Hennes David, Buckley Victoria, Rosamilia Anna
Ritchie Centre, Hudson Institute of Medical Research, Clayton, VIC, 3168, Australia.
Department of Obstetrics and Gynaecology, Monash University, Clayton, VIC, 3168, Australia.
Int Urogynecol J. 2025 Apr;36(4):929-931. doi: 10.1007/s00192-024-06010-z. Epub 2024 Dec 28.
Autologous fascia lata has been increasingly utilised in pelvic floor reconstructive surgeries such as sacrocolpopexy and sacrohysteropexy. This case highlights sacrohysteropexy with autologous fascia lata as a promising option for women with advanced uterovaginal prolapse who wish to preserve their uterus and avoid synthetic mesh.
We report the case of a 65-year-old woman with stage 3 pelvic organ prolapse following one forceps and one spontaneous vaginal delivery. She presented with cervical-dominant prolapse (6 cm beyond the hymen) and a widened genital hiatus. She was initially managed with a Gellhorn pessary for 7 months, which was removed before surgery. Preoperative findings included prolapse of the cervix, anterior, and posterior vaginal walls (+ 1 cm distal to the hymen). A robot-assisted laparoscopic sacrohysteropexy with autologous fascia lata was performed.
The 120-min procedure, conducted by a certified urogynaecologist, began with harvesting a 12 × 4 cm autologous fascia lata graft from the left thigh. The graft site was closed with 2-0 absorbable sutures and supported with a compression bandage for 4 weeks. The graft was secured to the cervix and anterior longitudinal ligament through laparoscopic dissection and robot-assisted suturing. No perioperative complications occurred, and the patient was discharged on postoperative day 2. At 1-year follow-up, there was no recurrence of prolapse.
Sacrohysteropexy using autologous fascia lata is a feasible and effective alternative to synthetic mesh, providing an additional surgical treatment option for women in settings where synthetic polypropylene meshes are not approved, contraindicated, or an unacceptable option.
自体阔筋膜在盆底重建手术（如骶骨阴道固定术和骶骨子宫固定术）中的应用越来越广泛。本病例强调了自体阔筋膜骶骨子宫固定术对于希望保留子宫并避免使用合成网片的重度子宫阴道脱垂女性而言是一个有前景的选择。
我们报告了一名65岁女性的病例，该女性在经历一次产钳助产和一次自然阴道分娩后出现3期盆腔器官脱垂。她表现为以宫颈为主的脱垂（处女膜外6厘米）和增宽的生殖裂孔。她最初使用Gellhorn子宫托治疗7个月，手术前取出。术前检查发现宫颈、阴道前壁和后壁脱垂（处女膜远端1厘米）。实施了机器人辅助腹腔镜自体阔筋膜骶骨子宫固定术。
由一名认证的泌尿妇科医生进行的120分钟手术，首先从左大腿采集一块12×4厘米的自体阔筋膜移植物。移植部位用2-0可吸收缝线缝合，并用压迫绷带支撑4周。通过腹腔镜解剖和机器人辅助缝合将移植物固定在宫颈和前纵韧带上。未发生围手术期并发症，患者术后第2天出院。在1年的随访中，脱垂未复发。
使用自体阔筋膜的骶骨子宫固定术是合成网片的一种可行且有效的替代方法，为在合成聚丙烯网片未获批准、禁忌或不可接受的情况下的女性提供了额外的手术治疗选择。
