MIGS Fellow Cleveland Clinic Florida Weston, Florida, United States
Objectives: To review an approach to treating pelvic organ prolapse in a patient with a J pouch.
Methods: This video will review the native tissue repair options, review the anatomy of a J pouch, and demonstrate an alternative approach to safely performing an apical suspension in someone with difficult anatomy.
Clinical Relevance: In patients with a complicated surgical history and pelvic adhesive disease, it is necessary to have alternative approaches to safely performing surgery. This video offers tips for how to successfully complete pelvic organ prolapse surgery in someone with difficult anatomy. The case presented has a history of a J pouch and during laparoscopy it was noted that the pouch was densely adhered to the right pararectal space. Given the location of the pouch, a uterosacral ligament suspension was unable to be performed and a left sacrospinous ligament fixation was instead chosen for apical suspension. Since the J pouch crossed the midline, the decision was made to complete the left sacrospinous ligament fixation under laparoscopic guidance to prevent injury.
