Transvaginal iliococcygeus fixation for posthysterectomy vaginal vault prolapse repair.
OBJECTIVE
Posthysterectomy vaginal vault prolapse repair is a surgical challenge. Successful surgical management using native tissue can be achieved via the vaginal approach by iliococcygeus fascia fixation. However, although iliococcygeus fascia fixation is technically simple and has a low morbidity, it is not commonly performed. The aim of the video is to provide anatomic views and the surgical steps necessary to achieve successful transvaginal iliococcygeus fascia fixation for vaginal vault prolapse repair.


METHODS
A 60-year-old woman with symptomatic stage III vaginal vault prolapse was admitted for transvaginal iliococcygeus fascia fixation according to the described technique.


RESULTS
Surgery was successful without complications. The final examination showed good apical support and preservation of vaginal length. This step-by-step video tutorial may be an important tool to improve practical surgical knowledge. In particular, proper suture positioning requires adequate pararectal space preparation and levator ani exposure, as shown in the video.


CONCLUSIONS
Transvaginal iliococcygeus fascia fixation is an alternative technique for apical support without the use of synthetic prosthetic materials. This technique may be indicated when an abdominal approach or a synthetic device is not recommended.
San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Rodolfo
R
Milani
San Gerardo Hospital, University of Milano-Bicocca, Monza, Italy.
Matteo
M
Frigerio
Infermi Hospital, University of Milano-Bicocca, Rimini, Italy.
Federico
F
Spelzini
ASST Monza, Ospedale San Gerardo, U.O. Ginecologia, Via Pergolesi, 33, 20900, Monza, MB, Italy. stefano.manodoro@gmail.com.
Stefano
http://orcid.org/0000-0002-1837-0806
S
Manodoro
D005260:Female; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D056887:Pelvic Organ Prolapse / Q000601:surgery*; D011183:Postoperative Complications / Q000601:surgery*
Iliococcygeus fascia fixation; Native tissue repair; Pelvic organ prolapse; Video tutorial