Outcome of Sacrospinous Ligament Fixation of the Vault during Repair of Pelvic Organ Prolapse

Abstract

Background: Pelvic organ prolapse includes descent of anterior/ posterior wall and apical (vault) prolapse with significant morbidity. In this study we evaluated the outcome of sacrospinous ligament fixation of vault through vaginal approach as part of the repair for massive uterovaginal (pelvic organ prolapse stage III and stage IV) and vault prolapse. Methods: This study on sacrospinous ligament fixation along with repair for pelvic organ prolapse at Kathmandu Model Hospital from November 2016 to April 2018 was done to assess the outcome in terms of early (during hospital stay) and delayed (six months) post-operative complications, need of removal of sacrospinous fixation suture and recurrence of prolapse. Results: Out of 95 pelvic organ prolapse patients, 80 (84%) were post-menopausal, 28 (29.4%) were in the age group of 70-79 years. There were 61 (64%) POPQ stage III. The post-operative complications during post-operative hospital stay were pain over right buttock in 42 (44%), urinary retention in 7 (7%) and UTI in 7 (7%). Sacrospinous suture was released in two patients for severe pain over right buttock. At one-week follow-up, 35 (36%) had right buttock pain of moderate severity and 8 (8%) had vaginal cuff infection. Sacrospinous suture was removed in one patient for neuropraxia two weeks following surgery. At four weeks follow-up, 25 (26%) patients had mild right buttock pain relieved by oral NSAIDs on need. At six months follow-up, five had occasional buttock pain, six had some recurrences and two had some vault prolapse and one each had short vagina and stress incontinence. Conclusions: Sacrospinous ligament fixation is a good procedure for the management of pelvic organ prolapse with better long-term outcome if performed with good surgical expertise. Keywords: Prolapse; repair; sacrospinous fixation; vaginal hysterectomy.

Clinical outcome of sacrospinous fixation following pelvic organ prolapse surgery

“…The source of gluteal pain often is attributed to injury to the nerve to levator ani or pudendal nerve. 12 Small number of patients who complains of the persistent severe buttock pain may necessitate the removal of suture as reported by Dangal et al 13 in their study.…”

Female sexual function after repair of uterovaginal prolapse

“…19 Although, the type of suture material (absorbable or nonabsorbable) has an impact on the development of pain, Dangal et al, reported persistent pain after 6 months of SSLF done with absorbable sutures. 20 An earlier study reported an increase in sexual activity by 21/94 women (22.3%) after the surgery, and two recommended sexual activity. 21 Another one reported improved sexual function significantly after surgery.…”

“…However; nerve injury is unavoidable even with proper suture placement 19 . Although, the type of suture material (absorbable or nonabsorbable) has an impact on the development of pain, Dangal et al, reported persistent pain after 6 months of SSLF done with absorbable sutures 20 …”

Surgical management of pudendal nerve entrapment after sacrospinous ligament fixation

“…But one question that needs to be raised is whether absorbable suture material does lead to lower postoperative pain, given the temporary entrapment until the suture is resolved. Although lower pain‐related complications seem likely, Dangal et al shows that absorbable sutures can also result in persistent buttock pain at 6 months after surgery 21 . However, the data are limited and the use of different suture materials for SSLF requires more evaluation.…”

“…Although lower pain-related complications seem likely, Dangal et al shows that absorbable sutures can also result in persistent buttock pain at 6 months after surgery. 21 However, the data are limited and the use of different suture materials for SSLF requires more evaluation. Nevertheless, in the case of severe direct postoperative pain, we would recommend removing the SSL sutures, regardless the type of suture material used.…”