title: How to manage peroperative haemorrhage when vaginally treating genital prolapse.
abstract: Surgery of genital prolapse causes haemorrhagic complications in about 1% of cases. The pelvis is highly vascular and accessing the usual landmarks of vaginal surgery, in particular the sciatic spine, is delicate work. Meticulous dissection of closed spaces is often difficult, and exposure and haemostatic procedures will be challenging in the event of any bleeding complication. When fixing prosthesis to the sacrospinous ligament, the inferior gluteal artery and its coccygeal branch are at risk. Fixation to the sacrospinous ligament must be performed more than 25mm away from the sciatic spine and, if possible, must not transfixiate it. Safe insertion of prosthesis requires sufficient experience, and an adequate learning curve. Being aware of vascular anatomy allows one to understand and treat haemorrhagic incidents. Packing or selective embolization seem to be the two methods to adopt, depending on the severity of bleeding and the conditions of exposure on the one hand, and on the technical resources available for embolization, on the other. Hypogastric ligature appears to be ineffective in this context.
authors.affiliation: Department of Gynecology, Lille University Hospital, Lille 59000, France. Electronic address: henriazais@gmail.com.
authors.forename: H
authors.initials: H
authors.lastname: Azaïs
authors.affiliation: Department of Gynecology, Lille University Hospital, Lille 59000, France.
authors.forename: A
authors.initials: A
authors.lastname: Bassil
authors.affiliation: Department of Gynecology, Lille University Hospital, Lille 59000, France.
authors.forename: G
authors.initials: G
authors.lastname: Giraudet
authors.affiliation: Department of Gynecology, Lille University Hospital, Lille 59000, France.
authors.forename: C
authors.initials: C
authors.lastname: Rubod
authors.affiliation: Department of Gynecology, Lille University Hospital, Lille 59000, France.
authors.forename: J-P
authors.initials: JP
authors.lastname: Lucot
authors.affiliation: Department of Gynecology, Lille University Hospital, Lille 59000, France.
authors.forename: M
authors.initials: M
authors.lastname: Cosson
mesh_terms: D005260:Female; D006470:Hemorrhage / Q000628:therapy*; D006488:Hemostasis, Surgical / Q000379:methods; D006801:Humans; D007431:Intraoperative Complications / Q000628:therapy*; D008022:Ligaments / Q000601:surgery; D012445:Sacrococcygeal Region / Q000098:blood supply; D014596:Uterine Prolapse / Q000601:surgery*; D014621:Vagina / Q000601:surgery
keywords: Gynaecological surgery; Pelvic haemorrhages; Pelvic organ prolapse; Pelvic vascular anatomy; complication