Abstract

BackgroundSacrospinous ligament fixation (SSLF) is a widely used vaginal procedure for correction of apical vaginal prolapse. The objective of this study was to evaluate subjective and objective outcomes of SSLF performed in a fast-track setting.MethodsThis was a prospective cohort study of sacrospinous ligament fixation performed using local anesthesia and light sedation in a fast-track setting at Aarhus University Hospital between April 2016 and December 2017. Objective signs of prolapse were assessed by gynecological examination preoperatively and at 6 months after the operation. Subjective symptoms were evaluated by questionnaires (the Pelvic Floor Distress Inventory (PFDI 20), and the Patient Global Impression of Improvement (PGI-I) supplemented with individual questions from the ICIQ-vaginal Symptoms (ICIQ-VS) and Sexual Questionnaire-IR (PISQ-12) questionnaires).ResultsOne hundred and three women with a median age of 65 (36–84) years were included. Previous hysterectomy had been performed in 40% of the women, and 43% had a history of previous prolapse operations. At follow-up, 75% of the women had apical descent less than stage 2. However, 18% had anterior vaginal wall prolapse beyond the hymen, and 25% had recurrence of the apical prolapse stage 2 or more and were offered reoperation. Bladder and anal symptoms improved in most women after the operation, and the number of women reporting dyspareunia was halved. In the overall assessment by Patient Global Impression of Improvement (PGI-I) questionnaire, 76% reported improvement. No serious operative complications were reported, and 81% of the patients were discharged on the day of the surgery.ConclusionIn this cohort with a high rate of previous prolapse surgery, sacrospinous ligament fixation performed in a fast-track setting showed subjective and objective results comparable to the results of apical native tissue repair reported in the literature. Furthermore, the complication rate was low.Trial registration This study was notified to The Central Denmark Region Committees on Health Research Ethics on July 7, 2015, and was approved by The Danish Data Protection Agency (1-16-02-442-15). All methods were performed in accordance with the relevant guidelines and regulations. An informed consent for participation in the study and acceptance of using data for scientific purposes and publication was signed by all patients.

Highlights

  • Sacrospinous ligament fixation (SSLF) is a widely used vaginal procedure for correction of apical vagi‐ nal prolapse

  • In this cohort with a high rate of previous prolapse surgery, sacrospinous ligament fixation performed in a fast-track setting showed subjective and objective results comparable to the results of apical native tissue repair reported in the literature

  • The use of less invasive surgical techniques, suture delivery devices and local anesthesia with sedation, has made it possible to perform sacrospinous ligament fixation (SSLF) as a fast-track procedure, with the patient being discharged on the day of the operation [4]

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Summary

Introduction

Sacrospinous ligament fixation (SSLF) is a widely used vaginal procedure for correction of apical vagi‐ nal prolapse. Surgical correction of symptomatic vaginal prolapse is performed in 12% of all women by the age of 80 [1]. The sacrospinous ligament fixation (SSLF), developed by Richter in 1958 [2], is one of the most widely used vaginal. While anterior vaginal wall prolapse is the most common site of prolapse, loss of apical support is usually present in women with prolapse that extends beyond the hymen [3]. The use of less invasive surgical techniques, suture delivery devices and local anesthesia with sedation, has made it possible to perform SSLF as a fast-track procedure, with the patient being discharged on the day of the operation [4]

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