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Transvaginal Sacrospinous Ligament Fixation for Pelvic Organ Prolapse Stage III and Stage IV Uterovaginal and Vault Prolapse.

Gupta P - Iran J Med Sci (2015)

Bottom Line: This patient was asymptomatic and did not require repeat surgery.All complications were dealt with successfully.No other major intra- and post-operative complications occurred.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology and Obstetrics, Post Graduate Institute of Medical Sciences and Research, ESI Hospital, Basai Darapur, New Delhi, India.

ABSTRACT
The result of transvaginal sacrospinous ligament fixation technique, as part of the vaginal repair procedure for massive uterovaginal (Pelvic Organ Prolapse stage III and stage IV and vault prolapse) is evaluated. A total of 32 women were included in the present case series. Marked uterovaginal prolapse was present in 28 women and four had vault prolapse following hysterectomy. Patients with vault prolapse and marked uterovaginal prolapse underwent sacrospinous colpopexy. The mean follow-up period was 2.5 years. Out of the 28 patients with previous marked uterovaginal prolapse, only one had small cystocele 3 years after the surgery. This patient was asymptomatic and did not require repeat surgery. One woman had post-operative urinary tract infection and two had buttock discomfort, one had ischiorectal abscess and two had cuff cellulitis. All complications were dealt with successfully. No other major intra- and post-operative complications occurred. Transvaginal sacrospinous colpopexy can be performed together with vaginal hysterectomy, with marked uterovaginal prolapse and vault prolapse.

No MeSH data available.


Related in: MedlinePlus

Description of the anatomy.
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Figure 1: Description of the anatomy.

Mentions: Patients were operated under general anesthesia in lithotomy position. Vaginal hysterectomy was done as an initial step in patients of marked uterovaginal prolapse. For sacrospinous fixation, a longitudinal incision is given in the posterior vaginal wall to expose the rectovaginal space. The epithelium is dissected laterally and the pararectal space opens on the right side. The suspension is most often done to the patient’s right because retraction of the rectum is easier and a right-handed surgeon can pass a suture forehanded. By blunt finger dissection, a window is created between the rectovaginal space and ischial spine. If correctly identified, the plane will usually develop without any difficulty. Dissection is done until ischial spines are reached. Using the ischial spine as a prominent landmark, the sacrospinous ligament is palpated; this ligament passes from the ischial spine to the lower part of the sacrum. Now, three narrow malleable retractors are used to retract the peritoneum and rectum, to visualize clearly the sacrospinous ligament (figure 1-2). The upper border of the ligament will now be clearly defined. In all cases, a delayed absorbable suture 0 monofilament polydioxanone, 1.5 m (loop) on 40 mm half-circle, a heavy round body needle is used for this procedure. With a twelve inch long needle holder, the suture is placed through the sacrospinous ligament coccygeus muscle complex starting from the superior border in an upside down direction, it should be 2 cm medial to the ischial spine, so that neurovascular bundle is not injured. When this suture is retrieved, as it is a loop, now it is divided to establish two sutures. Thus, two suture pairs are established with one pass. After enterocele closure and anterior colporrhaphy (if indicated), sacrospinous sutures are placed through the full thickness of vaginal muscularis at the point of new vaginal apex. Vaginal cuff is now sutured and closed. The sutures of sacrospinous ligament are now tied. This tying of sutures brings the sacrospinous ligament in direct contact with the vaginal epithelium. When healing occurs, vaginal epithelium is fused with the sacrospinous ligament and vault remains suspended up nicely thereafter. Postoperatively women were given broad-spectrum antibiotic for five days.


Transvaginal Sacrospinous Ligament Fixation for Pelvic Organ Prolapse Stage III and Stage IV Uterovaginal and Vault Prolapse.

Gupta P - Iran J Med Sci (2015)

Description of the anatomy.
© Copyright Policy
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4300482&req=5

Figure 1: Description of the anatomy.
Mentions: Patients were operated under general anesthesia in lithotomy position. Vaginal hysterectomy was done as an initial step in patients of marked uterovaginal prolapse. For sacrospinous fixation, a longitudinal incision is given in the posterior vaginal wall to expose the rectovaginal space. The epithelium is dissected laterally and the pararectal space opens on the right side. The suspension is most often done to the patient’s right because retraction of the rectum is easier and a right-handed surgeon can pass a suture forehanded. By blunt finger dissection, a window is created between the rectovaginal space and ischial spine. If correctly identified, the plane will usually develop without any difficulty. Dissection is done until ischial spines are reached. Using the ischial spine as a prominent landmark, the sacrospinous ligament is palpated; this ligament passes from the ischial spine to the lower part of the sacrum. Now, three narrow malleable retractors are used to retract the peritoneum and rectum, to visualize clearly the sacrospinous ligament (figure 1-2). The upper border of the ligament will now be clearly defined. In all cases, a delayed absorbable suture 0 monofilament polydioxanone, 1.5 m (loop) on 40 mm half-circle, a heavy round body needle is used for this procedure. With a twelve inch long needle holder, the suture is placed through the sacrospinous ligament coccygeus muscle complex starting from the superior border in an upside down direction, it should be 2 cm medial to the ischial spine, so that neurovascular bundle is not injured. When this suture is retrieved, as it is a loop, now it is divided to establish two sutures. Thus, two suture pairs are established with one pass. After enterocele closure and anterior colporrhaphy (if indicated), sacrospinous sutures are placed through the full thickness of vaginal muscularis at the point of new vaginal apex. Vaginal cuff is now sutured and closed. The sutures of sacrospinous ligament are now tied. This tying of sutures brings the sacrospinous ligament in direct contact with the vaginal epithelium. When healing occurs, vaginal epithelium is fused with the sacrospinous ligament and vault remains suspended up nicely thereafter. Postoperatively women were given broad-spectrum antibiotic for five days.

Bottom Line: This patient was asymptomatic and did not require repeat surgery.All complications were dealt with successfully.No other major intra- and post-operative complications occurred.

View Article: PubMed Central - PubMed

Affiliation: Department of Gynecology and Obstetrics, Post Graduate Institute of Medical Sciences and Research, ESI Hospital, Basai Darapur, New Delhi, India.

ABSTRACT
The result of transvaginal sacrospinous ligament fixation technique, as part of the vaginal repair procedure for massive uterovaginal (Pelvic Organ Prolapse stage III and stage IV and vault prolapse) is evaluated. A total of 32 women were included in the present case series. Marked uterovaginal prolapse was present in 28 women and four had vault prolapse following hysterectomy. Patients with vault prolapse and marked uterovaginal prolapse underwent sacrospinous colpopexy. The mean follow-up period was 2.5 years. Out of the 28 patients with previous marked uterovaginal prolapse, only one had small cystocele 3 years after the surgery. This patient was asymptomatic and did not require repeat surgery. One woman had post-operative urinary tract infection and two had buttock discomfort, one had ischiorectal abscess and two had cuff cellulitis. All complications were dealt with successfully. No other major intra- and post-operative complications occurred. Transvaginal sacrospinous colpopexy can be performed together with vaginal hysterectomy, with marked uterovaginal prolapse and vault prolapse.

No MeSH data available.


Related in: MedlinePlus