A New Technique for Sacrospinous-Sacrotuberous Fixation for the Treatment of Uterovaginal and Vaginal Vault Prolapse A Randomized Controlled Trial

Abstract

Apical prolapse is a rather frequent encounter either as a primary finding in patients with pelvic organ prolapse or following vaginal hysterectomy. Several operations and different approaches were presented to manage such a problem. One of the most performed procedure is the sacrospinous ligament fixation. In 1892, Zweifel was the first to describe a vaginal vault reconstructive surgery anchoring the prolapsed vault to the sacrotuberous ligament. Amreich and Reichter introduced sacrospinous ligament fixation some 70 years ago. Since then, the operation was a subject to several modifications aiming to make it more effective, easier to perform and free of complications. The vaginal approach is by far the most performed. It has been described using a variety of instruments including blunt, angular Deschamps ligature carrier, the Miya Hook ligature carrier and the Shutt Suture Punch System. The Autosuture Endostitch, which is originally designed for endoscopic surgery, was introduced by Schlesinger in 1997. Quiet recently, vaginal mesh kits were used but rapidly fell in disuse because of mesh related complications.