SACROSPINOUS LIGAMENT FIXATION FOR APICAL PROLAPSE REPAIR COMPARED TO OTHER VAGINAL PROCEDURES

Olivia Ionescu,Nahedd Saba,Gabriel Banceanu,Nicolae Bacalbasa

doi:10.37897/rjmp.2017.4.6

Abstract

The vaginal procedures for uterine prolapse and/or vaginal vault prolapse are based on the attachment of the vaginal apex at the sacrospinous ligament (SL), the uterosacral ligaments (USL) or the iliococcygeus fascia. The fixation at the sacrospinous ligament (SSL) known as sacrospinous ligament fixation (SSLF) is the most studied and performed method for apical prolapse repair. Generally, it is preferred for cases of vaginal vault prolapse post-hysterectomy compared with the suspension at the uterosacral ligament (USLS) that it is usually performed at the time of uterus removal. Due to its associated high rate of recurrence, especially prolapse of the anterior vaginal wall, SSLS has been progressively abandoned in the favor of other modern vaginal procedures such as the Saba Nahedd technique. However, the frequently reported esh associated complications, there are still logical reasons to continue the performance and development of the SSLF technique. In order to assess the current frequency of application and effectiveness of SSLF we have made a review on the recently published literature on the SSLF technique focusing on the rate of success and recurrence, the peri-and postoperative complications, its impact on the daily activities and sexual function. We have selected systhematic reviews, follow-up and retrospective studies as well as metanalyses which have been published in the last 10 years in the german or english language. The aim of this article is to describe the SSLF technique and its advantages in the treatment of sever uterovaginal or vaginal vault prolapse.

Highlights

Due to its associated high rate of recurrence, especially prolapse of the anterior vaginal wall, SSLS has been progressively abandoned in the favor of other modern vaginal procedures such as the Saba Nahedd technique
The aim of this article is to present the technique of the sacrospinous ligament fixation (SSLF) with regard to its efficiency, peri- and postoperative complications, recurrence rate compared with other vaginal procedures
These are passed through the vaginal apex and the sutures passed through the sacrospinous ligament (SSL) are tied

Summary

Techniques description

After assessing the length of the vagina, the SSL and the coccygeus muscle will be identified and the point where the vagina or uterus will be anchored to the SSL will be established [10]. The SSL can be palpated medially to the ischial spine until the distal part of the sacrum once the right pararectal space is opened. Different devices can be used to place sutures through the SSL almost 2 cm medial from the ischial spine [11]. The suture consists of a 1,5 m loop of non-absorbable monofilament polydioxanone so that every loop has two sutures These are passed through the vaginal apex and the sutures passed through the SSL are tied. One of the popular modified SSLF technique is the Michigan technique in which the vaginal walls are brought together to the SSL [12]. The operator will place the delayed absorbable sutures through the SSL, the anterior and posterior vaginal wall ad tie them on the SSL [11,12]. The modified Miching method appears to have good success and satisfaction rates, approximately 76% of patients reporting to have a better life quality after SSLF with the Michigan technique [13]

Complications and outcomes

Findings

CONCLUSIONS