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Operations: Sacrospinous fixation

Insurance code: P2450

Introduction: This information is written by John Fairbank and is provided for the benefit of his patients. Additional information will be given during consultation in the clinic and during the pre-operative discussion. It is not appropriate for all surgeons’ individual practice or for all patients.

Purpose of operation: Sacrospinous fixation is a type of vaginal repair operation which attaches the top of the vagina to a strong ligament providing elevation and a long term repair for certain types of prolapse.

Description of procedure: The posterior wall of the vagina is opened. The sacrospinous ligament is identified by direct vision or by palpation. Any separate hernias are identified and corrected. Two strong sutures (PDS) are inserted through the vaginal skin and through the ligament in such a way that they are fixed at one end and free running at the other. The vaginal skin is repaired with stitch material and the PDS sutures are then pulled to lift the vagina until it is held against the sacrospinous ligament. A vaginal pack is inserted to prevent bruising and a catheter is left in the bladder to allow drainage for 24-48 hours.

Anaesthetic: This operation can be carried out under either a general anaesthetic or with a spinal anaesthetic that uses local anaesthetic and a slight sedative.

Length of stay: The length of stay depends on post-operative recovery but four nights stay would be typical.

Potential complications
Complications at the time of surgery include peri-operative bleeding, and damage to structures such as bladder and bowel. These complications are rare but require corrective surgery immediately or as soon as a problem is recognised. Venous thrombosis (DVT) can follow any pelvic surgery. Stockings are therefore worn and heparin injections given each day to reduce the risk. Early mobilisation and early discharge from hospital reduce the risk of thrombosis. Infection in the vaginal skin is common because of proximity to the bowel and anti-biotics are given at the time of surgery to reduce risk of infection. If offensive discharge, increasing pain or unusual bleeding are noted during the post-operative phase a course of anti-biotics may be necessary. Elevating and straightening the vagina also straightens the urethra which may allow urine to flow easier. This will often correct bladder outflow obstruction but can sometimes lead to incontinence. If this happens a second day case procedure is required once the vaginal skin has healed to regain full continence. The PDS sutures used for this repair take about 9 weeks to dissolve and since they are sharp it is usually sensible to avoid intercourse until they have dissolved.

Post-operative consultation
A routine appointment is normally booked for six weeks to ensure the vagina is well healed although other appointments may be necessary to ensure the post-operative course goes smoothly.

Other considerations
Sex is best avoided until the skin has healed and sutures have dissolved. This may take up to nine weeks. Heavy lifting is best avoided for three months to prevent stitches giving way but light lifting is not a problem. Driving short distances is practical once comfortable and strong sedative pain killers are no longer being taken.

Relevant websites

Information on the surgical repair of prolapse.

Information on some issues related to vaginal prolapse repair surgery.

A good description of the operation with a picture.