Abdominal sacrospinous ligament colposuspension

Area of Science:

• Urogynecology
• Pelvic reconstructive surgery

Background:

• Abdominal repair of pelvic prolapse often involves paravaginal repair for cystoceles and retropubic urethropexy for stress incontinence.
• Concomitant vaginal vault prolapse necessitates a reliable method for vaginal vault support, ideally accessible through the space of Retzius.

Purpose of the Study:

• To describe an abdominal approach to the sacrospinous ligament for vaginal vault support.
• To present an alternative technique for pelvic reconstruction surgeons.

Main Methods:

• Accessing the space of Retzius and identifying key anatomical landmarks.
• Palpating and exposing the sacrospinous ligament complex.
• Fixing the superior posterolateral vaginal wall to the sacrospinous ligament complex, often bilaterally.

Main Results:

• Fifty-five women underwent abdominal sacrospinous ligament colpopexy at two centers.
• All patients had concurrent repairs for pelvic organ prolapse.
• No repeat operations for recurrent vault prolapse were required during an average follow-up of 23 months.

Conclusions:

• An abdominal approach to the sacrospinous ligament complex is a viable surgical option.
• This technique provides an alternative for vaginal vault support in pelvic reconstruction.
• It is particularly useful when other space-of-Retzius procedures are indicated.