International Journal of Advances In Case Reports

SACROSPINOUS LIGAMENT FIXATION (SSLF) FOR VAULT SUSPENSION IN ADVANCED PELVIC ORGAN PROLAPSE

Atin Halder1, Rahul Deb Mandal2, Kalyansree Chaudhury2, Supratick Basu3, Kousik Seth4*, Arya Goswami5

kousikseth.bappabmc@gmail.com

Pelvic organ prolapse, Sacrospinous ligament, Deschamps ligature carrier hook.

Our aim was to evaluate the efficacy of sacrospinous ligament fixation(SSLF) for vault suspension in advanced pelvic organ prolapse. This study had a prospective design. The study was carried from March 2012 to February 2014 and women who had pelvic organ prolapse to or beyond the hymen were selected. SSLF was performed and patients were followed up after 2 weeks, 1 month, 3 months and 6 months. Out of 40 patients selected, mean age was 43.3 years. Duration of prolapse ranged from 1 to 18 years. Most of them were para 3 or more. Repeated child birth was the commonest cause of prolapse. An average duration of hospital stay was 7.5 days. Four patients came with previous Fothergill’s repair. Vault prolapsed following abdominal and vaginal hysterectomy was observed in four cases. 80%(32/40) of patients presented with 2o uterine prolapse with cystocele & rectocele and 4 cases came with recurrent prolapse. Majority(28/40) of cases underwent vaginal hysterectomy with anterior colporrhaphy and posterior colpoperineorrhaphy along with SSLF. Postoperative immediate complication was hemorrhage observed in 8 cases managed conservatively. Pain right buttock was observed in 6 cases, rectal injury observed in one case and persistent vaginal bleeding for 1 month observed in 3 cases. 6(15 %) patients developed cystocele after this procedure. UTI observed in two cases and treated. We can conclude from our study that bias and experience of surgeons have historically dictated the approach and route of access with restoration of vaginal anatomy being the primary goal. However, transvaginal SSLF approach has the advantage of decreased operative time, decreased incidence of adhesion formation, less postoperative complications and quicker recovery.