Pelvic Organ Prolapse, Surgical Procedure; Complications, Late Effect of Complications
Conditions
Keywords
urogynecology, pelvic organ prolapse, sacrospinous ligament fixation, prolapse recurrence
Brief summary
This retrospective cohort study aimed to compare clinical outcomes between the classical double suture technique and a modified loop suture technique used in sacrospinous ligament fixation for stage 3 or 4 pelvic organ prolapse. A total of 195 patients underwent surgery at a tertiary care center between January 2020 and January 2023. The primary outcome was the rate of reoperation due to recurrence within 24 months. Secondary outcomes included operative time, prolapse recurrence rate, and postoperative complications such as gluteal pain. The study was designed to evaluate whether a simplified suture method could improve surgical efficiency and patient recovery without compromising anatomical success.
Detailed description
Sacrospinous ligament fixation is a commonly used surgical procedure for apical pelvic organ prolapse, particularly in women with advanced-stage prolapse who desire a native tissue repair approach. With increasing concerns regarding mesh-related complications, sacrospinous fixation has regained popularity as a mesh-free alternative. This retrospective cohort study was conducted to evaluate and compare the clinical performance of two different suture techniques: the classical double suture method and a modified loop suture method. The main objective was to assess whether the loop suture technique, which involves a single point of tension, offers advantages in terms of operative efficiency and patient outcomes. A total of 195 patients with stage 3 or 4 pelvic organ prolapse underwent sacrospinous ligament fixation between January 2020 and January 2023 at a tertiary urogynecology center. One group received the standard double suture technique, while the other underwent fixation using a single loop suture. All surgeries were performed by the same experienced surgical team. The primary outcome was reoperation rate due to recurrence within 24 months. Secondary outcomes included total operative time, recurrence rate (as defined by POP-Q stage ≥2), and postoperative complications such as gluteal pain and rectal injury. This study aims to provide evidence on whether a technical modification in a widely accepted native tissue repair procedure can improve surgical safety and reduce long-term complication rates.
Interventions
PROCEDUREsacrospinous ligament fixation
A longitudinal incision was made at the midline of the posterior vaginal wall, extending approximately 2-3 cm from the perineal body to the vaginal apex to form a tunnel. The incised vaginal epithelium was dissected from the underlying muscularis layer. Dissection was continued to the level of the ischial spine. The rectum was medialized to access the perirectal space. Upon palpating the ischial spine, the sacrospinous ligament was identified medial to it. Long retractors were placed over the ischial spine to protect the pudendal neurovascular structures. The bladder was retracted superiorly, and the rectum medially, for optimal visualization. Two separate or a loop 1-0 polypropylene suture(s) were placed approximately 1.5 fingerbreadths medial to the ischial spine on the ligament using a needle holder. These sutures were passed through the posterior vaginal tunnel to the apex and tied to secure the vaginal apex to the ligament
Sponsors
Zeynep Kamil Maternity and Pediatric Research and Training Hospital
Study design
Observational model
COHORT
Time perspective
RETROSPECTIVE
Eligibility
Sex/Gender
FEMALE
Age
30 Years to 80 Years
Inclusion criteria
* Stage 3 or 4 apical pelvic organ prolapse * Underwent SSF between Jan 2020 and Jan 2023
Exclusion criteria
* Concomitant malignancy * Previous apical prolapse surgery
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Reoperation rate | 24 months | Reoperation rate due to prolapse recurrence within 24 months |
Secondary
| Measure | Time frame |
|---|---|
| Total operative time (in minutes) | up to 200 minutes |
| Postoperative complications (e.g. gluteal pain, hematoma) | 24 months |
| Prolapse recurrence rate (Stage ≥2 on POP-Q) | 24 months |
Countries
Turkey (Türkiye)
Outcome results
None listed