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Transvaginal iliococcygeus fixation for posthysterectomy vaginal vault prolapse repair

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Abstract

Introduction and hypothesis

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.

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References

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Author information

Correspondence to Stefano Manodoro.

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Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

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Milani, R., Frigerio, M., Spelzini, F. et al. Transvaginal iliococcygeus fixation for posthysterectomy vaginal vault prolapse repair. Int Urogynecol J 28, 1599–1601 (2017). https://doi.org/10.1007/s00192-017-3315-6

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Keywords

  • Iliococcygeus fascia fixation
  • Pelvic organ prolapse
  • Video tutorial
  • Native tissue repair