Sacrospinous Ligament Fixation Under Local Anesthesia in Elderly Patients at High Risk of General Anesthesia

ABSTRACT

Introduction and Hypothesis: Sacrospinous ligament fixation(SSLF) is a commonly used surgical procedure in pelvic organ prolapse due to high treatment success rates. Many intraoperative and postoperative anesthesia-related obstacles may be encountered by the elderly population. Local anesthesia alone or with intravenous sedation may provide simple, cheap, and safe anesthesia. For elderly patients at high risk for general anesthesia according to the American Society of Anesthesiologists(ASA), it is better to operate through the vaginal route under local anesthesia. To perform minimal invasive SSLF surgery, the Pelvic Floor Repair Tissue Fixing Anchor, which is a target-specific system, can be used. In this prospective observational study, evaluation was made of elderly patients who underwent SSLF under local anesthesia. Materials and Methods: The study included 11 patients evaluated as high risk for general and regional anesthesia who underwent SSLF under local anesthesia as pelvic organ prolapse surgery. All operations were performed by a single experienced surgeon using 1% lidocaine infiltration and the Pelvic Floor Repair Tissue Fixing Anchor system. Results: The mean age of the patients was 69.6 years. Stage IV prolapse was determined in 7 (63.6%) patients, 4 (36.3%) had a history of hysterectomy, 5 (45.4%) were classified as ASA 3, and 6 (54.6%) as ASA 4. No complications occurred and patients were followed up for 24 months. In two patients, recurrence of POP was observed at postoperative 8 and 10 months, respectively. Conclusions: The results of this study demonstrated the surgical and anesthetic safety of SSLF under local anesthesia for pelvic organ prolapse in elderly patients.

Keywords::

• Anesthesia high-risk
• local anesthesia
• pelvic organ prolapse
• sacrospinous ligament fixation

DECLARATION OF INTEREST

The authors report no conflicts of interest. The authors alone are responsible for the content and writing of the paper.

AUTHORS CONTRIBUTION

Mehmet Baki Şentürk: Study conception and design, critical revision, and acquisition of data.

Ozan Doğan: Study conception and design, manuscript writing, and ethics approval, Editing of manuscript, analysis, and interpretation of data

AUTHORSHIP CREDITS

The authors declare that are qualified for authorship and have participated sufficiently in the work to take public responsibility for appropriate portions of the content. The authors declare that; the authors made a substantial contribution to the concept or design of the work; or acquisition, analysis or interpretation of data, drafted article, or revised it critically for important intellectual content, approved the version to be published, and each author have participated sufficiently in the work and take public responsibility for appropriate portions of the content.