SHOULD SACROSPINOUS LIGAMENT FIXATION FOR THE MANAGEMENT OF PELVIC SUPPORT DEFECTS BE PART OF A RESIDENCY PROGRAM PROCEDURE - THE UNIVERSITY-OF-MIAMI EXPERIENCE

OBJECTIVE: The objective of this article is to determine the safety an d effectiveness of transvaginal sacrospinous ligament fixation as part of the management of pelvic support defects in a residency program. S TUDY DESIGN: A retrospective chart review of patients undergoing sacro spinous ligament fixation at the Division of Gynecology, Jackson Memor ial Hospital, University of Miami School of Medicine, between July 199 0 and December 1995, was performed. Patients with vaginal vault prolap se and uterine prolapse with documented preoperative evaluation were i ncluded in this study. Data were obtained using a detailed predetermin ed flow sheet. RESULTS: A total of 160 patients was included in the st udy. All patients underwent right sacrospinous ligament fixation, ante rior and posterior colporrhaphy, and perineorrhaphy. In addition, 31 ( 19%) underwent enterocele repair, 5 (3%) underwent trachelectomy, and 9 (6%) underwent Burch procedure. Complications included fever 13 (8.1 %), urinary tract infection 16 (10%), blood loss requiring transfusion 7 (4.3%), sciatic neuralgia 2 (1.2%), and rectovaginal fistula 2 (1.2 %). The mean follow-up was 40 months (range 18 to 78 months). The succ ess of the operation was gauged by recurrence. Ninety-four percent of the patients had no evidence of vaginal vault prolapse on follow-up, a nd 85% had no recurrence of any pelvic support defect. Eleven of the 2 4 patients with recurrence underwent repeat surgery, whereas 13 opted for conservative management with pessaries. CONCLUSION: Transvaginal u nilateral sacrospinous ligament fixation is a safe and successful oper ation for the treatment of pelvic support detect and should be an esse ntial component in the training of gynecologic residents.