Chirurgia

Colposospensione post-isterectomia alla fascia del m. ileo-coccigeo

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Il prolasso vaginale implica un ampio spettro di alterazioni anatomiche che variano dal modesto descensus fino all’eversione totale della vagina. Esso si può accompagnare ad un’alterazione funzionale sia a carico del basso tratto urinario che della regione ano-rettale, con eventuale compromissione della sfera sessuale. La prevalenza di prolasso urogenitale è superiore al 30% nelle donne di età compresa tra 20 e 59 anni che si sottopongono a valutazione ginecologica (1-3).

Si isola il muscolo ileo-coccigeo e si applicano tre punti per ogni lato con un monofilamento a lento riassorbimento per la sospensione della cupola vaginale.

Questa procedura può essere utilizzata quando la via d’accesso intraperitoneale non è praticabile (11,21).

Le percentuali di successo sono sovrapponibili a quelle ottenute con la procedura di colposospensione al legamento sacrospinoso (22). La sospensione alla fascia ileo-coccigea assicura un orientamento più anatomico dell’asse vaginale rispetto alla sospensione al legamento sacrospinoso, e previene il rischio di danno del plesso pudendo. Siccome la distanza fra il punto apicale della vagina e l’ileo-coccigeo è maggiore rispetto alla spina ischiatica, esiste un rischio più frequente di riduzione della lunghezza della vagina.

Muscolo ileo-coccigeo: costituisce la parte laterale e posteriore del muscolo elevatore dell’ano. Nasce dalla spina ischiatica e dall’arco tendineo e si inserisce sui due ultimi segmenti del coccige. Alcuni suoi fasci si uniscono con le fibre controlaterali sul rafe ano-coccigeo.  

Questa tecnica è un valido intervento chirurgico che assicura un orientamento più anatomico dell’asse vaginale rispetto alla sospensione al sacro spinoso, e previene il rischio di eventuale danno al plesso pudendo. Considerando che il punto apicale della sospensione all’ileo-coccigeo è distale rispetto alla spina ischiatica, ciò potrebbe comportare una riduzione della lunghezza della vagina.

Conclusioni:  la colposospensione al muscolo ileo-coccigeo è una tecnica ormai ben conosciuta i cui risultati hanno dato e continuano a dare grande soddisfazione . L’ancoraggio al muscolo ileo-coccigeo se da un lato corregge bene il primo livello di De Lancey dall’altro resta comunque un ancoraggio anomalo, su un muscolo non deputato a tale funzione. 

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