Unilateral Pectineal Suspension With Mesh

INTRODUCTION: The pectineal suspension was first described in 2010 by Banerjee and Noe in which the cervix was suspended bilaterally with mesh to the iliopectineal ligaments. Since then, many variations of pectineal suspension have been used for those who are not surgical candidates for sacrocolpopexies. Variations have included uterine preservation, location of fixation, unilateral suspension, and mesh-free suspension. OBJECTIVE: To describe the surgical technique of performing laparoscopic unilateral pectineal apical suspension with mesh. METHODS: Our patient is a 53-year-old P3013 with stage 2 pelvic organ prolapse presenting for laparoscopic supracervical hysterectomy, bilateral salpingectomy, and sacrocolpopexy. Upon sacral dissection, it was noted that there was vasculature significantly obscuring the standard site of mesh attachment. The decision was made to proceed with a pectineal suspension. The left Cooper’s ligament was isolated with dissection through the space of Retzius after backfilling the bladder. The Y Mesh was introduced and attached with tacks and Ethibond suture to the anterior and posterior cervix. The opposite end of the mesh was then tensioned and tacked to the lateral left Cooper’s ligament for apical suspension. The peritoneum surrounding the mesh was then closed with a 0-vicryl suture in purse-string fashion. RESULTS: Procedure was performed with no complications. The patient was discharged the same day with a Foley catheter after failing her active trial of void 2 hours postoperatively. She passed an active trial of void two days later in the office. She was seen in the office for a 2-week postoperative exam and was recovering well at that time. CONCLUSIONS: Unilateral pectineal suspension with mesh is a suitable option for patients who are not candidates for sacrocolpopexies.