Urogynecology Unit, Nimes University Hospital, Nimes, France.
Urogynecology Unit, GHOL Group, Nyon Hospital, Nyon, Switzerland.
Int Urogynecol J. 2022 Dec;33(12):3519-3527. doi: 10.1007/s00192-022-05092-x. Epub 2022 Feb 28.
Anterior bilateral sacrospinous ligament fixation (ABSSLF) was first described in 2000 but only evaluated in a limited number of studies. However, due to the FDA's ban on transvaginal mesh, interest in this technique has re-emerged. The SSLF procedure is known for its inherent high risk for anterior compartment failure; hence, in our center we started performing a preemptive concomitant anterior repair with the intention to reduce such risk. The aim of this study was to review the feasibility and clinical outcomes of this innovative technique.
We performed a retrospective cohort study of all the women who had an ABSSLF and a concomitant anterior native tissue repair between May 2019 and July 2020 in a tertiary hospital in France. Our primary endpoint was surgical feasibility, while as secondary endpoints we wanted to explore the perioperative morbidities and clinical outcomes associated with this technique.
A total of 50 women were operated on in the studied period. The median follow-up time was 10 [8.5] months. It was feasible to perform the combined ABSSLF and concomitant anterior native tissue repair in all cases. The most frequent perioperative complications reported were urinary tract infection (14%) and difficulty in resuming voiding (16%). Anatomical and functional results were improved. The rate of anterior compartment recurrence was 37%.
ABSSLF with a concomitant anterior native tissue repair is feasible and relatively safe for treating anterior and apical pelvic prolapse. However, anterior compartment failure rate is still a limitation. Further larger studies with long-term anatomical and functional results comparing this technique to alternative transvaginal surgical approaches are needed.
前双侧骶棘韧带固定术（ABSSLF）于 2000 年首次描述，但仅在有限数量的研究中进行了评估。然而，由于 FDA 禁止使用阴道网片，人们对这项技术重新产生了兴趣。SSL 固定术以其前盆腔失败的固有高风险而闻名；因此，在我们中心，我们开始进行预防性同期前修补术，以降低这种风险。本研究旨在回顾这种创新技术的可行性和临床结果。
我们对 2019 年 5 月至 2020 年 7 月在法国一家三级医院接受 ABSSLF 和同期前固有组织修复的所有女性进行了回顾性队列研究。我们的主要终点是手术可行性，次要终点是探讨与该技术相关的围手术期并发症和临床结果。
研究期间共有 50 名女性接受了手术。中位随访时间为 10 [8.5] 个月。所有病例均可行联合 ABSSLF 和同期前固有组织修复。报告的最常见围手术期并发症是尿路感染（14%）和排尿困难（16%）。解剖和功能结果得到改善。前盆腔复发率为 37%。
ABSSLF 联合同期前固有组织修复治疗前盆腔和顶盆腔脱垂是可行且相对安全的。然而，前盆腔失败率仍然是一个限制。需要进一步开展更大规模的研究，以比较该技术与替代阴道手术方法的长期解剖和功能结果。
