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Sir,

We read with interest the case series presented in the above article. We have performed similar surgery for correction of symptomatic prolapse in young women wishing to preserve their uterus and desirous of future pregnancy. We have differed in the approach to attachment of the mesh. We attach a rectangular piece of mesh on the posterior surface of the vagina covering the defect in the rectovaginal septum and extend it superiorly to anchor it at cervicouterine junction, which corresponds anatomically to the attachment of the uterosacral ligaments. The posterior limb of the mesh is attached to the sacral promontory. We would raise concerns regarding the trousered graft used by the above authors as although the two limbs of the mesh are not sutured to each other anteriorly, the mesh does encircle the uterus, giving rise to our concerns about any effect on the circumferential enlargement of the uterus in subsequent pregnancy. Presumably, delivery of any subsequent pregnancy would be by caesarean section. In two of their patients, a uterosacral plication was performed with the sacrohysteropexy; was uterosacral plication alone not sufficient?

References

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  2. References
  • 1
    Buller JL, Thompson JR, Cundiff GW, et al. Uterosacral ligament: description of anatomic relationships to optimize surgical safety. Obstet Gynecol 2001;97(6):873879.
  • 2
    Barber MD, Visco AG, Weidner AC, et al. Bilateral uterosacral ligament vaginal vault suspension with site-specific endopelvic fascia defect repair for treatment of pelvic organ prolapse. Am J Obstet Gynecol 2000;183(6):14021410 (Discussion 1410–1411).
  • 3
    Ostrzenski A. A new, simplified posterior culdoplasty and vaginal vault suspension during abdominal hysterectomy. Int J Gynaecol Obstet 1995;49(1):2534.