Transvaginal iliococcygeus fixation for posthysterectomy vaginal vault prolapse repair

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Introduction and hypothesis

Posthysterectomy vaginal vault prolapse repair is a surgical challenge. Successful surgical management using native tissue can be achieved via the vaginal approach by iliococcygeus fascia fixation. However, although iliococcygeus fascia fixation is technically simple and has a low morbidity, it is not commonly performed. The aim of the video is to provide anatomic views and the surgical steps necessary to achieve successful transvaginal iliococcygeus fascia fixation for vaginal vault prolapse repair.


A 60-year-old woman with symptomatic stage III vaginal vault prolapse was admitted for transvaginal iliococcygeus fascia fixation according to the described technique.


Surgery was successful without complications. The final examination showed good apical support and preservation of vaginal length. This step-by-step video tutorial may be an important tool to improve practical surgical knowledge. In particular, proper suture positioning requires adequate pararectal space preparation and levator ani exposure, as shown in the video.


Transvaginal iliococcygeus fascia fixation is an alternative technique for apical support without the use of synthetic prosthetic materials. This technique may be indicated when an abdominal approach or a synthetic device is not recommended.

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  1. 1.

    Hill AJ, Barber MD. Apical prolapse repair: weighing the risks and benefits. Curr Opin Obstet Gynecol. 2015;27(5):373–379.

  2. 2.

    Inmon WB. Pelvic relaxation and repair including prolapse of vagina following hysterectomy. South Med J. 1963;56:577–582.

  3. 3.

    Shull BL, Capen CV, Riggs MW, Kuehl TJ. Bilateral attachment of the vaginal cuff to iliococcygeus fascia: an effective method of cuff suspension. Am J Obstet Gynecol. 1993;168(6 Pt 1):1669–1674. discussion 1674–1677.

  4. 4.

    Paz-Levy D, Yohay D, Neymeyer J, Hizkiyahu R, Weintraub AY. Native tissue repair for central compartment prolapse: a narrative review. Int Urogynecol J. 2017;28(2):181–189.

  5. 5.

    Serati M, Braga A, Bogani G, Leone Roberti Maggiore U, Sorice P, Ghezzi F, et al. Iliococcygeus fixation for the treatment of apical vaginal prolapse: efficacy and safety at 5 years of follow-up. Int Urogynecol J. 2015;26(7):1007–1012.

  6. 6.

    Milani R, Cesana MC, Spelzini F, Sicuri M, Manodoro S, Fruscio R. Iliococcygeus fixation or abdominal sacral colpopexy for the treatment of vaginal vault prolapse: a retrospective cohort study. Int Urogynecol J. 2014;25(2):279–284.

  7. 7.

    Maher CF, Murray CJ, Carey MP, Dwyer PL, Ugoni AM. Iliococcygeus or sacrospinous fixation for vaginal vault prolapse. Obstet Gynecol. 2001;98(1):40–44.

  8. 8.

    Meeks GR, Washburne JF, McGehee RP, Wiser WL. Repair of vaginal vault prolapse by suspension of the vagina to iliococcygeus (prespinous) fascia. Am J Obstet Gynecol. 1994;171(6):1444–1452. discussion 1452–1454.

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Correspondence to Stefano Manodoro.

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Written informed consent was obtained from the patient for publication of this video article and any accompanying images.

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Milani, R., Frigerio, M., Spelzini, F. et al. Transvaginal iliococcygeus fixation for posthysterectomy vaginal vault prolapse repair. Int Urogynecol J 28, 1599–1601 (2017).

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  • Iliococcygeus fascia fixation
  • Pelvic organ prolapse
  • Video tutorial
  • Native tissue repair