Sacrohysteropexy with synthetic mesh in Aba, South-Eastern Nigeria: A report of three cases and review of the literature

The surgical treatment of uterovaginal prolapse in women who wish to preserve their uteri for fertility presents a challenge to a gynecologist. This is particularly more challenging in Nigeria and the rest of Africa where there is not only a strong cultural aversion to hysterectomy but women also prefer large family size and male babies. This underscores the need for fertility friendly, uterus-preserving procedures. Three young women under the age of 40 presented with uterovaginal prolapse. They were of low parity and wanted to preserve their uteri for future reproductive function. They had open abdominal suspension of their uteri to the sacrum using a synthetic polypropylene mesh. A pus-string suture was also used to obliterate their pouch of Douglas to prevent future enterocele. Pelvic anatomy was restored and normal vaginal axis was achieved. They had uneventful post-operative period. In resource-limited settings, open abdominal (rather than laparoscopic) sacrohysteropexy with synthetic mesh is an effective and safe alternative to Manchester operation and other vaginal procedures in women who desire to preserve the uterus for future reproductive function.