Anterior sacrospinous vaginal vault suspension for prolapse

Background: We describe a nerv modification of sacrospinous vaginal vault s uspension, through the anterior compartment of the vagina. Technique: The anterior vaginal wall is opened and the endopelvic connectiv e tissue on the patient's right is separated from the pubic ramus at the le vel of the bladder neck to the ischial spine, exposing the paravesical and pararectal space. The sacrospinous ligament is identified and isolated thro ugh this defect. Two permanent sutures are placed approximately 2 cm apart through the ligament, anchored with pulley stitches underneath the vaginal epithelium, and tied down to the ligament. Experience: Seventy-five women with vaginal vault prolapses had anterior sa crospinous vaginal vault suspension between Tune 1993 and February 1997. Th e average age was 69 and parity was 3. Seventy women were postmenopausal an d 32 were taking hormone replacement therapy. Mean follow-up examination wa s 8.5 months. Recurrent vault prolapse occurred in five women, enterocele i n one, rectocele in five and cystocele in nine. Three women needed second o perations for prolapse. Conclusions: The anterior approach to sacrospinous vaginal vault suspension provides an alternative to the traditional posterior technique. It is a co nvenient route for apical suspension when posterior surgery is not needed. (C) 2000 by The American College of Obstetricians and Gynecologists.