Publication:

Sacrospinous fixation for prevention and treatment of vault prolapse: institutional experience from South India

Background Vaginal Vault Prolapsed (VVP) is defined as descent of vagina apex or vaginal cuff scar below a point that is 2 cm less than Total Vaginal Length (TVL) above the plane of hymen. VVP following hysterectomy is due to pre-existing weakness of pelvic floor tissue. Incidence is 0.2% and on clinical examination incidence is 45%. It is reported to be more common in Asian women (67%) compared to Caucasian (26%) or African (28%) women.

Methods 15 cases of prolapse cases were operated during a period of 2 year attending our department. The efficacy of the Sacrospinous Ligament Fixation of the Vault (SSLF) was evaluated. We performed prophylactic SSLF following vaginal hysterectomy in 5 cases and therapeutic SSLF in 10 cases of vault prolapse. Surgical repair of vault prolapse is to address the need to preserve or improve the function and restore the normal anatomy.

Results There was significant improvement in severity of prolapsed with preoperative staging ranging in stage 2 to 4 and postoperative staging in stage -3 to stage 1. Anterior vaginal wall prolapse was reduced immediate post- operative period most of the patients who had stage 2 and stage 3 were reduced to stage 1 and -3. No bladder or bowel injuries in this series.

Conclusions SSF is suitable in physically frail women, requires lesser operating time, rapid recovery, lesser blood loss and hospital stay in addition to being cost effective with patient satisfaction (91%). Sacrospinous fixation is chosen procedure for primary vault prolapse repair.