Summary of sacrospinous colpopexy, a technique used to treat vaginal vault prolapse. Also is called Americh-Richter technique, in honor to the surgeon that popularizes it in Europe.

1. Sacrospinous colpopexy
(Amreich-Richter technique)

2. Vaginal vault prolapse
 Concept: After hysterectomy when the
apex of the vagina descends below the
introitus so that the vagina turns inside out.
 Symptoms: vaginal bulge, pressure,
discomfort, difficulty voiding or defecating,
and sexual dysfunction.
 Diagnosis: history and psysical examination.

3. Vaginal vault prolapse
Treatment:
o Non-surgical management: pessaries and
Kegel exercise
o Surgical management: sacrospinous
colpopexy, sacrocolpopexy, uterosacral
colpopexy, colpocleisis…

4. Sacrospinous colpopexy: technique
1. Anterior and posterior median colpotomy.
2. Reconstruction of anterior compartment.
3. Disecction of pararrectal space to ishial spines and reflect
rectum medially with Breisky-Navratil retractor.
4. Visualization of right sacospinous ligament.
5. Insertion of No.0 deleayed absorbable polydioxanone suture
into the right sacospinous ligament 2 cm medial to ischial spine,
using a Deschamps/Miya Hook device or with direct suture.

5. Sacrospinous colpopexy: technique
6. Retrieved sutures with a nerve hook.
7. Bring the stitches out to the apex of the vagina and
fixed there to make a pulley suture.
8. Plicated rectovaginal fascia with the perineum and
close vaginal incision.
9. Tied the sutures and it will pull the vault to
sacrospinous ligament.

6. Sacrospinous colpopexy: technique

7. Sacrospinous colpopexy: results
 Objetive results: between 67-97%.
o Anatomical recurrence: cystocele (30%), vaginal vault
prolapse (10%).
 Subjetive results: 70-98%.
 Low rate of complications: rectal injury, buttock pain,
dyspareunia, hemorrhage.
 Cost: 2000-4000$

8. Sacrospinous colpopexy: conclusion
Is a cost-effective procedure, that can be
done at places with low financial resources.

9. THANKS