Abstract

Introduction: Vaginal reconstructive surgery should consider repairing all compartments and levels of vaginal support to pre- vent recurrence. Delancey’s Level III repair, commonly forgotten or not considered in prolapse surgeries, allows the recovery of the anatomy of the genital hiatus (GH) and turn the vaginal axis to horizontal in standing position, changing the force vectors and not allowing the displacement of the anterior wall over the weak hiatus and therefore vaginal protrusion under stress. Objective: To determine whether there is a relationship between the size of the postoperative urogenital hiatus and the descent in level I and II in women who have undergone surgery for sacrospinous fixation. Methods: An analytical retrospective study was made. The data- base of the urogynecology unit of the Guillermo Grant Benavente Hospital was used. All patients who were operated with the sacrospinous fixation technique for apical and anterior defects were evaluated during their 12-month follow-up, using the POPQ scale. Univariate analysis using absolute and relative fre- quencies. Bivariate analysis with Pearson's correlation test. Results: 98 patients were included in the study. Average age was 65.4 (SD 7,846). Average parity was 3.6. 91.4% were bilateral and 8.6% unilateral sacrospinous fixations. 53.3% were anterior access and 46.7% posterior access. 8.5% had concomitant hyster- ectomy. When correlating GH size with point C descent, there was no significance (p=0.245). When correlating GH size with Ba point descent, a significant relationship was determined (p=0.047). Conclusions: The size of the urogenital hiatus in the postoperative pe- riod in women who have been treated with sacrospinous fixation is related to the descent of the anterior wall at 1-year follow-up. This justifies the performance of routine perineoplasty in patients with a wide hiatus, as a measure of correction of level III and anterior wall recurrence