Important anatomical structures used in paravaginal defect repair: Cadaveric study


Ersoy M., Sagsoz N., Bozkurt M. C. , APAYDIN N., Elhan A., TEKDEMİR İ.

European Journal of Obstetrics and Gynecology and Reproductive Biology, vol.112, no.2, pp.206-213, 2004 (Peer-Reviewed Journal) identifier identifier

  • Publication Type: Article / Article
  • Volume: 112 Issue: 2
  • Publication Date: 2004
  • Doi Number: 10.1016/j.ejogrb.2003.06.015
  • Journal Name: European Journal of Obstetrics and Gynecology and Reproductive Biology
  • Journal Indexes: Science Citation Index Expanded, Scopus
  • Page Numbers: pp.206-213
  • Keywords: Paravaginal defect repair, Tendinous arch of levator ani, Tendinous arch of pelvic fascia

Abstract

Objective: To examine the variations and the anatomical characteristics of the tendinous arch of pelvic fascia (TAPF), the tendinous arch of levator ani (TALA) and the obturator fascia (Ofa) that are important structures in paravaginal defect repair and their relations with important neurovascular structures. Study design: We carried our study on 10 pelvic halves of five female cadavers fixed in 10% formaldehyde. Results: TALA could show a very high location or a low location near to inferior edge of obturator internus. TAPF was not observed in four of the cases. It was examined as a quite weak structure in two of the cases. The location of obturator vessel-nerve bundle could show difference. Obturator artery (OA) and vein sometimes do not course parallel to obturator vein (OV) and make an inclination and extend to the obturator foramen (OF). The distance between TAPF and the pectineal ligament (PL) (Cooper ligament) was measured as 5cm on average. The distance between TAPF and the entrance of obturator canal was measured as 3.2cm on average. While the distance of pudendal vessel-nerve bundle from levator ani (LA) at the anterior border of the spine was 0mm, 2cm anteriorly it was measured as 4.4mm on average. Conclusion: Since TAPF does not develop in every case, it is not a safe structure to be used in surgery. If TALA develop downward as a variation, it could be difficult to distinguish from TAPF. Since the obturator fascia is a thin membrane, it is not a strong structure for suture placement. The region that is 2cm in front of the ischial spine (IS) is a dangerous zone for pudendal vessel-nerve bundle. © 2003 Elsevier Ireland Ltd. All rights reserved.