Comparison of transvaginal sacrospinous ligament fixation with abdominal sacrocolpopexy in treatment of post-hysterectomy vault prolapse-a prospective randomized study

Abstract

Background: Vaginal vault prolapse is a common condition following abdominal or vaginal hysterectomy causing negative impact on women’s quality of life. The study compares the efficacy of abdominal and vaginal route surgery in correcting post-hysterectomy vault prolapse by postoperative assessment and at least twelve months follow up.Methods: A prospective comparative study among post-hysterectomy patients attending the GOPD of Midnapore Medical College diagnosed as vaginal vault prolapse at least stage2 between January 2013 to December 2019. The study population included 31 women divided into two groups-group A included 16 women underwent unilateral sacrospinous ligament fixation (SSF) and group B included 15 women underwent abdominal sacrocolpopexy (ASC).Results: There was no significant difference between the two groups in terms of mean age, mean weight, mean parity and BMI, hence both groups are comparable. The mean operating time was 117±19.68 min in ASC group and 83.25±11.28 min in SSF group (p<0.005); significant mean blood loss was reported in ASC group (373±97.79 ml in ASC group versus 193.125±98.97 ml in SSF group, p<0.005), more hospital stays in ASC group (p<0.005) and more post operative complications in ASC group than SSF group. At follow up, the mean vaginal length showed significantly longer for ASC group than that of SSF group (p<0.005).Conclusions: ASC and SSF, both techniques are effective in management of vault prolapse in hands of an expert though recovery time is much quicker in SSF group.

Vaginal morphology and position associated with prolapse recurrence after vaginal surgery: A secondary analysis of the DEMAND study

“…Clinically, the right sacrospinous ligament is believed to be more easily accessible during sacrospinous fixation by righthanded surgeons. 18 This preference may account for the disproportionate 'failure' of the right mesh arm (potentially due to asymmetrical tensioning and subsequent gradual lengthening) that leads to a laterally displaced upper vagina towards the patient's left side. Additionally, it was found that with hysterectomy, a lower vaginal position was associated with prolapse recurrence-which aligns with previous studies that demonstrated that the vagina of women with POP versus without POP was positioned lower within the 19,20 Our findings also showed that among successes, hysteropexy was better able to preserve a more horizontally and posteriorly oriented upper vagina than hysterectomy.…”

“…In these cases, the right mesh arm appeared loose and wave‐like compared with the left mesh arm on MRI, suggesting consistent asymmetrical loss of support. Clinically, the right sacrospinous ligament is believed to be more easily accessible during sacrospinous fixation by right‐handed surgeons 18 . This preference may account for the disproportionate ‘failure’ of the right mesh arm (potentially due to asymmetrical tensioning and subsequent gradual lengthening) that leads to a laterally displaced upper vagina towards the patient's left side.…”

Comparative study between vaginal sacrospinous ligament fixation with abdominal sacrocolpopexy

“…Vaginal eversion is essentially complete. For SSF: SSF is done classically as described by Randall et al 3 Vertical incision is given on anterior vaginal wall, vault and posterior vaginal wall. Dissection was carried out up to right sided ischial spine in pararectal space after dividing rectal pillar and rectum is mobilized away from site and curved needle was passed through right sacrospinous ligament about 2-3 cm medial to ischial spine by palpating the ligament.…”