How we perform a posterior sacrospinous ligament fixation by the vaginal route

Declas, E; Giraudet, Géraldine; Rubod, Chrystèle; Cosson, Michel

doi:10.1007/s00192-019-04149-8

Cited by 5 publications

(4 citation statements)

References 7 publications

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“…Estelle Declas and co-workers published an article detailing their technique of sacrospinous fixation. 19 This may be the only detailed description of the procedure. However, lots of differences exist when their technique is compared to the one we are proposing.…”

Section: Discussionmentioning

confidence: 99%

Modified technique for sacrospinous-sacrotuberous ligament complex colpopexy in apical prolapse: preliminary results of a pilot randomized study

Sweed¹,

Mostafa²,

Sammour³

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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Background: Apical prolapse is frequently encountered following vaginal hysterectomy either or as a primary finding in patients with pelvic organ prolapse. This pilot comparative study introduces a modified sacrospinous sacrotuberous ligament fixation with biologic mesh augmentation which necessitates no special kits to be performed.Methods: This study was conducted at Department of Obstetrics and gynecology, Ain Shams University, Cairo, Egypt, and Department of Women Health of Bethanien Hospital, Iserlöhn, Germany from March 2018 to May 2020. 40 women with either utero-vaginal or vaginal vault prolapse were randomized to either; group (A): 20 women scheduled for modified sacrospinous-sacrotuberous fixation procedure, or group (B): 20 women scheduled for conventional sacrospinous-sacrotuberous fixation procedure.Results: Improvement of the Pelvic organ prolapse quantification system (POP-Q) stage from the base line pre-operative stage was 1 stage higher in the modified SS/ST-F group compared to the conventional SSF group (3 stage improvement from baseline in SS/ST-F group versus 2 stage improvement only in conventional SSF group).Conclusions: This pilot study provides a modified sacrospinous sacrotuberous ligament colpopexy technique which is easier to be performed and mastered, does not need the use of special devices, provides better improvement of grade of prolapse and less complications compared to the conventional technique.

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Section: Discussionmentioning

confidence: 99%

Modified technique for sacrospinous-sacrotuberous ligament complex colpopexy in apical prolapse: preliminary results of a pilot randomized study

Sweed¹,

Mostafa²,

Sammour³

et al. 2020

Int J Reprod Contracept Obstet Gynecol

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“…The left pararectal fossa was dissected. The vaginal apex was attached to the left sacrospinous ligament at 2 cm from the ischia spine [ 11 , 14 ]. Then, the vagina was partially closed.…”

Section: Methodsmentioning

confidence: 99%

“…Moreover, according to several studies, the anchorage location on the sacrospinous ligament for SSF differs from 1.5 cm to 3 cm medial to the ischial spine [9,[11][12][13]. Giraudet et al demonstrated that the medial part of the sacrospinous ligament (between 16 and 32 mm from the ischial spine) was the most appropriate for the placement of the suture during SSF procedures, in order to avoid nerve and vessel injuries [14].…”

Section: Introductionmentioning

confidence: 99%

Mobility analysis of a posterior sacrospinous fixation using a finite element model of the pelvic system

Lallemant,

Shimojyo,

Mayeur

et al. 2024

PLoS ONE

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Introduction and hypothesis In order to improve the knowledge POP physiopathology and POP repair, a generic biomechanical model of the female pelvic system has been developed. In the literature, no study has currently evaluated apical prolapse repair by posterior sacrospinous ligament fixation using a generic model nor a patient-specific model that personalize the management of POP and predict surgical outcomes based on the patient’s pre-operative Magnetic Resonance Imaging. The aim of our study was to analyze the influence of a right and/or left sacrospinous ligament fixation and the distance between the anchorage area and the ischial spine on the pelvic organ mobility using a generic and a patient-specific Finite Element model (FEM) of the female pelvic system during posterior sacrospinous ligament fixation (SSF). Methods Firstly, we used a generic 3D FEM of the female pelvic system previously made by our team that allowed us to simulate the mobility of the pelvic system. To create a patient-specific 3D FEM of the female pelvic system, we used a preoperative dynamic pelvic MRI of a 68 years old woman with a symptomatic stage III apical prolapse and cystocele. With these 2 models, a SSF was simulated. A right and/or left SSF and different distances between the anchorage area and the ischial spine (1 cm, 2 cm and 3 cm.) were compared. Outcomes measures were the pelvic organ displacement using the pubococcygeal line during maximal strain: Ba point for the most posterior and inferior aspect of the bladder base, C point the cervix’s or the vaginal apex and Bp point for the anterior aspect of the anorectal junction. Results Overall, pelvic organ mobility decreased regardless of surgical technique and model. According to the generic model, C point was displaced by 14.1 mm and 11.5 mm, Ba point by 12.7 mm, and 12 mm and Bp point by 10.6 mm and 9.9 mm after left and bilateral posterior SSF, respectively. C point was displaced by 15.4 mm and 11.6 mm and Ba point by 12.5 mm and 13.1mm when the suture on the sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine respectively (bilateral posterior SSF configuration). According to the patient-specific model, the displacement of Ba point could not be analyzed because of a significative and asymmetric organ displacement of the bladder. C point was displaced by 4.74 mm and 2.12 mm, and Bp point by 5.30 mm and 3.24 mm after left and bilateral posterior SSF respectively. C point was displaced by 4.80 mm and 4.85 mm and Bp point by 5.35 mm and 5.38 mm when the suture on the left sacrospinous ligament was performed at 1 cm and 3 cm from the ischial spine, respectively. Conclusion According to the generic model from our study, the apex appeared to be less mobile in bilateral SSF. The anchorage area on the sacrospinous ligament seems to have little effect on the pelvic organ mobilities. Trial registration ClinicalTrials.gov Identifier: NCT04551859.

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“…Nonetheless, the bilateral Richter technique can lead to complications, as dyspareunia and chronic postoperative pain, (around 4.5% of cases) (6, 7) and therefore a low tolerance level. It is a difficult surgery that requires a good exposition which explains why the Richter is often unilateral and which requires a long learning curve for good reproducibility (8,9). An alternative to Richter's sacrospinofixation is the achievement of a posterior isthmic sling by vaginal route.…”

Section: Introductionmentioning

confidence: 99%