In 2007 we started to use the pectineal ligament for a bi-lateral fixation by laparoscopic route. Meanwhile we have performed more than 1000 procedures. The Pectopexy was imbedded in a multiple compartment setting to treat additional defects (lateral defect, midline defect or rectocele and entero-cele)
To avoid a displacement of the vaginal center line we investigated the proportion of the level S1 of sacral vertebra one to the course of the ligament. By exposing the psoas muscle crossing the pectineal ligament we could define this point as the same level as S1. As the PRP tape is positioned hammock like the vaginal axes is not compromised. This could be shown in MRI as well.
2013 and 2015 we published a prospective randomized controlled trial comparing sacropexy and pectopexy. No new complications occurred and the outcome was excellent. Due to the different position of the tape the pectopexy does not compromise the hypogastric nerve fibers and the space of the pelvic passage is not reduced. The study showed no de novo defecation disorders in the pectopexy group but nearly 20% in the sacropexy group. In a multi-center trial we will recruit more than 400 procedures and hope to present in the course of 2018 the first data.
The video shows the correct positioning of the tape. This is very important to avoid de novo entero-cele. Meanwhile there are similar techniques performed, unfortunately rarely combined with a treatment of the other compartments. Jhosi from India published in the 90s a pectineal hystero-pexy by laparotomy. According to the available video the placement lateral is not on the level S1.The data presented 2013 are very good without a clear differentiation of the defects. Nevertheless the pectineal ligament is a good alternative to sacopexy reducing the disadvantages of the “gold standard”.
Head of OB/GYN Comunal Hospital of Rhein Kreis Neuss
Vice president of the International Society for Gynecological Laparoscopy (ISGE)