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Published on: September 13, 2022
Technical Challenges and Surgical Considerations in Sacrospinous Ligament Fixation for Apical Prolapse Repair
Stavros Athanasiou1, Anastasia Prodromidou1, Dimitrios Zacharakis1
1Urogynecology Unit, 1st Department of Obstetrics and Gynaecology, "Alexandra" General Hospital, National and Kapodistrian University of Athens, 11528 Athens, Greece.
Journal of Clinical Medicine
|June 12, 2026
Summary
Sacrospinous ligament fixation (SSLF) effectively treats uterine prolapse with good outcomes. Careful anatomical knowledge and technique are crucial to minimize risks and ensure patient safety during this native tissue vaginal procedure.
Area of Science:
- Urogynecology
- Pelvic reconstructive surgery
- Female pelvic medicine and reconstructive surgery
Background:
- Sacrospinous ligament fixation (SSLF) is a key native tissue procedure for uterine and vaginal vault prolapse.
- The deep operative field and proximity to neurovascular structures present technical challenges.
- Optimizing SSLF requires understanding anatomical considerations, surgical techniques, and fixation strategies.
Purpose of the Study:
- To review current evidence on anatomical factors, surgical techniques, and fixation methods in SSLF.
- To analyze suture materials, device-assisted approaches, and perioperative complications.
- To synthesize data on outcomes for uterine and vaginal vault prolapse repair.
Main Methods:
- A structured narrative review of contemporary literature.
- Focus on comparative and systematic studies of SSLF.
- Critical analysis of anatomical, functional, and safety outcomes.
Main Results:
- SSLF demonstrates favorable anatomical success and significant symptom improvement.
- Unilateral fixation is common; bilateral may suit specific patients.
- Anterior approach may preserve vaginal length but increase operative time and urinary morbidity.
Conclusions:
- SSLF is a safe and effective suspension procedure when individualized and meticulously performed.
- Knowledge of sacrospinous ligament anatomy is critical for reducing complications.
- Further randomized trials are needed for long-term outcomes.
