Long-term analysis of the surgical management of pelvic support defects

• Published in: American journal of obstetrics and gynecology Vol. 171; no. 6; pp. 1518 - 1528
• Main Authors: Porges, Robert F., Smilen, Scott W.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.12.1994
• Subjects: cystorectocele; Enterocele; Female; Humans; Hysterectomy, Vaginal; Ligaments - surgery; Medical Illustration; Middle Aged; Pelvis - surgery; Postoperative Complications; Prolapse; Rectal Diseases - surgery; Recurrence; Retrospective Studies; sacrospinous ligament fixation; Time Factors; Urinary Bladder Diseases - surgery; uterine prolapse; Uterine Prolapse - surgery; vaginal hysterectomy; uterine prolapse; cystorectocele; vaginal hysterectomy; sacrospinous ligament fixation; Enterocele
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/0002-9378(94)90395-6

Objective: The aim of this study was to determine the success of various procedures to correct defects of pelvic support and to elucidate the role of sacrospinous ligament fixation in primary versus nonprimary vaginal operations. Study Design: This study was a retrospective analysis, covering 23 years, of 486 patients treated for pelvic support defects, grouped according to the location and severity of the defect, type of repair, and outcome. Results: For primary repairs the recurrences were more frequent the more severe the defect, but this relationship did not hold for repeat surgery. Sacrospinous ligament fixation, when performed concurrently with vaginal hysterectomy for patients with third-degree prolapse in primary cases reduced the rate of recurrence from 15.8% to 6.7%. Conclusion: The original degree and type of pelvic support defect is important in selecting the appropriate operative procedure for the highest likelihood of cure. There may be a wider role for sacrospinous ligament fixation in primary operations for patients with severe defects.