Our Sacrospinous Fixation (SSF) surgery results

Objective Research
Study uses samples of patients (n=101) with the sample criteria is POP-Q stage > II and selected patients
according to indication. Pelvic Organ Prolapse Quantifications System (POP-Q) is a system of assessing the
degree of prolapse of pelvic organs to help standardize diagnosing, comparing, documenting, and sharing of
clinical findings.This assessment is used the most frequently. More research publications related to pelvic organ
prolapse use the POP-Q as the measure of pelvic organ prolapse.
Study design
Research using techniques A prospective study (single arm). SSF surgery was performed in 101 patients using
self-cut mesh (Polyform: Boston Sci.) and re-usable needles Under spinal anesthesia. All patients were
followed up from 1- 3 years follow-up after the surgery.

Result
In this study found 5% patients who experienced complications in the surgical process. Consisting of Intraoperative
complications is bladder Injury (1 %), Postoperative complications that is mesh exposure (2 %), Hematoma (1 %) and
Significant PVR (> 100ml) in 1 % o found 3 anatomical recurrence and 1 Reoperation. Patients’ Satisfaction 1- year
follow-up Excellent are 40 (39.6), Very good 48 (47.5), Average 2 (2.0), Below average 2 (2.0) and 3-year follow-up
Excellent 42 (41.6), Very good 48 (47.5), Average 1 (1.0), Below average 0 (0).

Conclusion
SSF surgery provided excellent anatomical improvement not only after 1 year but also 3 years follow up.
Intraoperative and postoperative complications are relatively low. Patients’ satisfaction is relatively high at 3
years after the surgery. SSF surgery is a safe, effective and cost-efficient option of treating POP in appropriately
selected patients. It can be an alternative approach not only for recurrence cases but also as primary
management for POP.

Patients’ characteristics
VARIABLES (n=101)
Age (years) 69.7 + 6.8
Parity 2.0 + 0.8
BMI 23.8 + 3.10
Follow up period (months) 36.3 + 1.3
Operation time (min) 75.8 + 25.8
Blood loss (ml) 59.6 + 72.1
POP Stage
II 19 (18.8)
III 69 (68.3)
IV 13 (12.9)
Previous History of Operation
Hysterectomy 11(10.9)
Vaginal 1 (1.0)
Abdominal 10 (10.0)
Indication for Hysterectomy
POP 1 (1.0)
Non POP 10 (10.0)

Type of SSF and Concomitant Procedures

Variables (n= 101)

Type of SSF
A-SSF 78 (77.2)
AP- SSF 12 (11.9)
C- SSF 11 (10.9)
 Concomitant Procedure 12 (12.0)
TOT 3 (3.0)
Posterior Colporrhaphy 5 (5.0)
Cervical Amputation 1 (1.0)
Cervical Polypectomy 3 (3.0)
A-SSF= Anterior SSF, AP- SSF= Anterior Posterior SSF, C-SSF= Complete SSF
Values are expressed as frequency (percentage)

Complications and recurrence Outline

Variables (n= 101)

Complications 5 (5.0)
Intraoperative complications 1(1.0)
Bladder Injury 1 (1)
Postoperative complications 4 (4)
Mesh Exposure 2 (2)
Hematoma 1 (1)
Significant PVR (>100ml) 1 (1)

Anatomical Recurrence 3 (3)

Reoperation 1 (1)
Values are expressed as frequency (percentage)

Known complications of a sacrospinous fixation with for the treatment of pelvic organ prolapse are haemorrhage,
perforation of the bladder, rectum or small bowel, rectovaginal fistula, post-operative pain of the gluteal region and nerve
injury. In this study found 5% patients who experienced complications in the surgical process. Consisting of
Intraoperative complications is bladder Injury (1 %), Postoperative complications that is mesh exposure (2 %), Hematoma
(1 %) and Significant PVR (> 100ml) in 1 % , found 3 anatomical recurrence and 1 Reoperation. PVR > 100 mL
associated with increased risk of some urinary symptoms, but many with elevated PVR are asymptomatic, and elevations
in PVR frequently resolve within 2 years. Symptom-guided management of urinary symptoms may be more appropriate
than PVR-guided management in this population. In this study 3 % for anatomical recurrence, it is interesting to note that
the apex of the vagina generally remained well fixed deep inside the pelvis (to the sacrospinous ligament), but that the
weak point seemed to be the anterior compartment. Even after taking into account our criteria for anatomical recurrence
(descent of the anterior vaginal to orbeyond the hymenal ring), this percentage seems high. The explanation probably is
that the displacement of the vaginal axis changes the dynamic architecture of the pelvic floor resulting in a
disproportionate increase in pressure on theanterior compartment.

Comparison of Pre operative POP-Q Scores versus 1-year and 3-year follow up
Variables Preoperative 1-year follow-up 3-year follow-up

Aa +1 -2.9 a -2.9 a
Ba +3.0 -2.9 a -2.9 a
C +1.5 -6.6 a -6.4 a
Gh 5.0 3.7 a 3.4 a
Pb 3.6 3.6 b 3.5 b
TVL 8.0 7.5 a 7.4 a
Ap -0.1 -2.9 a -2.9 a
Bp -0.8 -2.9 a -2.8 a
D -2.5 -7.7 a -7.3 a
Values are expressed as the mean
Wilcoxon signed-rank test
a
: p<0.01 versus preoperative
b
: p>0.05 versus preoperative
Patients’ Satisfaction
Variables 1- year follow-up 3-year follow-
up

Excellent 40 (39.6) 42 (41.6)

Very good 48 (47.5) 48 (47.5)
Above average 8 (7.9) 10 (9.9)
Average 2 (2.0) 1 (1.0)
Below average 2 (2.0) 0 (0)
Fair 1 (1.0) 0 (0)
Poor 0 (0) 0 (0)
Values are expressed as frequency (percentage)