Iatrogenic Bladder Diverticulum 11 Years After Sacrospinous Ligament Fixation for Apical Prolapse

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.

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The Effect of Local Analgesia on Postoperative Gluteal Pain in Patients Undergoing Sacrospinous Ligament Fixation: A Randomized Trial

Case Medical Research ◽

10.31525/ct1-nct03995641 ◽

2019 ◽

Author(s):

Keyword(s):

Randomized Trial ◽

Local Analgesia ◽

Sacrospinous Ligament ◽

Sacrospinous Ligament Fixation ◽

Gluteal Pain

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Comparison of the effectiveness of sacrospinous ligament fixation and sacrocolpopexy: a meta-analysis

International Urogynecology Journal ◽

10.1007/s00192-021-04823-w ◽

2021 ◽

Author(s):

Wenju Zhang ◽

Willy Cecilia Cheon ◽

Li Zhang ◽

Xiaozhong Wang ◽

Yuzhen Wei ◽

...

Keyword(s):

Operative Time ◽

Meta Analysis ◽

Current Evidence ◽

Cochrane Library ◽

Surgical Approaches ◽

Sacrospinous Ligament ◽

Gastrointestinal Complications ◽

Sacrospinous Ligament Fixation ◽

Apical Support ◽

Abdominal Sacrocolpopexy

Abstract Introduction and hypothesis Sacrocolpopexy and sacrospinous ligament fixation (SSLF) have been used for the restoration of apical support. Studies comparing sacrocolpopexy and SSLF have reported conflicting results. We aim to assess the current evidence regarding efficiency and the complications of sacrocolpopexy compared with SSLF. Methods We searched PubMed, Embase, and Cochrane Library and performed a systematic review meta-analysis to assess the two surgical approaches. Results 5Five randomized controlled trials, 8 retrospective studies, and 2 prospective studies including 4,120 cases were identified. Compared with abdominal sacrocolpopexy (ASC), SSLF was associated with a lower success rate (88.32% and 91.45%; OR 0.52; 95% CI 0.29–0.95; p = 0.03), higher recurrence (11.58% and 8.32%; OR 1.97; 95% CI 1.04–3.46; p = 0.04), and dyspareunia rate (14.36% and 4.67%; OR 3.10; 95% CI 1.28–7.50; p = 0.01). Patients in this group may benefit from shorter operative time (weighted mean difference −25.08 min; 95% CI −42.29 to −7.88; p = 0.004), lower hemorrhage rate (0.85% and 2.58%; OR 0.45; 95% CI 0.25–0.85; p = 0.009), wound infection rate (3.30% and 5.76%; OR 0.55; 95% CI 0.39–0.77; p = 0.0005), and fewer gastrointestinal complications (1.33% and 6.19%; OR 0.33; 95% CI 0.15–0.76; p = 0.009). Conclusion Both sacrocolpopexy and SSLF offer an efficient alternative to the restoration of apical support. When anatomical durability and sexual function is a priority, ASC may be the preferred option. When considering factors of mesh erosion, operative time, gastrointestinal complications, hemorrhage, and wound infections, SSLF may be the better option.

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