Comparación de la efectividad y seguridad de la fijación sacroespinosa unilateral versus bilateral, en el tratamiento del prolapso de la cúpula vaginal
Abstract
To compare the effectiveness and safety of unilateral fixation of the spinous sacral ligaments against bilateral
fixation, for the treatment of post-hysterectomy apical prolapse.
Methods: Randomized, controlled, non-masked clinical trial in 96 women with vaginal vault prolapse, divided into two groups:
“A”, n=50 underwent unilateral fixation technique to the sacral spinous ligament; “B”, n=46 bilateral fixation technique was
used; between 2009 and 2015, in a highly complex clinic (Armenia, Colombia).
Results: The average age was 69 ± 4.83 years. The mean time interval for follow-up after surgery was 54 months. Unilateral
fixation demands a shorter operation time (42 ± 18 minutes versus 81 ± 24 minutes, p = 0.008), with a lower mean bleeding
(117 ± 72 mL versus 261 ± 93 mL, p = 0.009). At 24 months, no differences were found in success rates (82% unilateral fixation
vs 89.13% bilateral fixation) (p> 0.05). The mean of point «C» and vaginal length, at 72 months, was -5.75 ± 1.3 and 7.0 ± 1.4,
respectively, for unilateral fixation, and -6.86 ± 0,73 and 7.5 ± 1.5, respectively, for bilateral fixation (p> 0.05).
Conclusions: Fixation to the spinous sacral ligaments is an effective and safe option for the correction of vaginal vault
prolapse; it can be performed unilaterally or bilaterally, with low recurrence and minimal complications, but with greater
technical advantages in unilateral fixation.
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References
Lowder JL, Ghetti C, Nikolajski C, Oliphant SS,
Zyczynski HM. Body image perceptions in women
with pelvic organ prolapse: a qualitative study. Am J
Obstet Gynecol. 2011; 204(5):441.e1-5. doi: 10.1016/j.
ajog.2010.12.024.
Abrams P, Cardozo L, Fall M, Griffiths D, Rosier P,
Ulmsten U, et al. The standardisation of terminology
of lower urinary tract function: report from the
Standardisation Sub-committee of the International
Continence Society. Neurourol Urodyn. 2002;
(2):167-78. doi: 10.1002/nau.10052.
Rock J, Jones H, editores. Te linde’s. Operative
gynecology. 10th ed. Philadelphia: Lippincott – Raven;
Marchionni M, Bracco GL, Checcucci V, Carabaneanu
A, Coccia EM, Mecacci F, et al. True incidence of
vaginal vault prolapse. Thirteen years of experience. J
Reprod Med [Internet]. 1999 [citado 06 de septiembre
de 2021]; 44(8):679-84. Disponible en: https://
www.reproductivemedicine.com/toc/auto_abstract.
php?id=13260
Culligan PJ. Nonsurgical management of pelvic organ
prolapse. Obstet Gynecol. 2012; 119(4):852-860. doi:
1097/AOG.0b013e31824c0806.
Toh VV, Bogne V, Bako A. Management of recurrent
vault prolapse. Int Urogynecol J. 2012; 23(1):29-34.
doi: 10.1007/s00192-011-1487-z.
Deval B, Haab F. What’s new in prolapse surgery?
Curr Opin Urol. 2003; 13(4):315-323. doi:
1097/00042307-200307000-00008
Petros PE. Vault prolapse II: Restoration of dynamic
vaginal supports by infracoccygeal sacropexy, an axial
day-case vaginal procedure. Int Urogynecol J Pelvic
Floor Dysfunct. 2001; 12(5):296-303. doi: 10.1007/
pl00004039.
Goldberg RP, Tomezsko JE, Winkler HA, Koduri S,
Culligan PJ, Sand PK. Anterior or posterior sacrospinous
vaginal vault suspension: long-term anatomic
and functional evaluation. Obstet Gynecol. 2001;
(2):199-204. doi: 10.1016/s0029-7844(01)01446-6.
Espitia-De La Hoz FJ, Orozco-Santiago L, OrozcoGallego
L. Eficacia del reparo de la procidencia
genital completa en la recuperación de la sexualidad
de las mujeres intervenidas quirúrgicamente. Rev
Col de Menopausia [Internet]. 2018 [citado 12 de
enero de 2022]; 24(1):21-31. Disponible en: http://
asomenopausia.com/r/24_1.pdf
Lee RA, Symmonds RE. Surgical repair of
posthysterectomy vault prolapse. Am J Obstet
Gynecol. 1972; 112(7):953-956. doi: 10.1016/0002-
(72)90819-8.
Holley RL, Varner RE, Gleason BP, Apffel LA, Scott
S. Recurrent pelvic support defects after sacrospinous
ligament fixation for vaginal vault prolapse. J Am Coll
Surg [Internet]. 1995 [citado 03 de septiembre de 2021];
(4):444-448. Disponible en: https://europepmc.org/
article/med/7719548
Carey MP, Slack MC. Transvaginal sacrospinous
colpopexy for vault and marked uterovaginal prolapse.
Br J Obstet Gynaecol. 1994; 101(6):536-540. doi:
1111/j.1471-0528.1994.tb13158.x.
Karram M, Goldwasser S, Kleeman S, Steele A,
Vassallo B, Walsh P. High uterosacral vaginal vault
suspension with fascial reconstruction for vaginal
repair of enterocele and vaginal vault prolapse. Am J
Obstet Gynecol. 2001; 185(6):1339-1342; discussion
-1343. doi: 10.1067/mob.2001.119077.
Klauschie JL, Cornella JL. Surgical treatment of
vaginal vault prolapse: a historic summary and review
of outcomes. Female Pelvic Med Reconstr Surg. 2012;
(1):10-17. doi: 10.1097/SPV.0b013e3182404189.
Benson JT, Lucente V, McClellan E. Vaginal versus
abdominal reconstructive surgery for the treatment
of pelvic support defects: a prospective randomized
study with long-term outcome evaluation. Am J Obstet
Gynecol. 1996; 175(6):1418-1421; discussion 1421-
doi: 10.1016/s0002-9378(96)70084-4.
Bump RC, Mattiasson A, Bø K, Brubaker LP,
DeLancey JO, Klarskov P, et al. The standardization
of terminology of female pelvic organ prolapse and
pelvic floor dysfunction. Am J Obstet Gynecol. 1996;
(1):10-17. doi: 10.1016/s0002-9378(96)70243-0.
Weber AM, Abrams P, Brubaker L, Cundiff G, Davis
G, Dmochowski RR, et al. The standardization of
terminology for researchers in female pelvic floor
disorders. Int Urogynecol J Pelvic Floor Dysfunct.
; 12(3):178-86. doi: 10.1007/pl00004033.
Amreich J. Aetiologie und Operation des
Scheidenstumpfprolapses [Etiology and surgery of
vaginal stump prolapses]. Wien Klin Wochenschr.
; 63(5):74-77.
Richter K. [The surgical anatomy of the vaginaefixatio
sacrospinalis vaginalis. A contribution to the surgical
treatment of vaginal blind pouch prolapse]. Geburtshilfe
Frauenheilkd. 1968; 28(4):321-327.
Echavarria-Restrepo LG. Fijación sacroespinosa en
el manejo del prolapso de cúpula vaginal y hernia
pélvica: diez años de experiencia (1992-2002). Rev
Col Obstet Ginecol. 2004; 55(1):37-42. doi: https://doi.
org/10.18597/rcog.609
Espitia-De La Hoz FJ. Manejo quirúrgico del prolapso
de la cúpula vaginal utilizando mallas de polipropileno
y el abordaje por vía vaginal con la fijación bilateral
al ligamento sacroespinoso. Rev Col de Menopausia
[Internet]. 2017 [citado 09 de septiembre de 2021];
(2):70-78. Disponible en: http://asomenopausia.
com/r/23_2.pdf
Beer M, Kuhn A. Surgical techniques for vault prolapse:
a review of the literature. Eur J Obstet Gynecol
Reprod Biol. 2005; 119(2):144-155. doi: 10.1016/j.
ejogrb.2004.06.042.
Mothes AR, Wanzke L, Radosa MP, Runnebaum IB.
Bilateral minimal tension sacrospinous fixation in
pelvic organ prolapse: an observational study. Eur
J Obstet Gynecol Reprod Biol. 2015; 188:1-5. doi:
1016/j.ejogrb.2015.02.022.
Espitia-De La Hoz FJ. Factores de riesgo asociados con
prolapso genital femenino: estudio de casos y controles.
Urol Colomb. 2015; 24(1):12-18. doi: 10.1016/j.
uroco.2015.03.003.
Espitia-De La Hoz FJ. Complicaciones del uso del
pesario con soporte y sin soporte en el prolapso
genital completo. MÉD UIS. 2015; 28(3):309-315.
doi:10.18273/revmed.v28n3-2015005.
Crafoord K, Sydsjö A, Johansson T, Brynhildsen J,
Kjølhede P. Factors associated with symptoms of pelvic
floor dysfunction six years after primary operation of
genital prolapse. Acta Obstet Gynecol Scand. 2008;
(9):910-915. doi: 10.1080/00016340802311243.
Nygaard IE, McCreery R, Brubaker L, Connolly
A, Cundiff G, Weber AM, et al. Abdominal
sacrocolpopexy: a comprehensive review. Obstet
Gynecol. 2004; 104(4):805-823. doi: 10.1097/01.
AOG.0000139514.90897.07.
Gilleran JP, Johnson M, Hundley A. Robotic-assisted
laparoscopic mesh sacrocolpopexy. Ther Adv Urol. 2010;
(5-06):195-208. doi: 10.1177/1756287210379120 .
Maher CF, Qatawneh AM, Dwyer PL, Carey MP,
Cornish A, Schluter PJ. Abdominal sacral colpopexy
or vaginal sacrospinous colpopexy for vaginal vault
prolapse: a prospective randomized study. Am J
Obstet Gynecol. 2004; 190(1):20-26. doi: 10.1016/j.
ajog.2003.08.031.
Yazdany T, Wong K, Bhatia NN. Sacrospinous ligament
fixation for pelvic organ prolapse in the era of vaginal
mesh kits. Curr Opin Obstet Gynecol. 2011; 23(5):391-
doi: 10.1097/GCO.0b013e32834ac743.
Rajmaheswari N, Gunasekaran G. Transvaginal
sacrospinous colpopexy for vault prolapse and for
marked uterovaginal prolapse. J Obstet Gynecol Ind
[Internet] 2004 [citado 12 de septiembre de 2021]; 54(3):
-7. Disponible en: https://jogi.co.in/dashboard/files/
transvahginal_sacrospinous_colpopexy.pdf
Faber VJ, van der Vaart HC, Heggelman BG,
Schraffordt Koops SE. Serious complication 1 year
after sacrospinous ligament fixation. Int Urogynecol
J Pelvic Floor Dysfunct. 2008; 19(9):1311-1313. doi:
1007/s00192-008-0599-6.
Visco AG, Brubaker L, Nygaard I, Richter HE, Cundiff
G, Fine P, et al. The role of preoperative urodynamic
testing in stress-continent women undergoing
sacrocolpopexy: the Colpopexy and Urinary Reduction
Efforts (CARE) randomized surgical trial. Int
Urogynecol J Pelvic Floor Dysfunct. 2008; 19(5):607-
doi: 10.1007/s00192-007-0498-2.
Espitia-De La Hoz FJ. Evaluación de la calidad de
vida en mujeres climatéricas con prolapso genital
luego del uso del pesario. Rev Col de Menopausia
[Internet]. 2018 [citado 12 de enero de 2022];
(4):7-18. Disponible en: https://docs.bvsalud.org/
biblioref/2019/04/988620/002-evaluacion-de-lacalidad-de-vida-en-mujeres-climatericas-co_jvc8xeE.
