Posterior Prolapse Repair Utilizing Apical Fixation to the Sacrospinous Ligament

Objectives: To share our experience managing posterior vaginal prolapse using a novel procedure utilizing apical fixation to the sacrospinous ligament. This video demonstrates examples of posterior vaginal prolapse as a result of apical detachment of the rectovaginal fasica causing advanced posterior vaginal prolapse and a novel technique to correct and restore anatomy.

Methods: We performed a retrospective study of 64 women who underwent surgical repair for symptomatic posterior prolapse utilizing sacrospinous fixation at our institution. At follow-up of 8 1/2 months objective success defined as POP-Q stage less than two was 91% and subjective success defined as patient global impression of improvement of very much better or much better with 76%. In this video we present several examples of posterior vaginal defects that are a result of apical detachment. We demonstrate the steps for repair of such posterior defects utilizing sacrospinous ligament suspension.

Clinical Relevance: Posterior vaginal prolapse is commonly a result of apical detachment of the rectovaginal septum. We present a technique to correct posterior vaginal prolapse utilizing posterior fixation to the sacrospinous ligament with good success. We are comparing this approach to the traditional lateral placation techniques that have been traditionally applied.