Sacrospinous Ligament Fixation
Sacrospinous Ligament Fixation
SSLF – Sacrospinous Ligament Fixation
Definition and Indication:
SSLF is a surgical procedure for the treatment of apical vaginal prolapse (the apex of the vagina). Correction of vaginal vault prolapse in women after hysterectomy, or central repair in women with prolapse of the uterus itself who wish to preserve the uterus. This is a reconstructive surgery that aims to return the vaginal vault or uterus to its normal anatomical position by fixing it to the sacrospinous ligament.
Description of the procedure:
During the operation, a transvaginal dissection is performed to identify the sacrospinous ligament (usually on the right side), and the vagina or cervix is fixed to the ligament with permanent sutures (usually Prolane or Ethibond). The procedure can be performed alone or as part of a pelvic floor reconstruction that includes anterior and/or posterior repairs as needed.
Variation in the procedure technique:
SSLF is a technically diverse procedure, and it can be performed with different approaches depending on the surgeon’s preference and the patient’s anatomical characteristics. Unilateral (usually right) or bilateral fixation can be performed, using one or more sutures to fix the vagina or cervix to the sacrospinous ligament. The sacrospinous ligament can be accessed through the posterior or anterior wall of the vagina. There are a large number of dedicated devices, guidance systems, and unique sutures on the market (such as Capio®, Miya Hook®, Deschamps and others) manufactured by different companies, which allows for customization, improved performance, and reduced complications. Today, there are also techniques for fixing the sacrospinous ligament without dissection (Enplace, Mendite, and others).
Possible risks and complications:
Nerve damage, especially the pudendal nerve – may cause chronic pain or dyspareunia.
Bleeding – due to proximity to major blood vessels in the area (inferior gluteal artery, obturator artery).
Infection.
Non-absorbable suture reaction and granulation tissue formation.
Pelvic pain or pain localized to the buttocks or thigh.
Recurrence of prolapse, or new development of prolapse, mainly anterior.
Tilting of the vaginal angle, mainly to the right, to the point of difficulty in sexual intercourse.
Success rates:
The procedure is reported to have a high success rate, around 80-90%, in preventing recurrence of apical prolapse in the short term. and moderate. Overall satisfaction with the surgery is high, but chronic pain may occur in some women (5-10%).
