[Feasibility of bilateral sacrospinous ligament vaginal suspension with a stapler. Prospective studies with the 34 first cases].
OBJECTIVE
Evaluation of the feasibility of bilateral sacropinous ligament suspension with a stapler. Morbidity study and short term results.


METHODS
Prospective study from July 1994 to August 1996.


RESULTS
Bilateral sacrospinous ligament suspension with a stapler was possible in 100% of cases and surgical technique is described. Our indications are stage III Bp and stage IV genital prolapses (according to the American Urogynecologic Society classification, 1996), with or without uterus, and when a Bologna's procedure is performed, in order to prevent enterocele. In 24 patients, the uterus was present. 20 vaginal hysterectomies and 4 conservative bilateral uterine suspensions were performed. The sacrospinous ligament suspension was associated to anterior colporrhaphy (in 74% of patients), repair of rectocele (82%), repair of enterocele (26%), posterior colpoperineorrhaphy (79%), bladder neck suspension (71%). No vascular injury nor post operative constipation was noted. In 2 patients, a small rectal laceration occurred, and in one patient one branch of the staple transfixed the rectal mucosa. Removal of the staple was easily performed without any post-operative complication. First results after an average 19 months follow-up (range 9 to 32) shows a perfect anatomic result in 77% of cases. We noted one recurrence of a vaginal vault prolapse; the patient underwent a second sacrospinous ligament fixation with good result. One patient had a stage II Aa cystocele post-operatively and three patients had a short vagina (< 6 cm). Patients who were continent before the sacrocolpopexy did not develop further urinary stress-incontinence.


CONCLUSIONS
Bilateral transvaginal sacrospinous ligament suspension with a stapler facilitates the procedure. No post-operative constipation was noted with this method. Our first results are good. The cost of the stappler may limit its extensive use.
Febbraro
W
W
Clinique de Gynécologie-Obstétrique et de Reproduction Humaine, CHU, Caen.
Beucher
G
G
Von Theobald
P
P
Hamel
P
P
Barjot
P
P
Heisert
M
M
Levy
G
G
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005240:Feasibility Studies; D005260:Female; D006547:Hernia / Q000209:etiology / Q000517:prevention & control; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008875:Middle Aged; D011446:Prospective Studies; D012008:Recurrence; D013528:Surgical Staplers; D013536:Suture Techniques; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000145:classification / Q000150:complications / Q000601:surgery*; D014621:Vagina / Q000601:surgery*
Faisabilité de la sacrocolpopexie vaginale bilatérale à l'agrafeuse. Etude prospective des 34 premiers cas.