SACROSPINOUS LIGAMENT FIXATION, A SAFE AND EFFECTIVE WAY TO MANAGE VAGINAL VAULT PROLAPSE.A 10-YEAR OBSERVATIONAL STUDY OF CLINICAL PRACTICE

• Main Author: Waleed S. Alwaneen
• Format: Article
• Language: English
• Published: University of Faisalabad 2018-03-01
• Series: Journal of University Medical & Dental College
• Subjects: environmental issues; Vermicomposting; plant growth; bacteria species; animal manure; benefits
• Online Access: http://jumdc.tuf.edu.pk/articles/volume-9-1/6-325%20Final.pdf

ABSTRACT: OBJECTIVE: The purpose of this study was to determine the functional outcomes, and to link the success of sacrospinous fixation with the age of patients, time interval between surgery and recurrence of prolapse. Also, to see if concomitant surgeries affect the outcome. STUDY DESIGN: An original observational study. METHODS AND MATERIALS: Between 2006 and 2015, 109 women underwent sacrospinous fixation for the management of symptomatic vaginal vault prolapse in North Cumbria University Hospital. Follow-up data was available for 107 patients. Inclusion criteria were women with symptomatic vaginal or vault prolapse with Baden-Walker system ≥ grade 2 which needs surgical treatment, surgically fit for surgery and have the capacity to consent to surgery. Exclusion criteria were the previous surgical treatment of vault prolapse, contraindication for a surgical intervention and have no capacity to consent to surgery. RESULTS: Out of 107 patients, 45 underwent SSLF with anterior and posterior colporrhaphy, 18 had vaginal hysterectomy, anterior and posterior colporrhaphy and sacrospinous fixation. SSLF was combined with anterior colporrhaphy in 4 and with posterior colporrhaphy in 38 women. Recurrence of prolapse was seen in only 14 patients. Advanced age showed the slightly increased risk of recurrence as of those who had the recurrence, 8 were over the age of 70. The successful surgical outcome was seen in 82%, 89%, 75% and 100% of patients when SSF was performed in combination with anterior and posterior repair, with posterior repair, with anterior repair, and with vaginal hysterectomy respectively. Among recurrence group, 57% noticed it within a year of surgery. 57% of women with the recurrence of vault prolapse successfully underwent repeated surgeries in the form of repeat sacrospinous ligament fixation, 3 women were operated with anterior and posterior colporrhaphy with synthetic mesh and 4 had anterior and posterior vaginal wall repair. CONCLUSION: Sacrospinous ligament fixation is an effective procedure with a low recurrence rate. Recurrence is slightly higher with advanced age. Concomitant surgeries do not increase the risk of recurrence. In cases of recurrence, the majority of cases showed it within 12 months of surgery.