An anatomic evaluation of the sacrospinous ligament colpopexy.

A series of 31 sacrospinous ligament suspensions performed for correction of genital prolapse between 1980 and 1986 is reviewed. The success rate was 81 per cent. A cadaver dissection of the sacrospinous ligament was also performed with the same approach used at operation. This was done to understand better the relationships involved, to identify areas of potential complications and to improve the technique used. A dense fascia covers the coccygeus muscle, and care should be taken not to confuse this with the sacrospinous ligament. The possibility of injury to the nearby vessels and nerves can be avoided with the careful placement of suture through the sacrospinous ligament and two fingerbreadths medial to its insertion on the ischial spine. At the conclusion of the suspension, the vaginal apex should be intimately attached to the coccygeus muscle and sacrospinous ligament complex. The use of absorbable suture has been recommended by some, but the success of the procedure may be increased by using permanent suture. If anatomic relationships of the nearby structures are remembered, sacrospinous ligament suspension can be a safe, effective and relatively simple procedure for the correction of severe prolapse of the vaginal vault.