Comparison of Anterior and Posterior Approach Bilateral Sacrospinous Ligament Fixation for Vaginal Vault Prolapse
Background: We aimed to investigate the outcomes of anterior and posterior approaches in patients who underwent sacrospinous ligament fixation for apical prolapse. Methods: The study included hysterectomized women with grade ≥2 apical prolapse according to the Pelvic Organ Prolapse Quantification (P...
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IMR Press
2023-10-01
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| Series: | Clinical and Experimental Obstetrics & Gynecology |
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| Online Access: | https://www.imrpress.com/journal/CEOG/50/10/10.31083/j.ceog5010216 |
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| author | Fatih Şahin Ramazan Adan |
| author_facet | Fatih Şahin Ramazan Adan |
| author_sort | Fatih Şahin |
| collection | DOAJ |
| description | Background: We aimed to investigate the outcomes of anterior and posterior approaches in patients who underwent sacrospinous ligament fixation for apical prolapse. Methods: The study included hysterectomized women with grade ≥2 apical prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system, who presented to our center between 2019 and 2022. Out of the 48 patients included in the study, 24 underwent posterior bilateral sacrospinous ligament fixation (PB-SSLF), while the other 24 underwent anterior bilateral sacrospinous ligament fixation (AB-SSLF). Postoperative anatomical recurrence of anterior vaginal wall prolapse, according to the POP-Q system, was defined as follows: cystocele ≥ stage II (Aa or Ba ≥–1 cm), recurrent apical prolapse ≥ stage II (C ≥–1 cm), and posterior vaginal wall prolapse ≥ stage II (Ap or Bp ≥–1 cm). Postoperative follow-up visits were scheduled routinely at 1, 3, 6, and 12 months after the operation, and then annually. Complications were recorded according to the Clavien-Dindo classification. Rates in the groups were compared using the Chi-square test. Independent two-group comparisons of numerical variables were performed using the Student t-test when the normal distribution assumption was met and the Mann-Whitney U test when the assumption was not met. The significance level (alpha) was set at p < 0.05. Results: No significant difference was observed in terms of postoperative anterior recurrence between the groups that underwent bilateral anterior and posterior SSLF (16.7% each). Regarding the operation durations, the group that underwent AB-SSLF had longer operation times compared to the group that underwent PB-SSLF (80 minutes and 42.5 minutes, respectively). A higher incidence of postoperative urinary dysfunction was observed in patients who underwent anterior bilateral sacrospinous ligament fixation (p = 0.012). No grade 3b or higher complications were observed according to the Clavien-Dindo classification. Conclusions: AB-SSLF is an effective method in the surgical treatment of apical and anterior pelvic prolapse. However, the anterior compartment failure rate is still a limitation. Further research is required to investigate its long-term efficacy. |
| format | Article |
| id | doaj-art-2d17b588142e4629b83a7bc5f765482f |
| institution | DOAJ |
| issn | 0390-6663 |
| language | English |
| publishDate | 2023-10-01 |
| publisher | IMR Press |
| record_format | Article |
| series | Clinical and Experimental Obstetrics & Gynecology |
| spelling | doaj-art-2d17b588142e4629b83a7bc5f765482f2025-08-20T03:18:32ZengIMR PressClinical and Experimental Obstetrics & Gynecology0390-66632023-10-01501021610.31083/j.ceog5010216S0390-6663(23)02223-6Comparison of Anterior and Posterior Approach Bilateral Sacrospinous Ligament Fixation for Vaginal Vault ProlapseFatih Şahin0Ramazan Adan1Department of Obstetrics and Gynecology, Prof. Dr. Cemil Tascıoglu City Hospital, 34384 Istanbul, TurkeyDepartment of Obstetrics and Gynecology, Prof. Dr. Cemil Tascıoglu City Hospital, 34384 Istanbul, TurkeyBackground: We aimed to investigate the outcomes of anterior and posterior approaches in patients who underwent sacrospinous ligament fixation for apical prolapse. Methods: The study included hysterectomized women with grade ≥2 apical prolapse according to the Pelvic Organ Prolapse Quantification (POP-Q) system, who presented to our center between 2019 and 2022. Out of the 48 patients included in the study, 24 underwent posterior bilateral sacrospinous ligament fixation (PB-SSLF), while the other 24 underwent anterior bilateral sacrospinous ligament fixation (AB-SSLF). Postoperative anatomical recurrence of anterior vaginal wall prolapse, according to the POP-Q system, was defined as follows: cystocele ≥ stage II (Aa or Ba ≥–1 cm), recurrent apical prolapse ≥ stage II (C ≥–1 cm), and posterior vaginal wall prolapse ≥ stage II (Ap or Bp ≥–1 cm). Postoperative follow-up visits were scheduled routinely at 1, 3, 6, and 12 months after the operation, and then annually. Complications were recorded according to the Clavien-Dindo classification. Rates in the groups were compared using the Chi-square test. Independent two-group comparisons of numerical variables were performed using the Student t-test when the normal distribution assumption was met and the Mann-Whitney U test when the assumption was not met. The significance level (alpha) was set at p < 0.05. Results: No significant difference was observed in terms of postoperative anterior recurrence between the groups that underwent bilateral anterior and posterior SSLF (16.7% each). Regarding the operation durations, the group that underwent AB-SSLF had longer operation times compared to the group that underwent PB-SSLF (80 minutes and 42.5 minutes, respectively). A higher incidence of postoperative urinary dysfunction was observed in patients who underwent anterior bilateral sacrospinous ligament fixation (p = 0.012). No grade 3b or higher complications were observed according to the Clavien-Dindo classification. Conclusions: AB-SSLF is an effective method in the surgical treatment of apical and anterior pelvic prolapse. However, the anterior compartment failure rate is still a limitation. Further research is required to investigate its long-term efficacy.https://www.imrpress.com/journal/CEOG/50/10/10.31083/j.ceog5010216apical prolapseanterior approachbilateral sacrospinous ligament fixation (bsslf)pelvic organ prolapse |
| spellingShingle | Fatih Şahin Ramazan Adan Comparison of Anterior and Posterior Approach Bilateral Sacrospinous Ligament Fixation for Vaginal Vault Prolapse Clinical and Experimental Obstetrics & Gynecology apical prolapse anterior approach bilateral sacrospinous ligament fixation (bsslf) pelvic organ prolapse |
| title | Comparison of Anterior and Posterior Approach Bilateral Sacrospinous Ligament Fixation for Vaginal Vault Prolapse |
| title_full | Comparison of Anterior and Posterior Approach Bilateral Sacrospinous Ligament Fixation for Vaginal Vault Prolapse |
| title_fullStr | Comparison of Anterior and Posterior Approach Bilateral Sacrospinous Ligament Fixation for Vaginal Vault Prolapse |
| title_full_unstemmed | Comparison of Anterior and Posterior Approach Bilateral Sacrospinous Ligament Fixation for Vaginal Vault Prolapse |
| title_short | Comparison of Anterior and Posterior Approach Bilateral Sacrospinous Ligament Fixation for Vaginal Vault Prolapse |
| title_sort | comparison of anterior and posterior approach bilateral sacrospinous ligament fixation for vaginal vault prolapse |
| topic | apical prolapse anterior approach bilateral sacrospinous ligament fixation (bsslf) pelvic organ prolapse |
| url | https://www.imrpress.com/journal/CEOG/50/10/10.31083/j.ceog5010216 |
| work_keys_str_mv | AT fatihsahin comparisonofanteriorandposteriorapproachbilateralsacrospinousligamentfixationforvaginalvaultprolapse AT ramazanadan comparisonofanteriorandposteriorapproachbilateralsacrospinousligamentfixationforvaginalvaultprolapse |