectomy is also to be performed..........