Management of arterial and venous hemorrhage during sacrospinous ligament fixation: cases and review of the literature

Pahwa, Avita K.; Arya, Lily A.; Andy, Uduak U.

doi:10.1007/s00192-015-2818-2

Cited by 17 publications

(13 citation statements)

References 12 publications

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“…However, it occurs more often in SSLF than in USLS, with a longer duration; the degree of pain is more severe in SSLF, with more drug treatment needed, some even needing surgical removal of sutures (Barber et al, 2019; Dangal et al, 2018; Detollenaere et al, 2015). For hemorrhage, previous studies have reported that SSLF may lead to severe bleeding; we found that the intraoperative blood transfusion rate of USLS can be 0.9%–2.3%, which is similar to that of SSLF (Table 4) (Chapman et al, 2021; Detollenaere et al, 2015; Nager et al, 2019; Pahwa et al, 2016). Urinary system injury usually occurs in USLS (Jackson et al, 2015; Nager et al, 2019).…”

Section: Commentssupporting

confidence: 81%

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Bilateral medial sacrospinous ligament suture for apical suspension through natural spaces: A single‐center study with low perioperative complications

OuYang

Wang

et al. 2022

Clinical Anatomy

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Sacrospinous ligament fixation (SSLF) is one of the most used native tissue approaches for apical suspension with a high rate of perioperative complications. This study aimed to review cases undergoing a modified SSLF and assess its perioperative adverse events. It was a retrospective study of 168 consecutive patients undergoing modified transvaginal SSLF at a single tertiary center from 2017 to 2021. The sutures were placed on the sacrospinous ligament (SSL) approaching the sacrum through natural spaces under direct vision. Moreover, it was performed bilaterally. Patient demographics and perioperative complications were reviewed. The median age was 65 years, and 85.7% (144/168) had stage III–IV prolapse. Among the 168 patients undergoing this modified SSLF, 161 were for uterovaginal prolapse, and seven were for posthysterectomy vaginal vault prolapse. 83.9% (135/161) patients were concomitant with hysterectomy, and 70.2% (118/168) were with anteroposterior colporrhaphy. The median operation time was 82 min (interquartile range [IQR], 61–100 min), and the median intraoperative blood loss was 50 ml (IQR, 30–50 ml). Two cases had pelvic hematoma, and both were cured after expectant treatment. No patient required a homologous blood transfusion, and none complained about buttock or lower limb pain 2 weeks postoperatively. Nor did injury of the ureters, bladder, or rectum occur intraoperatively. This modified transvaginal SSLF procedure was safe and had no severe perioperative complications.

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Section: Commentssupporting

confidence: 81%

“…Although these two technologies are relatively “old,” some severe perioperative complications are still reported. SSLF can incur life‐threatening hemorrhage, ranging from 0.2% to 2% (Pahwa et al, 2016). It can also incur a high rate of suture‐related pain, as high as 23.8%–44% (Barber et al, 2014; Dangal et al, 2018).…”

Section: Introductionmentioning

confidence: 99%

Bilateral medial sacrospinous ligament suture for apical suspension through natural spaces: A single‐center study with low perioperative complications

OuYang

Wang

et al. 2022

Clinical Anatomy

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“…Dubuisson and Dubuisson, who also used the anterior laparoscopic approach, stated that they experienced no perioperative complication, but did not mention the total number of patients they had treated (Dubuisson and Dubuisson, ). In contrast, there are numerous reports of perioperative complications in the vaginal approach (David‐Montefiore et al, ; Monk et al, ; Pahwa et al, ). Wang et al explained their preference for the anterior over the posterior approach once laparoscopy has been performed by the fact that the vascular plexus and the ureter are easily injured using the posterior route (Wang et al, ).…”

Section: Discussionmentioning

confidence: 99%

Anatomical structures at risk using different approaches for sacrospinous ligament fixation

et al. 2019

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For 50 years now, sacrospinous ligament fixation (SSLF) has been used to treat pelvic organ prolapse consequent on altered integrity of the pelvic myofascial structures. It is usually performed vaginally, but it has recently been performed laparoscopically through either an anterior or a posterior approach, with the broad ligament as a landmark to differentiate the two. In the present study, these two laparoscopic approaches were assessed using Thiel-embalmed cadavers. The anterior and posterior approaches were compared in terms of the closest distance to anatomical structures at risk, including pelvic viscera, the obturator nerve, and vascular structures. The posterior approach was more often closer to the investigated vessels and the rectum. The obturator nerve and the ureter were close to both the anterior and posterior approaches. The urinary bladder was closer using the anterior approach. From an anatomical standpoint, therefore, the anterior laparoscopic approach for SSLF is more likely to cause injury to the urinary bladder, whereas the posterior approach is more prone to causing rectal and vessel injuries. This study illustrates, from a basic science perspective, the importance of combining fascia research, novel endoscopic or minimally invasive surgical exposures informed by anatomy, and contemporary trends in gynecology in order to improve patient outcomes. Clin. Anat. 33:522-529, 2020.

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“…This will provide control for most of the venous bleeding. 1 In the present case, when the hematoma was detected, a vaginal tamponade was applied with pressure onto the SSL area and remained in place for 48 h. Monitoring of vital signs and urinary output, repeated blood counts every 4-6 h and white blood count checks were carried out. No remarkable signs or changes were detected within the parameters, and the stable dimensions of the hematoma demonstrated that the close follow-up and vaginal tamponade treatment had succeeded.…”

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confidence: 93%

“…1,2 Despite a significant number of postoperative hemorrhage and hematoma cases reported in the literature, life-threatening hemorrhage as a complication during sacrospinous hysteropexy is rare. In this case, the hematoma developed on the 10 th postoperative day following sexual intercourse.…”

Section: Introductionmentioning

confidence: 99%

A late-onset hematoma developed after sexual intercourse following sacrospinous hysteropexy and mid-urethral sling surgery: case report

Doğan

Pulatoğlu

Başbuğ

et al. 2017

Proc Obstet Gynecol

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Management of arterial and venous hemorrhage during sacrospinous ligament fixation: cases and review of the literature

Abstract: Life-threatening bleeding is a rare complication of transvaginal SSLF. Knowledge of surrounding pelvic vascular anatomy, treatment options, and communication with ancillary staff is essential for the treatment of sacrospinous ligament hemorrhage.

Cited by 17 publications

References 12 publications

Bilateral medial sacrospinous ligament suture for apical suspension through natural spaces: A single‐center study with low perioperative complications

Bilateral medial sacrospinous ligament suture for apical suspension through natural spaces: A single‐center study with low perioperative complications

Anatomical structures at risk using different approaches for sacrospinous ligament fixation

A late-onset hematoma developed after sexual intercourse following sacrospinous hysteropexy and mid-urethral sling surgery: case report

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