Unilateral mesh pectopexy in a patient with severe pelvic adhesions

The human body is a complex structure where organs are held in place by a network of tissues and ligaments. When these supports weaken, the pelvic organs can slip out of their proper position, a condition known as pelvic organ prolapse. This issue is common and can significantly disrupt daily life, causing discomfort and physical limitations. For decades, surgeons have relied on a standard procedure to fix this problem: a laparoscopic sacrocolpopexy. In this operation, a surgeon uses a small, synthetic mesh to lift the pelvic organs back into place and anchors the other end of the mesh to the sacral promontory, a sturdy bony ridge at the base of the spine. This method is widely considered the gold standard because it is highly effective. However, this standard approach requires clear access to the lower abdomen and the spine. For patients who have undergone multiple abdominal surgeries in the past, the internal landscape is often altered by scar tissue. These adhesions, or bands of sticky tissue, can bind organs together and cover the surgical landmarks, making the standard procedure dangerous or impossible to perform safely.

In a recent case report from Showa Medical University, a team of surgeons addressed this specific challenge in a 54-year-old woman who had never given birth but had undergone four previous abdominal surgeries. She presented with stage II pelvic organ prolapse, a moderate degree of displacement. The medical team initially planned the standard surgery to reposition her organs. However, once inside the abdomen, they encountered dense, extensive adhesions that made it unsafe to expose the sacral promontory. Furthermore, the scar tissue on the right side of her pelvis was so severe that it prevented the surgeons from safely attaching a mesh to that side. Faced with these obstacles, the surgeons adapted their approach. Instead of the standard two-sided attachment, they performed a unilateral mesh pectopexy. In this modified procedure, they anchored a polypropylene mesh to the left Cooper's ligament, a strong band of tissue in the pelvic floor, and secured the other end to the cervical stump under moderate tension. This single-sided fixation was chosen because the right side was too adherent to operate on, and the left side provided a safe, accessible anchor point.

The outcome of this adaptation was successful. At a follow-up appointment twelve months after the surgery, the patient reported no symptoms. There was no sign that the prolapse had returned, and she experienced no complications related to the mesh. The surgeons observed that this unilateral approach provided adequate support to the pelvic organs while avoiding the risks associated with trying to dissect through the heavy scar tissue. The case suggests that when extensive adhesions prevent the use of the standard two-sided technique or the standard anchor point, a single-sided attachment to a different ligament can be a viable and safe alternative. This method allows surgeons to restore support without forcing a procedure that could damage surrounding structures. By using only one side, the surgery also minimizes the tension on the pelvic floor, potentially preserving more natural movement. The report concludes that for patients with severe internal scarring, this modified technique offers a practical solution where conventional methods cannot be used, ensuring that effective treatment remains available even in complex cases.