Introduction: Vault prolapse, characterized by the descent of the vaginal apex following hysterectomy, affects a significant proportion of patients and carries a prevalence rate ranging from 0.2% to 43%1. Current clinical approaches for addressing apical defects vary widely, encompassing abdominal, laparoscopic, and robotic-assisted sacrocolpopexy, as well as vaginal fixation techniques such as sacrospinous or iliococcygeus suspensions2. 

Objectives and methods: This was a retrospective case review of 15 bilateral abdominal sacrocolpopexies undertaken at a tertiary center over 24 months. The primary objective of this study is to assess the clinical success and anatomical outcomes of bilateral abdominal sacrocolpopexy at a tertiary center in a developing country. A telephone conversation was carried out at 6 months and 12 months looking for subjective assessment of recurrence.

Results: A total of 15 bilateral sacrocolpopexies were undertaken using a standardized sacrocolpopexy mesh called Vault-Sacrum (VASA) mesh. These were done by the same surgeon and 7 were open (47% while 8 were laparoscopic. All save one reported a return of symptoms (recurrence) in the open group. This patient had a BMI of 42, and she had other co-morbidities in the way of diabetes and hypertension. 

Conclusion: This study confirms that sacrocolpopexy remains the gold standard for managing vault prolapse due to its superior anatomical and functional outcomes. 

Johnstone Shabaya Miheso MBChB, DFFP, FRCOG (London) is a Consultant Obstetrician and Gynaecologist and Urogynaecologist with over 25 years of international experience spanning East Africa, the United Kingdom, and New Zealand. He graduated from Moi University, Kenya, in 1999 before moving to the UK for specialist training. He attained his MRCOG in 2007 and his Certificate of Completion of Specialist Training (CCST) in 2011, alongside a subspecialty fellowship in Urogynaecology. Following a role as an NHS Consultant at Crosshouse University Hospital, Dr Miheso spent eight years at the Aga Khan University Hospital, Nairobi, as an Assistant Professor and Programme Director. There, he established a specialized Urogynaecology department, training residents and nursing staff. Holding advanced diplomas from the RCOG and the University of Kiel, Germany, he became a Fellow of the Royal College (FRCOG) in 2019. He is a published author and peer reviewer for JOGECA.