13.1: Viginal Suspensory Procedures

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Page ID: 18627

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The sacrospinous ligament suspension

Sacrospinous ligament suspension (SSLS) or fixation is popular, allowing simultaneous repair of anterior or posterior vaginal wall defects with less postoperative bowel dysfunction. Infrequent complications include buttock pain or a sacral / pudendal nerve injury. The recurrence of a high cystocoele is around 22% and may be a problem. Randomized trials favour the robust abdominal approach of the sacrocolpopexy, with the reservations mentioned previously.

High uterosacral ligament suspension (HUSLS) was first reported in 1997, and suspends the vaginal apex to the remnants of the uterosacral ligaments at the level of the ischial spines, and maintains the vaginal apex in the midline. However ureteric injury occurs in up to 11% of cases, with post – op bowel dysfunction due to recto - sigmoid narrowing. But it optimizes vaginal length and provides good vaginal support. This procedure has the same principle of action as the Mayo or McCall culdoplasty, although no comparative data exist.