Lowest colpopexy sacral fixation point alters vaginal axis and cul-de-sac depth

• Published in: American journal of obstetrics and gynecology Vol. 208; no. 6; pp. 488.e1 - 488.e6
• Main Authors: Balgobin, Sunil, MD, Good, Meadow M., DO, Dillon, Shena J., MD, Corton, Marlene M., MD
• Format: Journal Article
• Language: English
• Published: United States Mosby, Inc 01-06-2013
• Subjects: Aged; Aged, 80 and over; Cadaver; Douglas' Pouch - anatomy & histology; Female; Gynecologic Surgical Procedures - methods; Humans; Longitudinal Ligaments - anatomy & histology; Lumbosacral Region - anatomy & histology; Middle Aged; Obstetrics and Gynecology; posterior cul-de-sac; Pubic Symphysis - anatomy & histology; sacrocolpopexy; Surgical Mesh; Uterine Prolapse - pathology; Uterine Prolapse - surgery; Vagina - anatomy & histology; vaginal axis; sacrocolpopexy; posterior cul-de-sac; vaginal axis
• ISSN: 0002-9378; 1097-6868
• DOI: 10.1016/j.ajog.2013.03.006

Objective To determine the variation in vaginal axis and posterior cul-de-sac depth when the lowest suture used to attach the sacrocolpopexy mesh to the anterior longitudinal ligament is anchored at different levels. Study Design At five lumbosacral mesh attachment sites, the anterior vaginal wall axis angle was measured relative to a line between the lowest border of the pubic symphysis and fourth sacral (S4) foramen in 9 unembalmed cadavers. The vertical distance from S4 to the posterior mesh was measured as a surrogate of cul-de-sac depth. Results From a mesh fixation point at the lower border of S2 to a point at the lower border of L5, there was a 3-fold increase in both vaginal axis angle (13.04 ± 3.19 vs 42.88 ± 4.16 cm) and distance from S4 to the posterior mesh (2.50 ± 0.61 vs 7.38 ± 1.30 cm) between these points. Conclusion During sacrocolpopexy, progressively cephalad sacral attachment increases vaginal axis angle and cul-de-sac depth.