Lowest colpopexy sacral fixation point alters vaginal axis and cul-de-sac depth

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Objective: To determine the variation in vaginal axis and posterior cul-de-sac depth when the lowest suture used to attach the sacrocolpopexy mesh to the anterior longitudinal ligament is anchored at different levels. Study Design: At five lumbosacral mesh attachment sites, the anterior vaginal wall axis angle was measured relative to a line between the lowest border of the pubic symphysis and fourth sacral (S4) foramen in 9 unembalmed cadavers. The vertical distance from S4 to the posterior mesh was measured as a surrogate of cul-de-sac depth. Results: From a mesh fixation point at the lower border of S2 to a point at the lower border of L5, there was a 3-fold increase in both vaginal axis angle (13.04 ± 3.19 vs 42.88 ± 4.16 cm) and distance from S4 to the posterior mesh (2.50 ± 0.61 vs 7.38 ± 1.30 cm) between these points. Conclusion: During sacrocolpopexy, progressively cephalad sacral attachment increases vaginal axis angle and cul-de-sac depth.

Original languageEnglish (US)
JournalAmerican Journal of Obstetrics and Gynecology
Issue number6
Publication statusPublished - Jun 2013



  • posterior cul-de-sac
  • sacrocolpopexy
  • vaginal axis

ASJC Scopus subject areas

  • Obstetrics and Gynecology

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