Mesh Fixation to the Sacral Promontory From the Left Side of the Mesosigmoid: Two Cases of Robot-Assisted Sacrocolpopexy for Persistent Descending Mesocolon

Introduction

Persistent descending mesocolon is a congenital fixation abnormality where the left-sided colon deviates medially. When significantly displaced to the right, it may affect sacrocolpopexy. We report two cases of persistent descending mesocolon in which robot-assisted sacrocolpopexy was successfully performed with mesh fixation to the sacral promontory from the left side of the mesosigmoid.

Case Presentation

Two patients with pelvic organ prolapse underwent robot-assisted sacrocolpopexy. In both cases, the sigmoid colon was displaced to the right, making exposure of the sacral promontory from the right side of the mesosigmoid challenging. Therefore, the sacral promontory was exposed and mesh fixed from the left side of the mesosigmoid. The postoperative course was uneventful.

Conclusion

When the sigmoid colon is displaced rightward due to persistent descending mesocolon, sacral promontory fixation from the left mesosigmoid may be a safe, feasible option.