Correction of the Vault Prolapse Vaginally through Apical Sling with Fixation in the Sacrospinous Ligament with a New Device

Abstract

Study Objective Evaluate the efficacy and safety of the technique for correction of the vaginal vault prolapse through the use of Apical Sling with fixation in sacrospinous ligament (AS-FSL) using a new device (SPLENTIS). Design We did a retrospective cohort and the range of follow-up was 6-42 months. Setting Patient at lithotomy position and asseptic procedures performed as usual for vaginal surgery. Patients or Participants In the national health system, our center is positionated as a reference for surgical gynecological cases receiving patients referred from basic health units on a random basis. We included the patients that we received in the period (2016-2019) that needed vault prolapse correction. A total of 20 patients were included at the study. Interventions Was performed the dissection of the vault prolapse and paravaginal spaces until the sacrospinous ligament. With the rod of the AS-FSL, the harpoons are fixed 0.5 cm from the ischial spine. Through the harpoon wires, a specific sling for vault prolapse was placed and the mucosa was closed with simple suture. Measurements and Main Results There was only one case of relapse, and with the exception of this case, all patients assessed would indicate surgery to a friend (95%) with the average satisfaction via Likert Scale of 9.25. There were no tape extrusions (100%) or complications requiring readmission (100%). Cure of 45% of the cases of urinary incontinence associated, only one case reporting sexual life worsening, only one case of defect appearance during Valsalva maneuver, total vaginal length of > 6cm at 50% of the cases. Conclusion It has been demonstrated, within the limitations of the small number of patients and single treatment center, that surgical repair of the vault prolapse can be performed vaginally through the AS-FSL safely with satisfactory objective and subjective results and reduced length of stay.