BILATERAL SACROSPINOUS LIGAMENT FIXATION COMBINED WITH A GRAFT AUGMENTED POSTERIOR REPAIR

I.A. Oyama, A.C. Steinberg, M. Feloney, M.H.T. Grody, A.S. Holzberg, J. Maccarone

UMDNJ/RWJMS-Camden, Cooper University Hospital, Camden, NJ

OBJECTIVE: This study was undertaken to describe the objective outcomes following a bilateral sacrospinous ligament fixation with a concomitant posterior repair using porcine dermis.

MATERIALS AND METHODS: This was a retrospective study looking at all patients (42) who received a bilateral sacrospinous ligament fixation and a posterior repair with porcine dermis in 2002 for symptomatic pelvic prolapse. The Baden-Walker classification was used to stage pelvic prolapse.  Comparisons were made between the preoperative values and the most recent postoperative exam by using the Mantel Haenszal Mean Score. 

RESULTS:  The mean age of the patients was 59.9 +/-11.5 years.  Patients had a mean follow up of 8.3 +/-7.19 months. Preoperatively 33% (14/42) had first degree, 52.4 % (22/42) had second degree and 14.3% (6/42) had third degree posterior vaginal wall prolapse.  Apically 47.6% (20/42) had first degree, 31% (13/42) had second degree and 19 % (8/42) had third degree prolapse. Postoperatively there was a decrease in apical and posterior compartment prolapse (p <.0001). At the apex on most recent postoperative exam, 86% had no prolapse, 12% had first degree and 2% had second degree prolapse.  The posterior compartment similarly showed 81% with no prolapse, 17% with first degree and 2% with second degree prolapse.  When analyzed separately, each preoperative stage of prolapse showed a significant improvement postoperatively (p<.0001).  Age, hormone replacement therapy and medical conditions such as hypertension, diabetes, and hypothyroidism did not influence outcome.

CONCLUSION: Bilateral sacrospinous ligament fixation concomitantly with posterior repair using porcine dermis is effective in correcting apical and posterior compartment defects.

Key Words:  bilateral sacrospinous ligament fixation, posterior compartment prolapse, apical prolapse, porcine dermis

Disclosure - Speakers Bureau: A.S. Holzberg, Pfizer; Proctor, BARD, Inc.; J. Maccarone, Pfizer, Proctor, BARD, Inc.; Consultant: A.S. Holzberg, Boston Scientific.