Comparación de la efectividad y seguridad de la fijación sacroespinosa unilateral versus bilateral, en el tratamiento del prolapso de la cúpula vaginal

Abstract

Objective: To compare the effectiveness and safety of unilateral fixation of the spinous sacral ligaments against bilateral fixation, for the treatment of post-hysterectomy apical prolapse. Methods: Randomized, controlled, non-masked clinical trial in 96 women with vaginal vault prolapse, divided into two groups: “A”, n=50 underwent unilateral fixation technique to the sacral spinous ligament; “B”, n=46 bilateral fixation technique was used; between 2009 and 2015, in a highly complex clinic (Armenia, Colombia). Results: The average age was 69 ± 4.83 years. The mean time interval for follow-up after surgery was 54 months. Unilateral fixation demands a shorter operation time (42 ± 18 minutes versus 81 ± 24 minutes, p = 0.008), with a lower mean bleeding (117 ± 72 mL versus 261 ± 93 mL, p = 0.009). At 24 months, no differences were found in success rates (82% unilateral fixation vs 89.13% bilateral fixation) (p> 0.05). The mean of point «C» and vaginal length, at 72 months, was -5.75 ± 1.3 and 7.0 ± 1.4, respectively, for unilateral fixation, and -6.86 ± 0,73 and 7.5 ± 1.5, respectively, for bilateral fixation (p> 0.05). Conclusions: Fixation to the spinous sacral ligaments is an effective and safe option for the correction of vaginal vault prolapse; it can be performed unilaterally or bilaterally, with low recurrence and minimal complications, but with greater technical advantages in unilateral fixation.