title: Repair of recurrent vaginal vault prolapse using sacrospinous ligament fixation with mesh interposition and reinforcement.
abstract: OBJECTIVE
  Our goal was to study the efficacy of performing the repeated sacrospinous ligament fixation with mesh interposition and reinforcement in women with recurrent vaginal vault prolapse.
  
  
  METHODS
  Fifteen consecutive patients with symptomatic severe vaginal vault or uterus prolapse after previous sacrospinous ligament fixation were enrolled. The sacrospinous ligament fixation was performed with a mesh interposition between sacrospinous ligament complex and vaginal apex. The mesh was extended to anterior and posterior vaginal wall for the repair of concurrent cystocele and rectocele, if indicated. The surgical results and complications were evaluated. The prolapse evaluation was performed according to International Continence Society (ICS) ordinal stages of pelvic organ prolapse.
  
  
  RESULTS
  The mean age was 55 years. The mean follow-up was 2.9 years (range 1.0-5.5 years). Repeated sacrospinous ligament fixation was performed for all patients. Eleven were performed unilaterally to the right and four to the left. The average time for sacrospinous fixation was 20 min. The average blood loss for sacrospinous fixation was 75 ml. No major complication except one accidental rectotomy was observed. It was repaired intraoperatively without sequel. The concurrent pelvic surgeries included vaginal total hysterectomies, anterior colporrhaphies, posterior colporrhaphies, and tension-free vaginal tape procedures. No recurrence of apical prolapse was observed. However, two patients developed stage I prolapse on anterior vaginal wall (cystocele) and required no further repair. Minor postoperative complications were observed.
  
  
  CONCLUSIONS
  Repeated sacrospinous ligament fixation with mesh interposition and reinforcement is a safe and effective procedure for the correction of recurrent vault prolapse. The extended implanted mesh can be used for the repair of concurrent cystorectocele effectively. A long-term follow-up is necessary to detect any late complication.
authors.affiliation: Division of Urogynecology, Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital, Linkou Medical Center, Kwei-shan, Tao-Yuan Hsien, Taiwan, Republic of China. 2378@adm.cgmh.com.tw
authors.forename: Tsia-Shu
authors.initials: TS
authors.lastname: Lo
authors.forename: Shang-Gwo
authors.initials: SG
authors.lastname: Horng
authors.forename: Huei-Jean
authors.initials: HJ
authors.lastname: Huang
authors.forename: Shu-Jane
authors.initials: SJ
authors.lastname: Lee
authors.forename: Ching-Chung
authors.initials: CC
authors.lastname: Liang
mesh_terms: D000328:Adult; D000368:Aged; D002681:China / Q000453:epidemiology; D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods; D006801:Humans; D008022:Ligaments / Q000601:surgery*; D008875:Middle Aged; D012008:Recurrence; D012445:Sacrococcygeal Region; D013526:Surgical Mesh; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000453:epidemiology* / Q000209:etiology / Q000473:pathology / Q000601:surgery*