Pectopexy for Patients with Contraindications to Sacrocolpopexy: A Video Case Series

INTRODUCTION: Sacrocolpopexy is the gold standard for apical prolapse repair, but some patients have contraindications such as extensive pelvic adhesions, severe diverticulosis, or anomalous sacral vasculature. Pectopexy is a newer mesh suspension technique that involves a hammock-like suspension of the uterus or vaginal apex from the lateral pectineal ligaments. Randomized trials in Europe and Asia as well as an observational study in North America have demonstrated results similar to those of sacrocolpopexy. OBJECTIVE: To demonstrate how the novel prolapse repair known as pectopexy can be used in certain patients with contraindications to sacrocolpopexy. METHODS: Narrated surgical video is used to show how pectopexy was employed in three patients with contraindications to sacrocolpopexy: case 1: a patient with an intact uterus and severe intraabdominal adhesive disease; case 2: a patient with post-hysterectomy prolapse and severe diverticulosis; case 3: a patient in whom a robotic sacrocolpopexy was aborted due to the presence of an anomalous vessel crossing the sacral promontory. RESULTS: All three patients achieved complete resolution of prolapse symptoms, and there were no significant complications. CONCLUSIONS: For patients who have certain contraindications to sacrocolpopexy, pectopexy can be employed to yield similar results.