Meshless sacrocolpopexy for post-hysterectomy vaginal vault prolapse: vascularized flap technique. Case report. Video case**

The absence of rigid fixation point, tissue atrophy and multi-compartment defects make post-hysterectomy vaginal vault prolapse a real challenge for the surgeon. The gold standard for treatment of post-hysterectomy vaginal vault prolapse is sacrocolpopexy. Unfortunately, this approach does not allow to perform reliable long-term meshless reconstruction in the anterior and posterior compartments. Moreover, the use of a mesh is associated with the risk of erosion. Aim – to show the possibility of replacing a standard mesh with a vaginal flap during laparoscopic sacrocolpopexy. A 60-year-old patient with post-hysterectomy prolapse stage III underwent meshless laparoscopic vaginal-assisted sacrocolpopexy. The duration of the surgery was 105 min (35 min vaginal part and 70 min LS part). Intraoperative blood loss was 55 ml. No intraoperative and early postoperative complications were recorded. According to the ultrasound postvoiding residual was 35 ml, hematomas in the operation area were not visualized. During the exam in 12 months after the surgery, no signs of POP (Aa -2 Ba -3 C -8 Ap -3 Bp -3 tvl 9 gh 4 pb 3), erosion and any pain were detected. The results of the questionnaires were as follows: PFDI-20 – 22,92, PISQ-12 – 31 and ICIQ-SF – 1. According to ultrasound the volume of residual urine was 0 ml. This approach allows to eliminate completely the risk of erosion and create a unified plastic natural construction from the vaginal cuff and tailored flap.