SHOULD SACROSPINOUS LIGAMENT FIXATION FOR THE MANAGEMENT OF PELVIC SUPPORT DEFECTS BE PART OF A RESIDENCY PROGRAM PROCEDURE - THE UNIVERSITY-OF-MIAMI EXPERIENCE
M. Penalver et al., SHOULD SACROSPINOUS LIGAMENT FIXATION FOR THE MANAGEMENT OF PELVIC SUPPORT DEFECTS BE PART OF A RESIDENCY PROGRAM PROCEDURE - THE UNIVERSITY-OF-MIAMI EXPERIENCE, American journal of obstetrics and gynecology, 178(2), 1998, pp. 326-329
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.