Outcomes of Native Tissue Sacrospinous Ligament Fixation with Unilateral Deschamp Needle Suture Ligature
Chopra V, Irish V, and Atiemo H. Outcomes of Native Tissue Sacrospinous Ligament Fixation with Unilateral Deschamp Needle Suture Ligature. Neurourol Urodyn 2019; 38:S239-S240.
Introduction: The prevalence of pelvic organ prolapse (POP) is 3-6% based on symptoms and up to 50% when based on examination. Risk factors for POP include vaginal birth, obesity, smoking and fetal macrosomia. Randall and Nichols described sacrospinous ligament fixation (SSLF) in 1971 which was found to have a 63% success rate at 2-years by the OPTIMAL trial. This study describes our institutional outcomes of SSLF using the Deschamps needle passer. Methods: IRB approval was obtained for a retrospective chart review of patients who underwent unilateral SSLF using the Deschamp needle passer. Primary and secondary outcomes measured change in pelvic organ quantification stage and urinary symptom scores (AUASS, ISI, PFDI-20), respectively. Failure defined as occurrence of prolapse related reoperation. Our cohort consisted of patients who underwent SSLF using Deschamps, performed by a single surgeon from 2012-2017; excluding patients who underwent SSLF with another device. Paired t-test and Wilcoxin rank-sum test were used for normal distribution and non-normal distribution, respectively. P-value < 0.05 was considered statistically significant. Results: Thirty-four patients met the inclusion criteria. Mean age of the population was 65.11 years (+/-8.8 years). Of the sample size, 62% White, 32% Black, 3% American Indian, 3% declined. The mean parity was 2.97 (+/-1.34). The median follow-up time was 10 months (-/+ 9 months). The median preoperative POP-Q stage was 3 (+/-0.52) and median postoperative POP-Q stage was 0 (+/-1.09) [p<0.001]. Median preoperative AUASS score was 15 and median postoperative AUASS score was 10 [p<0.001]. No patient required prolapse related reoperation. Analysis of the PFDI-20 revealed statistical improvement in the POPDI-6 [p = 0.006] with no difference in the CRAD-8 or the UDI-6 scores. Conclusion: Within short-term follow up, the Deschamps needle passer for SSLF was associated with a high success rate, improved prolapse related symptom scores and POP-Q stages. Although SSLF technique was not specifically described in the OPTIMAL trial, the Deschamps needle passer appears to have a high success rate. The Extended OPTIMAL trial concluded a surgical failure rate of 61.5% and 70.3% with USLF and SSLF at 5-years with no statistically significant improvement between symptom scores. Long term follow-up of this cohort will determine if similar outcomes are noted.