Transvaginal sacrospinous colpopexy for marked uterovaginal and vault prolapse

Objective: The transvaginal sacrospinous ligament fixation technique was us ed as part of the vaginal repair procedure for marked uterovaginal prolapse , and in the treatment of vault prolapse. Method. Out of the 26 women treat ed with sacrospinous ligament suspension of the vaginal vault, 23 had marke d uterovaginal prolapse and three had vault prolapse following hysterectomy . Patients with vault prolapse underwent posterior vaginal repair, oblitera tion of the enterocele sac and sacrospinous colpopexy. Patients with marked uterovaginal prolapse underwent vaginal hysterectomy with high ligation of the enterocele sac, anterior and posterior vaginal repair, and sacrospinou s colpopexy. Bilateral salpingoopherectomy was added to the procedure in fi ve patients. All patients were examined 6 weeks after the operation and, su bsequently, on an annual basis. The mean follow-up period was 2.6 years (1- 5 years). Results: Out of the three patients with previous vault prolapse, none had recurrences. Out of the 23 patients with previous marked uterovagi nal prolapse, only two had small cystocele, and one had small enterocele at 36 months following the operation. These patients were asymptomatic and di d not need an operation. Vaginal vault prolapse was not observed in any of these patients. Two women had post-operative urinary tract infection and fi ve had buttock discomfort, which subsided after 2 months. No other intra- o r post-operative complications occurred. Conclusion: Transvaginal sacrospin ous colpopexy can be performed together with vaginal hysterectomy; and ante rior and posterior vaginal wall repair in patients with marked uterovaginal prolapse because of its high success in avoiding possible vault prolapse, and low intra- and post-operative complication rates. (C) 2001 Internationa l Federation of Gynecology and Obstetrics. All rights reserved.