ABSTRACT

OBJECTIVE:

To evaluate our surgical experience with iliococcygeus fixation for enterocele and vaginal vault prolapse repair. DESIGN: Prospective longitudinal study. SETTING: Tertiary care referral centre, St. George’s Hospital, London.

METHOD:

Comprehensive questionnaire for pre- and postoperative prolapse, urinary, bowel, and sexual symptoms, a pre and postoperative site-specific vaginal examination following the standardized International Continence Society scoring for prolapse, preoperative urodynamic studies, analysis of surgical results. POPULATION: 32 consecutive women who underwent bilateral iliococcygeus fixation. OUTCOME MEASURES: Feasibility of the procedure, intra- and postoperative complications, short-term postoperative prolapse-associated symptoms and pelvic organ prolapse quantification.

RESULTS:

Three patients were lost for follow-up. The mean postoperative follow up for the reminder 29 patients (90.6%) was 11.5±6.25 months (range 6-25). Twenty-five patients (78.1%) had a previous hysterectomy. Concomitant surgery was performed in 30 patients (93.7%). The iliococcygeus fixation was completed successfully in all cases. The mean blood loss per surgical procedure was 224±104 ml (range 100-400). There were no intraoperative complications. Postoperatively, one patient needed a blood transfusion, one had transitory left leg pain, and four had temporary voiding difficulty. The mean hospitalization time was 4.5±1.9 days (range 3-9). There was a statistically significant improvement in all pelvic organs prolapse quantification measurements (p<0.0001). Three patients (10.3%) had recurrence of vault prolapse or enterocele. The mean total vaginal length was shorter postoperatively (7.2±0.8 cm versus 8.6±1.0 preoperatively, p<0.001).

CONCLUSIONS:

iliococcygeus fixation is a relatively safe vaginal surgery for the treatment of enterocele and vaginal vault prolapse.