Abstract
Sacrospinous ligament fixation (SSLF) is one of the most utilized surgeries in the management of pelvic organ prolapse (POP). We conducted a large-series study of SSLF in a tertiary center by an experienced urogynecologic team. The 453 women with POP who underwent SSLF at National Taiwan University Hospital in the period from 2002 to 2015 are reviewed. All patients received unilateral SSLF with Veronikis ligature carrier. Concomitant anterior colporrhaphy was performed in 75.3% of the cases and posterior colporrhaphy in 78.6%. The mean operation time was 92.3 ± 31.5 minutes. The intraoperative blood loss was 92.3 ± 91.4 ml. The objective cure rate was 82.5%, and 79 (17.5%) patients recurred. The Kaplan-Meier recurrence-free analysis showed a steep decline during the first postoperative year, and the yearly number of recurrent patients decreased as the follow-up period proceeded. A comparison of the site of recurrence found that anterior compartment prolapse was the most common with 57 cases (12.6%). Paravaginal repair is frequently implemented in the management of recurrent anterior prolapse. In conclusion, SSLF provides excellent support to the apex compartment, and our long-term results show that the anterior compartment is the most commonly encountered type of POP recurrence.
Highlights
Pelvic organ prolapse (POP) occurs when the female bladder, uterus, vaginal stump, small bowels and/or large bowels descend into the vagina
Cruikshank et al published a 695-patient series and followed up to 16 years, their patients were divided into three groups according to the evolution of surgical methods
The largest group (Group C) showed that the 301 patients who underwent SSLF and 12 different kinds of adjunct repairs had a mean follow-up of 3.6 year[16]
Summary
Pelvic organ prolapse (POP) occurs when the female bladder, uterus, vaginal stump, small bowels and/or large bowels descend into the vagina. Sacrospinous ligament fixation (SSLF) is one of the most utilized surgical procedures in the management of pelvic organ prolapse (POP). In 2019, the U.S Food and Drug Administration (FDA) ordered all manufacturers to stop selling and distributing surgical mesh intended for transvaginal repair of anterior compartment prolapse because of safety issues. This triggered an alarm against transvaginal mesh use and has put native tissue repair, including SSLF, once again under the spotlight. Few suggestions have been proposed to lessen recurrence after POP surgery We conducted this retrospective, large-series study to obtain 2–10-year (mean of 5 years) follow-up outcomes after SSLF in a tertiary center by an experienced urogynecologic team. We aim to describe the long-term results, defining the anatomic failure sites, and develop strategies to manage recurrence
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