Sacrospinous ligament fixation for eversion of the vagina.

During the period from January 1, 1974, through June 30, 1987, 100 patients were treated with a sacrospinous ligament suspension of the vaginal apex at the University of Michigan Medical Center. Fifty-seven patients had a posthysterectomy complete vaginal prolapse; 38 patients, an incomplete vaginal prolapse; and five, a posthysterectomy enterocele. Fifty-one patients had had an abdominal hysterectomy and 49 a vaginal hysterectomy previously. Almost half of the patients had had at least one attempt at surgical correction of the prolapse and three patients had had four previous procedures. The immediate postoperative complications were not unexpected. Febrile morbidity responding to appropriate therapy was the most common complication. There was no surgical mortality. Seventy-one of the 78 patients were operated on greater than or equal to 1 year ago and were the subjects of the review. Sixty-four of the patients (90%) had complete symptomatic relief after operation. Ten of these patients had some asymptomatic laxity of the vaginal walls and nine others had satisfactory support but vaginal stenosis or symptoms of stress urinary incontinence after operation. Four patients developed cystoceles and three others had recurrent vaginal prolapse. The vaginal approach to the treatment of eversion of the vagina has many advantages, as reported. The surgical goals described were attained; therefore, use of the sacrospinous ligament fixation procedure as a therapeutic procedure only is defended. The surgical technique is described. Finally, the sacrospinous ligament fixation of vaginal vault prolapse should assume high priority in our therapeutic regimen.