SACROSPINOUS LIGAMENT FIXATION FOR VAGINAL VAULT PROLAPSE - COMPLICATIONS AND RESULTS

Sixty-nine patients with vaginal vault prolapse or enterocele were treated with 70 sacrospinous ligament fixation procedures over 9 years at the UCLA Medical Center. Patients' records were reviewed, and the individual patients were interviewed by telephone and questionnaire. Median follow-up was 42 months. Sixty-six patients previously had undergone a hysterectomy, and 53 patients previously had had surgery for pelvic relaxation, with 11 patients having had 3 or more prior surgeries. Patients were evaluated by physical examination and, when indicated, urodynamics. Concomitant with the sacrospinous ligament fixation, 3 vaginal hysterectomies, 32 anterior colporrhaphies, 44 posterior colporrhaphies, 16 Pereyra, and 3 Kelly procedures were performed. Mean blood loss was 456 ml, and mean operating time was 163 minutes. Two procedures were abandoned intraoperatively, 1 following enterotomy and 1 secondary to excessive hemorrhage. There were 5 other intraoperative complications: 2 enterotomies, 2 cystotomies, and 1 massive hemorrhage. Twenty-eight patients (40%) had one or more minor postoperative complications. Three patients (4%) have chronic urinary retention, and 1 had a persistent lumbr plexus neuropathy. Among 61 evaluable patients, 3 (5%) had recurrent symptomatic pelvic relaxation (2 cystoceles, 1 recurrent vault prolapse), and 3 (5%) had new onset postoperative stress urinary incontinence. Fifty patients responded to questions regarding postrepair coital function. Thirty-six (72%) had satisfactory coitus, 8 (16%) were not longer coitally active, and 6 (12%) had suboptimal function. We conclude that (1) significant intraoperative and immediate postoperative complications of sacrospinous ligament fixation are uncommon but may be life-threatening, persistent, and debilitating, (2) new onset stress urinary incontinence is rare in patients who have undergone sacrospinous ligament fixation, and (3) adequate coital function is restored by sacrospinous liagment fixation in 86% (36/42) of patients who are sexually active.