VM13 - Transvaginal Sacrospinous Ligament Suture Rectopexy

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Purpose/Background: Ventral mesh rectopexy is widely used for treating obstructed defecation syndrome (ODS); however, concerns about mesh-related complications have prompted the development of alternative, minimally invasive techniques. This study assesses the outcomes of transvaginal sacrospinous ligament suture rectopexy.

Methods/Interventions: This retrospective cohort study included 190 patients who underwent transvaginal sacrospinous ligament suture rectopexy for obstructed defecation syndrome (ODS) between January 2018 and May 2024. We followed up with patients who had completed at least one year of postoperative follow-up. Perioperative data, as well as follow-up assessments using ultrasound and POP-Q measurements, were evaluated.
Surgical Technique:
A horizontal incision was made along the midline of the posterior vaginal wall, followed by blunt dissection to the sacrospinous ligaments bilaterally. A 0-polydioxanone suture was placed into each ligament using a Capio Slim suturing device, approximately 2–2.5 cm medial to the ischial spine. Sutures were passed through the lateral rectal ligament and muscular layer around 7–8 cm above the anal verge to suspend the rectum. Bilateral rectal suspension was followed by sutures to secure the posterior vaginal wall to the rectum for additional support. Posterior colporrhaphy was performed as needed.

Results/Outcomes: At the 30-month follow-up, 87.3% of patients reported subjective improvement in all ODS symptoms, with 66.7% achieving anatomical success, defined as a rectal compression ratio of less than 50%, and 77.3% showing a compression ratio of less than 20%. Short-term outcomes included a mean estimated blood loss of 63.9 ± 59.8 mL and a mean operative time of 78.5 ± 37.8 minutes. Concomitant procedures were performed in a substantial number of patients, with 65.3% undergoing apical prolapse repair, 86.2% having posterior repair, and 60% receiving mid-urethral sling placement. Postoperative complications within 30 days included urinary retention in 29.8% of patients and rectal injuries in 4 cases, two of which required intraoperative repair. The overall reoperation rate was 3.7%, with no major infections, sepsis, or mortalities observed​

Conclusion/Discussion: Transvaginal sacrospinous ligament suture rectopexy proves to be a safe, effective, and minimally invasive alternative for treating obstructed defecation syndrome (ODS) and partial rectal prolapse, offering promising outcomes over both short- and long-term follow-ups. The majority of patients experienced significant symptomatic and anatomical improvements, with a high success rate sustained over 30 months. Despite some short-term complications, such as urinary retention and minor rectal injuries, the procedure demonstrated a low reoperation rate and no major adverse events, reinforcing its role as a viable mesh-free option in the surgical management of ODS. Further studies are warranted to evaluate its long-term durability and broader clinical application.