TITLE:
Sacrospinous Fixation in the Gynecology Department of Hôpital du Mali
AUTHORS:
Traoré Alassane, Sissoko Abdoulaye, Coulibaly Mamadou Bakary, Traoré Soumana Oumar, Sima Mahamadou, Bocoum Amadou, Traoré Soumaila, Touré Moustapha, Tegueté Ibrahima, Traoré Youssouf
KEYWORDS:
Sacrospinous Fixation, Genital Prolapse, Hôpital du Mali
JOURNAL NAME:
Open Journal of Obstetrics and Gynecology,
Vol.11 No.1,
January
20,
2021
ABSTRACT: Sacrospinous
fixation (SSF) or Richter’s intervention (RI) aims to treat genital prolapse by
securing the posterior vaginal wall to the small sacrospinous ligament. It is
performed by low approach and includes a dissection of the pararectal space,
visual exposure of the sacrospinous ligament and a needle with strait needle
holder with nonabsorbable threads. It is often associated with a more complex
corrective procedure, including cystocele cure, vaginal hysterectomy and
posterior myorrhaphy. The objective of this study is to report the results of
SSF in the gynecology department of Hopital du Mali. A descriptive study was
conducted from September 2014 to September 2015 concerning 37 patients operated
on for uterine prolapse (UP). All patients with grade III UP were included in
our study in whom a unilateral hysterectomy (UH) and sacrospinous fixation
(SSF) were performed. All the patients were scheduled. Preoperatively they had
benefited from an assessment and a pre-anesthetic consultation. Hospitalization
of at least 24 hours prior to the operation was required. Postoperative
follow-up was two years with a physical examination at 3 months, 9 months and
15 months, and phone calls between physical consultations. During the study
period, we performed 37 RIs. The mean age of the patients was 48 years with
extremes of 41 to 73 years. The large multiparity was found out in 35 cases
(94.59%), the pauciparous were two with 3 deliveries for each. Long labor of
more than 18 hours was found out in 9 patients (24.32%) and home delivery in 13
cases (35.13%). The duration of the occurrence of prolapse was at least two
years and 35 patients were going through menopause. The type of anesthesia used
for the surgery was spinal anesthesia for all patients. The average duration of
the operation was 90 minutes. Complications occurred in three patients or 8.10%
of cases, two cases of acute urine retention and one case of hematoma of the
para-rectal space. The medium time of hospital stay was 5 days. The anatomical
result was satisfactory in all patients. However, two patients presented with
grade II rectocele one year after the operation. Sacrospinous fixation is a technique
suitable for our patients who present with genital prolapse with extreme laxity
of the suspension ligaments. Well done, it brings anatomical satisfaction and
its complications are rare and slight.