Vaginal Sacrospinous Ligament Fixation Research Articles

Complications during Vaginal Sacrospinous Fixation along with McCall Culdoplasty in Stage III and IV POP

In Bangladesh, about half a million women are suffering from stage III or IV pelvic organ prolapse (POP). With traditional surgical methods, there is a chance of recurrence, especially of apical prolapse. Sacrospinous fixation (SSF) along with MacCall Culdoplasty during vaginal hysterectomy can reduce this recurrence rate enormously. This study was designed to identify, manage as well as to prevent per-/post-operative complications during SSF. The study period was from August 2017 to December 2021 at Kumudini Women’s Medical College and Hospital, Bangladesh. Total 335 stage III and IV utero-vaginal prolapse cases were included in this study. The surgeries performed were vaginal hysterectomy followed by modified McCall Culdoplasty and right-sided vaginal sacrospinous ligament fixation (SSF) along with anterior and posterior fascial closure and perineorrhaphy. A standard data collection sheet was used to record the information. Per-operatively, main complications were hemorrhage (3.57%) due to vessel injury and rectal injury (0.90%). The immediate early postoperative complication was buttock pain (24%). Of these, in 97.53% cases, pain subsided within 6 weeks with analgesic and counselling. Only one patient had recurrence of apical prolapse within 1st week of operation. It should be concluded that with proper knowledge of anatomy and careful surgical technique, most of the complications can be avoided. Bangladesh J Obstet Gynaecol, 2022; Vol. 37(2): 90-97

Laparoscopic Pectopexy versus Vaginal Sacrospinous Ligament Fixation in the Treatment of Apical Prolapse.

To compare the follow-up results of a sacrospinous ligament fixation (SSLF) technique for laparoscopic bilateral fixation of the vagina to the iliopectineal ligament via a PVDF-mesh (laparoscopic pectopexy technique, LP) in terms of cure rate and postoperative complications rate. This prospective study included 160 patients diagnosed with pelvic organ prolapse stage II-IV according to the POP-Q system. Eighty-two patients (51.25%) underwent vaginal sacrospinous ligament fixation and seventy-eight patients (48.75%) underwent the laparoscopic pectopexy procedure. The cure rate was high in both groups, 95.12% of the patients (78 out of 82) in the SSLF group and 93.59% of the patients (73 out of 78) in the LP group were cured post surgery, leading to an overall cure rate of 151 out of 160 patients. Pelvic pain was present in 5.00% of all patients, but was notably more frequent in the SSLF group (7, 8.54%) than in the LP group (1, 1.28%). Dyspareunia occurred in 4.37% of all patients, slightly more frequently in the SSLF group (6, 7.32%) than the LP group (1, 1.28%), but without significant difference. The laparoscopic pectopexy procedure has comparably positive follow-up results with the conventional sacrospinous ligament fixation procedure. Both SSLF and LP are effective in the treatment of pelvic organ prolapse, with favorable anatomical and subjective results, a high cure rate and low rates of serious postoperative complications.

Comparison of Laparoscopic Sacrocolpopexy and Vaginal Sacrospinous Ligament Fixation Techniques Applied Concomitantly in Patients Undergoing Vaginal or Laparoscopic Hysterectomy for Uterovaginal Pelvic Prolapse

Comparison of Laparoscopic Sacrocolpopexy and Vaginal Sacrospinous Ligament Fixation Techniques Applied Concomitantly in Patients Undergoing Vaginal or Laparoscopic Hysterectomy for Uterovaginal Pelvic Prolapse

Comparing Laparoscopic Sacrocolpopexy with Vaginal Sacrospinous Ligament Fixation in the Treatment of Vaginal Apical Prolapse; the First Randomized Clinical Trial: A pilot study.

To compare two methods of laparoscopic sacrocolpopexy (LSCP) and sacrospinous ligament fixation (SSLF) in terms of efficacy and safety in the treatment of vaginal apical prolapse. This prospective, randomized controlled clinical trial was conducted on 32 patients with symptomatic vaginal apical prolapse, referred to the female urology clinic of Kerman University, Iran, during 2018-2019. The patients were re-examined at 12 months after surgery. Objective success was recorded using Pelvic Organ Prolapse Quantification (POP-Q) classification as primary outcome. The subjective success of the methods was determined by the quality-of-life parameters, based on Pelvic Floor Impact Questionnaire (PFIQ-7), Pelvic Floor Distress Inventory (PFDI-20), and Organ Prolapse/Urinary Incontinence Sexual Questionnaire (PISQ-12) scores as secondary outcomes. Moreover, complications were recorded in both groups. The amount of intraoperative bleeding was significantly higher in the SSLF group, compared to the LSCP group (P = 0.01). Persistent pain was observed in two (12%) patients in the LSCP group and five (31%) patients in the SSLF group (P = 0.2). The decrease in the total PFIQ-7 score was in favor of the LSCP group but not statistically significant (p = 0.06). The LSCP group showed bigger improvement in vaginal (p = 0.04) and bowel (p = 0.03) scores. The results of the PISQ-12 and PFDI-20 questionnaires as well as POP-Q examination were not different in two groups. Although the surgical methods of LSCP and SSLF can be equally effective in the treatment of apical prolapse, LSCP appears to be superior to SSLF regarding less bleeding.

Vaginal sacrospinous ligament fixation versus abdominal sacrocolpopexy for the treatment of vaginal cuff prolapse: A retrospective study

Vaginal sacrospinous ligament fixation versus abdominal sacrocolpopexy for the treatment of vaginal cuff prolapse: A retrospective study

Medium-term outcomes of laparoscopic sacrocolpopexy or sacrohysteropexy versus vaginal sacrospinous ligament fixationfor middle compartment prolapse.

To compare laparoscopic sacrocolpopexy (LSC) or sacrohysteropexy (LSH) with vaginal sacrospinous ligament fixation (VSSLF) for middle compartment pelvic organ prolapse (POP). Data were retrospectively reviewed from patients with POP (stage 3 or worse) who underwent LSC, LSH, or VSSLF at a center in Shanghai between January 2009 and March 2014. POP quantification (POP-Q) and Pelvic Floor Distress Inventory scores were compared at the 2-year follow-up. Data were available for the 2-year follow-up for 102 LSC, 11 LSH, and 94 VSSLF procedures. Compared with patients who had undergone VSSLF, those who had undergone LSC/LSH had better POP-Q C values (P<0.001), longer total vaginal length (TVL) (P<0.001), and lower Aa and Ba scores (P=0.003 and P=0.002, respectively). Apical compartment and overall success rates of LSC/LSH and VSSLF did not differ significantly. Quality of life was improved in both groups (P<0.001). Both groups achieved symptomatic relief, although bowel and urinary functions were significantly improved only in the VSSLF group (P<0.001 for both). More patients in the LSC/LSH group were sexually active at 2years (P<0.001); improvement in sex life was similar between the groups. Although LSC/LSH achieved longer TVL, both groups achieved the same success rate and improvement in quality of life. Specifically, VSSLF yielded a significant improvement in bowel and urinary function.

A new reusable suturing device for vaginal sacrospinous fixation: feasibility and safety study

ObjectiveWe sought to evaluate the feasibility and safety of SeraPro® (Serag-Wiessner, Germany), an innovative reusable suturing device for vaginal sacrospinous ligament fixation. Study designWe reviewed the electronic files of all women who underwent vaginal sacrospinous ligament fixation with SeraPro® for apical pelvic floor prolapse, with or without mesh implant, performed between April 2013 and September 2013. Preoperative demographic, clinical, operative and postoperative data were analyzed. The women were interviewed and examined before the procedure, at one month postoperatively and tele-interviewed again after three months. ResultsOverall, 88 women were included in the study. Fifty-three patients (60.2%) had additional anterior mesh placement, 42 (47.7%) had posterior mesh, and 16 (18.2%) had both anterior and posterior mesh insertion. Five patients (5.7%) had no mesh implant. Sixteen patients (18.2%) had an additional mid-urethral sling for the treatment of stress urinary incontinence. No significant technical difficulty was recorded at the procedures. None of the patients had significant long-term morbidity. The mean 3-month follow-up demonstrated significant anatomical and functional improvement. ConclusionsThe SeraPro® reusable suturing device is a feasible and safe tool for sacrospinous ligament fixation during vaginal pelvic floor reconstruction.

Comparison of outcomes after vaginal reconstruction surgery between elderly and younger women

ObjectiveThe objective of this study was to estimate the association of vaginal sacrospinous ligament fixation with anterior-transobturator mesh repair surgery for advanced pelvic organ prolapse in patients of two different age groups. Materials and methodsVaginal sacrospinous ligament fixation with anterior mesh repair as primary prolapse surgery was performed on 225 patients with advanced pelvic organ prolapse (POP-Q ≥ stage III). POP-Q < stage II was objective cure and subjective cure was determined according to feedback of POPDI-6 (Questions 2 and 3). Patients provided responses to UDI-6, IIQ-7, POPDI-6, and PISQ-12 pre- and postsurgery. Outcome measures were observed in cohorts of two age groups (<75 years and ≥75 years). ResultsPostoperative data of 217 patients were available. The cumulative objective cure rates were 93.0% and 92.5% for patients aged ≥75 years and <75 years, respectively, with mean follow-up of 33.93 ± 18.52 months and 36.44 ± 19.34 months respectively. The UDI-6, IIQ-7, POPDI-6, and PISQ-12 scores within each of the two age groups improved significantly after surgery. Comparatively, the POPDI-6 score was better whereas the PISQ-12 score was poorer among patients aged ≥75 years. Older women had significantly more preoperative comorbidities. The operative time, perioperative complications, and length of hospital stay showed no difference between the two groups. The intraoperative blood loss was significantly less in the older group and neither group had mortality. ConclusionThis study showed that adequately optimized older patients undergoing pelvic organ prolapse surgery experienced the same anatomical outcomes, comparable improved quality of life, morbidity, and mortality as their counterparts of younger age.

The water separator rectum guided vaginal sacral spine ligament fixation treatment for pelvic organ prolapse

Objective To explore the clinical efficacy and surgical techniques of vaginal sacrospinous ligament fixation,which was used for treatment of uterine prolapse and vaginal prolapse of the top.Methods 25 patients with uterine prolapse and vaginal vault prolapse were treated with VSSLF,and its feasibility and effiency was analyzed.Results All patients were successfully conducted the surgical indexing method based on POP-Q,25 cases of uterine prolapse,vaginal anterior and posterior wall prolapse and urinary incontinence and other symptoms all had been corrected.There was no intraoperative and postoperative bleeding or pelvic organ injury in surgry.25 patients recovered well after operation,postoperative morbidity,not observed in other complications associated with surgery.All the patients were followed up for 24 months,patients'cervix 4 cm from the hymen edge,related symptoms disappeared or improved significantly.Conclusion Vaginal sacrospinous ligament fixation is a safe,simple,effective and minimally invasive surgery for uterine prolapse and vaginal prolapse of the top. Key words: uterine prolapse and vaginal prolapse of the top; Water separation; Anal guide ; Vaginal sacrospinous ligament fixation

Surgical outcomes of anterior trans-obturator mesh and vaginal sacrospinous ligament fixation for severe pelvic organ prolapse in overweight and obese Asian women

The aim of this study is to compare the outcomes of patients who underwent surgical repair of advanced pelvic organ prolapse amongst with normal-weight, overweight and obese Asian women. Vaginal sacrospinous ligament fixation with anterior mesh repair as primary surgery was performed on 200 patients with advanced pelvic organ prolapse (POP-Q ≥ stage III). POP-Q < stage II was objective cure and subjective cure was based on POPDI-6 (questions 2 and 3). Patients completed the UDI-6, IIQ-7, POPDI-6, and PISQ-12 pre- and post-surgery. Outcome measures were observed in three categories of Asian BMI (normal weight 18.5 to 23.0 kg/m(2), overweight >23.0 to 27.5 kg/m(2), and obese ≥ 27.5 kg/m(2)). Postoperative data were available for 195 patients. Objective cure for the normal-weight, overweight, and obese were 93.0%, 92.5% and 90.6% respectively with an overall mean follow-up of 35.69 ± 18.97 months. The subjective cure was no different. All categories improved significantly with regard to anatomical outcome, UDI-6, IIQ-7, POPDI-6, PISQ-12 after primary surgery (p < 0.05) and none had recurrence requiring further surgery. However, obese patients have significantly less improvement in POPDI-6 (p <0.037) and PISQ-12 (p <0.005) compared with normal weight. There were no differences with regard to perioperative complications and the vaginal mesh exposure rate was 4.1%. There was no difference in the objective outcome of sacrospinous ligament fixation with anterior mesh repair surgery among the three Asian BMI categories; however, obese patients showed less improvement in POP symptoms and sexual function.

Technik der vaginalen sakrospinalen Fixation und Stellenwert im Vergleich zur Sakrokolpopexie und der vaginalen Netzeinlage

PURPOSE: Aim of the study was to examine the application and technique of vaginal sacrospinous ligament fixation (SLF) in the treatment of middle compartment defects compared to abdominal or laparoscopic sacrocolpopexy and vaginal repair with meshes among urogynaecological specialists in German-speaking countries. MATERIAL AND METHODS: An anonymised questionnaire was sent to all members of the AGUB requesting information about the number of surgical procedures performed for prolapse repair, the technique of SLF and its application in the differential treatment of women with prolapse in a defined clinical situation. RESULTS: A total of 212 members replied. On average, 35 SLF, 28 vaginal meshes, 10 abdominal and 7 laparoscopic sacrocolpopexies and 5 other operations were carried out to treat middle compartment defects. Departments with a high level of laparoscopic expertise performed significantly more laparoscopic sacrocolpopexies. SLF is most often performed unilaterally using late-absorbable sutures. The vagina is predominantly fixated subepithelially and knotted tightly on the sacrospinous ligament. Most surgeons prefer SLF in elderly patients. CONCLUSIONS: SLF with modifications is the preferred method of treatment for middle compartment prolapse. Surgeon with a lot of endoscopic experience carry out laparoscopic sacrocolpopexy procedures more often.

Is standardised vaginal sacrospinous ligament fixation a safe teaching procedure for residents?

Several modifications of sacrospinous ligament fixation (SLF) are described. This study presents a standardised SLF technique. Perioperative course and outcome are compared retrospectively after surgery is performed by experienced surgeons or by residents. Two hundred three SLF were analysed. Eight residents (LO) operated on 41 patients (5.1 ± 2.2). Six experienced surgeons (SO) operated on 162 patients (27.0 ± 25.7). Mean operating time was 67 ± 33 min. (LO 99 ± 45 min vs. SO 59 ± 22 min, p < 0.05). The overall morbidity rate was 7.8%. There was no significant difference regarding complications and outcomes between SO and LO. Operation time was longer but outcomes were identical, and morbidity rate was not increased in the group of resident surgeons. In comparison to literature, complication rate was low. SLF should be part of residency programmes.

Early prolapse of a neovagina created with self-dilatation and treated with sacrospinous ligament suspension in a patient with Mayer-Rokitansky-Küster-Hauser syndrome: a case report

To report a case of a patient who had an early prolapse of the neovagina, while using Frank's dilators method, that was successfully treated with sacrospinous ligament suspension. Case report. Tertiary-care university hospital. A 22-year-old woman with Mayer-Rokitansky-Küster-Hauser syndrome. Frank's vaginal dilators method. Vaginal elongation by self-dilatation. Early prolapse of the neovagina. Surgical repair with vaginal sacrospinous ligament suspension. A few months after the beginning of the treatment the patient had a prolapse of the neovagina. On pelvic examination, the total vaginal length was 5 cm with eversion of the vaginal apex 3 cm beyond the hymen with strain. Vaginal length was not satisfactory for the patient yet; therefore, the vaginal dilation program was continued to reach the prefixed vaginal length. Two months later the total vaginal length was 8 cm with eversion of the vaginal apex 6 cm beyond the hymen with strain. The patient underwent a sacrospinous ligament suspension. Twenty months after surgery, the patient had no symptoms and was highly satisfied with the result. Prolapse of a neovagina may occur early after conservative treatment. If the initial prefixed goal of vaginal length has not been reached when prolapse develops, the vaginal dilatation program may be continued. In our case vaginal sacrospinous ligament fixation was successful, with good anatomic and functional results.

Clinical analysis of 8 cases of uterine prolapse treating with vaginal sacrospinous ligament fixation procedures

Objective To investigate the feasibility and efficacy of vaginal sacrospinous ligament fixation (VSSLF) procedure which reserving uterus in the treatment of uterine prolapse. Methods 8 cases with uterine pro-lapse underwent VSSLF procedures which reserving uterus from July 2006 to December 2008. Those with incontinence d urine simultaneously underwent ventrofixation of the middle piece of the urethra and folding of the ligamentum pos-terius of the uretha and those with anterior or posterior vaginal wall prolapse underwent eolporrhaphia anterior-posteri-or. Results All patients successfully accomplished by VSSLF,without intraoperative or postoperative hemorrhage or organ injury. All patients' prolapse symptoms were relieved efficently according to the pelvic organs prolapse quantifi-cation(POP-Q). Patients were followed-up for 18 months after operation. 8 patients all recovered well without any complication related to the procedure after operation. Conclusion VSSLF is a simple,safe,effective and micro-inva-sire way for patients with uterine prolapse who want to reserve uterus. Key words: Reserving uterus; Vaginal; Sacrespinous ligament fixation; Uterine prolapse

Sacrospinous Ligament Fixation for Neovaginal Prolapse Prevention in Male-to-Female Surgery

To report our experiences of vaginal sacrospinous ligament fixation after vaginoplasty in male transsexual patients with the aim of preventing its postoperative prolapse. From August 1997 through November 2005, a total of 62 male transsexual patients (mean age 26 years, range 18 to 58) underwent sacrospinous ligament fixation for neovaginal prolapse during male-to-female sex reassignment surgery. The neovagina was created from a penile skin tube flap combined with a urethral flap. A deep and wide perineal cavity between the urethra, bladder, and rectum was created by dissection of the tendineous center and rectourethral muscle. The right pararectal space was opened by penetrating the right pararectal fascia (rectal pillar) and right ischial spine was palpated. Using the ischial spine as a prominent landmark, the sacrospinous ligament was palpated. Long-handled Deschamps ligature was used to pierce the ligament medially to the ischial spine. Vaginopexy to the sacrospinous ligament was performed, and the neovagina was placed deep in the perineal cavity. The median follow-up was 32 months (range 7 to 102). Sacrospinous ligament fixation was successfully performed in all patients. The mean vaginal length was 10.7 cm (range 9.5 to 16). Of the 62 patients, 42 (76%) were able to have normal sexual intercourse. The appearance of the neovagina was aesthetically acceptable in 52 patients. In 3 cases, a minor bulge of the anterior vaginal wall was easily resolved by simple excision. Vaginal sacrospinous fixation is feasible in male transsexuals for neovaginal prolapse prevention. However, extensive experience with male pelvic surgery is required to avoid possible complications.

Perioperative complications in abdominal sacrocolpopexy and vaginal sacrospinous ligament fixation procedures

This study assessed perioperative complications in abdominal sacrocolpopexy and vaginal sacrospinous ligament fixation procedures. Perioperative complications were defined as any complication occurring during surgery or the first 6 weeks postoperatively. Forty-five patients underwent abdominal procedures (20 sacrohysteropexy and 25 sacrocolpopexy) and 60 patients underwent vaginal sacrospinous fixation. Of the 105 patients, 13 had vaginal vault prolapse. In the abdominal group, one bladder injury, four hemorrhages, and three wound dehiscences occurred. In the vaginal group, one rectal injury and one postoperative vaginal vault infection occurred. Major and minor complications were more frequent in the abdominal group than in the vaginal group. Blood loss was not significantly different. The operating time and hospital stay in the abdominal group were significantly longer than in the vaginal group. In conclusion, abdominal sacrocolpopexy had a higher rate of perioperative complications and longer hospital stay and operating time.

Anatomic and functional assessment and risk factors of recurrent prolapse after vaginal sacrospinous fixation.

To identify risk factors in recurrence and to evaluate anatomic and functional results of vaginal sacrospinous ligament fixation and pelvic floor reconstruction for genital prolapse. One hundred and thirty-eight women underwent surgery for uterovaginal or vault prolapse. Follow-up data were available for 122 cases; 83% were examined and others were interviewed by telephone. The median (range) follow-up was 24 (1-141) months. Cox regression was used to identify risk factors associated with recurrence; uni- and multivariate regression was used to identify risk factors underlying postoperative infections because infections were found to be a risk factor of recurrence. Recurrence-free survival was estimated using the Kaplan-Meier method. Seven (5%) patients suffered severe cardiopulmonary complications including one postoperative death due to a pulmonary embolism. Twenty-six (21%) patients suffered a recurrence, 14 with cystocele. Ten patients with recurrence were symptomatic and six underwent a re-operation. The Cox regression model showed that vaginal cuff infection raised the odds ratio (OR) for recurrence to 6.13 [confidence interval (CI) 1.80-20.83] and urinary tract infection to 3.65 (CI 1.40-9.47). In both uni- and multivariate analysis, lack of intravenous antibiotic prophylaxis, age less than 73 years and vaginal ulcerations were statistically significant risk factors for postoperative infection. Eleven (33%) out of 33 sexually active women reported improvement and three (9%) complained of dyspareunia. Transvaginal sacrospinous ligament fixation with pelvic floor repair is an effective means of correcting both vault prolapse and uterine procidentia. Women who wish to preserve coital function will also benefit from this operation. Postoperative infection is an independent and most important individual risk factor underlying recurrence. Prophylactic antibiotics seem to be effective in reducing the rate of postoperative infections.

Subtotal Vaginal Hysterectomy with Sacrospinous Ligament Fixation for Treatment of Uterine Prolapse

We report a case of severe uterine prolapse in a 43-year-old woman. She had presented with menorrhagia, dyspareunia, and backache for several years, which were treated (unsuccessfully) with medication. Preoperative cervical biopsy and cytology were benign. Vaginal subtotal hysterectomy and sacrospinous ligament fixation were performed, and the endocervix and exocervix were then ablated electrosurgically to minimize the potential of vaginal bleeding and neoplastic transformation. It allowed for a normal social and sexual life for this patient.

Sacrospinous ligament fixation for massive genital prolapse in women aged over 80 years

Objective To assess the feasibility of vaginal sacrospinous ligament fixation for women over 80 years of age with massive vaginal vault or uterovaginal prolapse. Design Retrospective observational study with long term follow up. Setting Department of Obstetrics and Gynaecology, Tampere University Hospital, Finland. Sample and Methods The study group consisted of 25 women with a mean (SD) [range] age of 83 (3) [80-93] years: 13 had posthysterectomy vaginal vault prolapse and 12 had massive uterovaginal prolapse. All underwent vaginal sacrospinous ligament fixation with repair of pelvic floor relaxation. Women with uterovaginal prolapse also underwent concomitant vaginal hysterectomy. The long term outcome was assessed in 19 women. The mean follow up period was 33 (31) [2-113] months. Main outcome measures Intra- and post-operative morbidity, mortality and recurrence of prolapse. Results Sixteen of the 25 women (64 %) had no major intra- or post-operative complications. The mean estimated blood loss was 400 (280) mL, and seven women received blood transfusions. Four women (16%) had cardiovascular complications, and one died of pulmonary embolism. All four had a history of vascular disease. One woman had symptomatic recurrence of vault prolapse treated with a vaginal pessary; two women had asymptomatic cystocele and one had an enterocele requiring no treatment. The outcomes were similar for women with or without concurrent vaginal hysterectomy. Conclusion Transvaginal sacrospinous ligament fixation is an effective treatment for massive vaginal vault or uterovaginal prolapse in aged women. Increased blood loss may elevate the risk of cardiovascular complications especially in elderly patients with a history of vascular disease, thus indicating the importance of intraoperative bleeding control.

Sacrospinous ligament fixation for massive genital prolapse in women aged over 80 years.

To assess the feasibility of vaginal sacrospinous ligament fixation for women over 80 years of age with massive vaginal vault or uterovaginal prolapse. Retrospective observational study with long term follow up. Department of Obstetrics and Gynaecology, Tampere University Hospital, Finland. and Methods The study group consisted of 25 women with a mean (SD) [range] age of 83 (3) [80-93] years: 13 had posthysterectomy vaginal vault prolapse and 12 had massive uterovaginal prolapse. All underwent vaginal sacrospinous ligament fixation with repair of pelvic floor relaxation. Women with uterovaginal prolapse also underwent concomitant vaginal hysterectomy. The long term outcome was assessed in 19 women. The mean follow up period was 33 (31) [2-113] months. Intra- and post-operative morbidity, mortality and recurrence of prolapse. Sixteen of the 25 women (64 %) had no major intra- or post-operative complications. The mean estimated blood loss was 400 (280) mL, and seven women received blood transfusions. Four women (16%) had cardiovascular complications, and one died of pulmonary embolism. All four had a history of vascular disease. One woman had symptomatic recurrence of vault prolapse treated with a vaginal pessary; two women had asymptomatic cystocele and one had an enterocele requiring no treatment. The outcomes were similar for women with or without concurrent vaginal hysterectomy. Transvaginal sacrospinous ligament fixation is an effective treatment for massive vaginal vault or uterovaginal prolapse in aged women. Increased blood loss may elevate the risk of cardiovascular complications especially in elderly patients with a history of vascular disease, thus indicating the importance of intraoperative bleeding control.