Abdominal sacrospinous ligament colposuspension

Background: When an abdominal approach is chosen for repair of pelvic prola pse, a paravaginal repair is often used to correct lateral cystoceles and a retropubic urethropexy to correct genuine stress incontinence. If concomit ant vaginal vault prolapse exists, an approach for vaginal vault support, w hich can be done through the space of Retzius, would be beneficial. We desc ribe an abdominal approach to the sacrospinous ligament. Technique: The space of Retzius is accessed and important anatomic landmark s, including the obturator canal and neurovascular bundle, paravaginal vein s, bladder, and ischial spine, are identified. The sacrospinous ligament co mplex is palpated and exposed. The superior posterolateral vaginal wall is then fixed to the complex. Often a bilateral repair is possible. Experience: Fifty-five women at two centers had abdominal sacrospinous liga ment colpopexies for vaginal vault prolapse. All had other repairs for pelv ic organ prolapse. No follow-up operations were needed for recurrent vault prolapse, over an average of 23 months follow-up. Conclusion: An abdominal approach to the sacrospinous ligament complex can be used, providing pelvic reconstruction surgeons with an alternative techn ique for vaginal vault support when other space-of-Retzius procedures are r equired. (Obstet Gynecol 1999;94:1039-41. (C) 1999 by The American College of Obstetricians and Gynecologists.).