A 65-year-old woman with vault prolapse after previous hysterectomy undergoes abdominal sacrocolpopexy. The mesh is sutured between the vaginal apex and which structure?

• A Sacral promontory (S1 vertebral body)
• B Iliac crest
• C Anterior longitudinal ligament of the sacrum (S2-S3 level) ✓
• D Ischial spine

Explanation

In abdominal sacrocolpopexy, the mesh is attached to the anterior longitudinal ligament of the sacrum at the S2-S3 level, not the sacral promontory (S1). The S2-S3 level is chosen to avoid the sacral promontory where the middle sacral vessels and common iliac vessels pose a risk of hemorrhage. The mesh is then sutured to the vaginal apex (or cuff), restoring normal vaginal axis.

Reference: Williams Gynecology, 4th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.