Cite as: Svabik K, Masata J, Hubka P, Martan A. Failed laparoscopic sacrohysteropexy in a patient with total uterine and vaginal prolapse after delivery with major pelvic floor defect. Actual Gyn. 2016;8:61-62 Study objective: The recurrence rate of pelvic floor surgery regardless of its type is higher in the group of patients with pelvic floor muscle injury (1). Data from randomized studies show that using native tissue repair in this group of patients poses a risk for anatomical recurrence of

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... more than 60% (2). We deal with the appropriate choice for primary treatment and, in case of failure, the choice of secondary treatment. In recurrent prolapse patients the investigation should not only describe the current situation but also, if possible, ascertain the failed effect of previous surgery. This is especially important in patients with failed mesh surgery. The polypropylens implants are hyperechogenic, which means they are easily visible as white objects or lines during the ultrasound examination. Imaging adds accuracy and confirmation to the performed clinical examination, because our examination skills are limited, focusing on surface anatomy, rather than true structural abnormalities (3). Design: Longitudinal follow-up of patients with major pel-vic floor trauma after failed laparoscopic sacrocolpopexy for uterine and vaginal prolapse. We present a second look laparoscopy after failed sacrohysteropexy. We also documented the location of the abdominal mesh by ultrasound, and during the re-operation we documented the localization of abdominal mesh from the vaginal approach, additional documentation from other similar case has been added. Settings: It is a unique follow-up of a 36-year-old woman (BMI 20.4) with the large symptomatic prolapse after second delivery. POPQ (Pelvic Organ Prolapse Quantifica-tion)-Aa +3, Ba +8, C +8, Ap +3, Bp +8, Gh 7, Pb 4. She suffered major pelvic floor trauma during delivery, with bilateral avulsion and levator hiatus size 46 cm 2 on Val-salva. She doesn't want the uterus to be removed. We document by ultrasound the preoperative situation, and laparoscopical sacrohysteropexy was suggested as a first choice of treatment. Sixth weeks after the procedure she was asymptomatic with POPQ Aa 0, Ba +1, C +1, Ap-3. Three month after the primary procedure it became obvious that there was a failure associated with symptoms of prolapse and POPQ-Aa +3, Ba +5, C +5, Ap-2, Bp-2. We examined the patient with ultrasound to ascertain the position of the mesh. The mesh was attached to the cervix and spread on the anterior and posterior wall. On the anterior wall it did not reach the bladder neck, which means that it didn't reach all prolapsed part of the vagina (4). The patient requested further treatment, and we had to suggest a secondary procedure. As second line treatment the anterior and posterior mesh was chosen. The rationale behind this decision was the need to better support the anterior compartment; in our experience the currently available anterior meshes with sacrospinous fixation do not provide sufficient apical support in such a large prolapse and uterus on site. During the second procedure we provided second look laparoscopy to establish whether there was some explanation for the previous