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Laparoscopic sacrocolpopexy (LSC) is becoming more popular for the treatment of pelvic organ prolapse since the Food and Drug Administration's safety concerns over transvaginal mesh surgery in 2008 and 2011. However, the standard procedure of LSC varies among facilities,1 and especially the use of posterior mesh remains controversial2 in contrast to the essential role of the anterior mesh. From the point of safety improvement of LSC, the Posterior mesh, possibly causing severe complications such as rectal mesh expositions,3 is desirable to avoid if its efficacy of LSC could be changed. Therefore, laparoscopic posterior colporrhaphy with a barbed suture instead of using a posterior mesh has been developed. We here report the case of a 66-year-old woman, gravida 2 para 2, diagnosed with pelvic organ prolapse grade 3. The preoperative POP-Q showed the point at 3 cm away from genital hiatus on the anterior vaginal wall (Aa), the most descending position between Aa and C on the anterior vaginal wall (Ba), cervix or cuff (C), genital hiatus (Gh), perineal body (pb), total vaginal length (TVL), the point at 3 cm away from genital hiatus on the posterior vaginal wall (Ap), the most descending position between Ap and D on the posterior vaginal wall (Bp), and posterior fornix (D) were þ2.5, þ3, 2, 4, 3, 6, 2, 2, and 4, independently. For cystocele, LSC with an anterior mesh was performed and laparoscopic posterior colporrhaphy using a unidirectional barbed suture instead of a posterior mesh was performed to repair the rectovaginal fascial defect.

Laparoscopic posterior colporrhaphy using a unidirectional barbed suture for risk hedging laparoscopic sacrocolpopexy