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

## TL;DR

This paper presents two successful cases of robot-assisted sacrocolpopexy in patients with a rare anatomical condition called persistent descending mesocolon.

## Contribution

The novel approach of mesh fixation to the sacral promontory from the left side of the mesosigmoid is introduced for this specific anatomical challenge.

## Key findings

- Mesh fixation from the left side of the mesosigmoid allowed successful sacrocolpopexy in two patients with persistent descending mesocolon.
- The postoperative outcomes were uneventful, suggesting the approach is safe and feasible.
- Rightward displacement of the sigmoid colon can be effectively managed using this left-sided technique.

## Abstract

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.

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.

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.