What Is Sacrospinous Ligament Fixation?

Sacrospinous ligament fixation (SSLF) is a vaginal surgery that resuspends the apex (top) of the vagina — or the cervix/uterus if it is being preserved — to the sacrospinous ligament, a strong ligament on the side of the pelvis that runs between the ischial spine and the sacrum.

SSLF is used to treat apical prolapse, which includes:

  • Vaginal vault prolapse — the top of the vagina drops after a hysterectomy
  • Uterine prolapse — when the uterus descends and the patient wishes to preserve the uterus (hysteropexy)
  • Combined prolapse — often performed alongside anterior and/or posterior repair

Why Choose SSLF?

SSLF is an excellent option for women who want a mesh-free vaginal repair, who prefer a shorter recovery than abdominal/robotic surgery, or who have medical reasons that make an abdominal procedure less ideal.

Who Is a Candidate?

Ideal Candidates

  • Symptomatic apical prolapse (post-hysterectomy vault or uterine prolapse)
  • Want to avoid mesh or abdominal surgery
  • Prefer a single-day vaginal procedure
  • Older patients or those with medical comorbidities limiting abdominal surgery
  • Need combined anterior/posterior repair at the same operation

May Not Be Ideal For

  • Very short vaginal length (may limit suture placement)
  • Young, highly active women seeking the most durable option — robotic sacrocolpopexy may be a better fit
  • Patients with recurrent failure of prior vaginal repairs
  • Severe obesity with specific anatomic concerns

How the Procedure Works

SSLF is performed entirely through the vagina — there are no abdominal incisions. Your surgeon uses permanent or delayed-absorbable sutures to anchor the vaginal apex to the sacrospinous ligament on one or both sides.

The Steps

  • Anesthesia: general or regional (spinal)
  • Position: dorsal lithotomy
  • Incision: posterior or apical vaginal incision
  • Dissection: the sacrospinous ligament is identified through the pararectal space
  • Sutures: 2–3 permanent or delayed-absorbable sutures are placed into the ligament
  • Suspension: the vaginal apex is lifted and anchored to the ligament — unilateral or bilateral depending on anatomy
  • Closure: the vaginal incision is closed; cystoscopy confirms ureter integrity

At-a-Glance

  • Duration: 60–120 minutes (longer when combined with anterior/posterior repair)
  • Incisions: vaginal only — no abdominal scars
  • Hospital stay: outpatient or 1-night observation
  • Catheter: usually overnight, removed with a voiding trial
  • Often combined with: anterior repair, posterior repair, midurethral sling

Success & Durability

SSLF has strong published outcomes, especially for apical support, with over 30 years of clinical data.

Outcome Result
Apical support success 80–90%
Symptom improvement Very high
Recurrent prolapse requiring re-operation ~10–15% over 5–10 years
Return to normal activity 6 weeks

Compared with abdominal/robotic sacrocolpopexy, SSLF has a shorter recovery and no mesh, but sacrocolpopexy offers a slightly higher long-term anatomic success rate. We discuss the trade-offs for your situation.

Recovery

Week 1

  • Mild to moderate pelvic or buttock discomfort is common
  • Some women notice right-sided buttock pain from the pudendal nerve area — usually resolves within 4–6 weeks
  • Pain controlled with oral medications
  • Light walking encouraged; no heavy lifting (>10 lbs)

Weeks 2–6

  • Gradual return to most daily activities
  • No intercourse, tampons, or swimming until your surgeon clears you (usually 6 weeks)
  • Follow-up pelvic exam to confirm healing

Beyond 6 Weeks

  • Resume exercise, sexual activity
  • Continue measures to protect the repair — weight, bowel habits, cough control
  • Pelvic floor physical therapy as recommended

Risks & Potential Complications

SSLF is a well-studied, generally safe procedure, but as with any surgery there are potential risks:

  • Buttock pain on the side of the suspension — common, almost always temporary
  • Recurrent prolapse — in the same or a different compartment
  • Bleeding — rare; the sacrospinous ligament area has large vessels that are carefully avoided
  • Nerve injury — rare, usually transient
  • Bladder or ureter injury — uncommon, identified at surgery with cystoscopy
  • Urinary retention — usually short-term
  • New-onset stress urinary incontinence — can occur after any prolapse repair; often treated with a concurrent or later sling
  • Dyspareunia (discomfort with sex) — uncommon

Frequently Asked Questions

Does this surgery use mesh?

No. SSLF is a native-tissue, mesh-free repair. The vaginal apex is anchored with sutures to your own ligament.

Will I have a scar?

The incision is inside the vagina — no visible scar.

Can I preserve my uterus?

Yes. SSLF can be done as a hysteropexy — the uterus is resuspended rather than removed. We will discuss whether this is appropriate for you.

Should I choose SSLF or robotic sacrocolpopexy?

Both are excellent. Sacrocolpopexy tends to be more durable long-term and is favored for younger, very active women. SSLF avoids mesh and abdominal surgery, and is especially good when combined with other vaginal repairs. We will recommend the best fit for your anatomy and goals.

Is the buttock pain permanent?

No. Some women feel discomfort on the side of the suspension in the first few weeks — almost always it resolves completely within 4–6 weeks.

Restore Apical Support Without Mesh

If you have apical prolapse and want a durable, mesh-free repair with a short recovery, sacrospinous ligament fixation may be right for you. Our experienced pelvic reconstructive surgeons perform SSLF alongside comprehensive anterior and posterior repair when needed.

  • ✅ Mesh-free, all-vaginal approach
  • ✅ Same-day or single-night stay
  • ✅ Combined with anterior/posterior repair and sling when appropriate
  • ✅ Experienced female pelvic medicine team
Schedule Your Consultation

Call 678-344-8900 to speak with our team