Milani Rodolfo, Frigerio Matteo, Manodoro Stefano
San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
ASST Monza, Ospedale San Gerardo, U.O. Ginecologia, Via Pergolesi, 33 - 20900, Monza, MB, Italy.
Int Urogynecol J. 2017 Jul;28(7):1103-1105. doi: 10.1007/s00192-016-3255-6. Epub 2017 Jan 9.
Posthysterectomy vaginal vault prolapse repair is a challenge for urogynecologists. Surgical management can be successful with native tissue by the vaginal approach with sacrospinous ligament fixation. However, severe complications have been described, including nerve injury and life-threatening hemorrhage.
A 68-year-old woman with symptomatic stage III vaginal vault prolapse was admitted for transvaginal sacrospinous ligament fixation according to the described technique.
The surgical procedure was successful without complications. The final examination revealed excellent apical support and preservation of vaginal length. This step-by-step video tutorial may be an important tool for improving surgical knowledge, thus leading to a reduction in the risk of complications. In particular proper suture positioning requires adequate preparation of the pararectal space and exposure of the sacrospinous ligament, as shown in the video.
Transvaginal sacrospinous ligament fixation is a safe and effective technique for apical support without the use of prosthetic materials. Adequate preparation of the pararectal space, direct visualization of the sacrospinous ligament and proper suture positioning are the key points in minimizing the risk of complications.
子宫切除术后阴道穹窿脱垂修复术对妇科泌尿医生来说是一项挑战。通过阴道入路利用自体组织行骶棘韧带固定术进行手术治疗可能会成功。然而，已有严重并发症的报道，包括神经损伤和危及生命的出血。
一名68岁有症状的Ⅲ期阴道穹窿脱垂女性患者，根据所述技术入院接受经阴道骶棘韧带固定术。
手术过程顺利，无并发症。最终检查显示顶端支持良好且阴道长度得以保留。这个分步视频教程可能是提高手术知识的重要工具，从而降低并发症风险。特别是如视频所示，正确的缝线定位需要充分准备直肠旁间隙并暴露骶棘韧带。
经阴道骶棘韧带固定术是一种不使用假体材料进行顶端支持的安全有效技术。充分准备直肠旁间隙、直接观察骶棘韧带以及正确的缝线定位是将并发症风险降至最低的关键要点。
