Sacrospinous fixation is for strengthening:
Ans. A. Apical defecta. Sacrospinous ligament fixation: - The main indication for sacrospinous ligament fixation is to correct total procidentia or post-hysterectomy vaginal vault prolapse with an associated weak cardinal uterosacral ligament complex and to correct post hysterectomy enterocele. The contraindication for the procedure is a short vagina.b. The principle of this procedure is the fixation of the vaginal vault to the sacrospinous ligament with nonabsorbable sutures. The fixation site is typically the right sacrospinous ligament. However, bilateral fixation is performed in patients with recurrent vault prolapse and with the goal of restoring a vaginal axis and sexual life. The routes of entry to the sacrospinous ligament may be posterior and anterior. Usually, a unilateral, right-sided, posterior approach is preferred.c. This procedure has advantages, including success rates comparable to abdominal procedures, the ability to repair concomitant pelvic floor defects, the absence of laparotomy, shorter hospital stays, and the preservation of vaginal length and function.d. The most common problem after this procedure is the high rate of postoperative cystocele, which approaches 20% to 33%, resulting from the deviation of the vaginal axis. Recurrent cystoceles have been reported in 6% to 92% of patients.e. Other disadvantages include difficulty in exposing the ligament, the potential need for excessive tensioning during tying, injury risk to the pudendal or inferior gluteal vessels and sciatic or pudendal nerve, alterations in the vaginal axis, and vaginal narrowing.f. Thomson et al have reported that by placing the sutures through the sacrospinous ligament 2.5cm more medially from the ischial spine along the superior border of the ligament and not through the full thickness of the ligament, the risk of complications is minimal.
Apical defect
Posterior defect
Lateral defect
Anterior defect
Operative Obs