Search

Objective: To describe the anatomy of the arcus tendineus fasciae pelvis., Material and Methods: Two fixed female cadaver pelvises (88 and 66 years old) were dissected., Results: The arcus tendineus fasciae pelvis is a 10-cm-long fibrous thickening of the pelvic fascia which is medial to the obturator internus muscle and lateral to the peritoneum. It is inserted on the ischiatic spine and courses downward and anteriorly to the pubovesical ligament. The posterior third of the arcus tendineus fasciae pelvis is fused with the posterior third of the arcus tendineus musculus levatoris ani, forming a curve with upward and anterior concavity. This portion of the arcus tendineus is thick and easy to recognise upon palpation. It is located 1cm slightly above and anterior to the ischiatic spine and 2 cm from of the pudendal vessels, which course around the posterior inferior margin of the ischiatic spine. The superior margin of the median part of the arcus tendineus fasciae pelvis is crossed laterally by vessels for the obturator internus muscle arising from the internal iliac vessels., Conclusion: In genital prolapse cure, sutures must be placed through the anterior or median parts of the arcus tendineus fasciae pelvis. In any case, they must remain anterior to the posterior part of the arcus tendineus fasciae pelvis to avoid injury to the pudendal vessels.

Objective: To reveal the anatomy of arcus tendineus fascia pelvis., Material: and methods. 2 fixed female cadaver pelvises (88 and 66 years old) were dissected., Results: The arcus tendineus fascia pelvis is a fibrous recess of the pelvic fascia which is 10 cm long, laterally to the obturator internus muscle and medially to the peritoneum. It reaches the ischial spine lower and anteriorly to the pubo-vesical ligament. The third posterior part of the arcus tendineus of the pelvic fascia is commun with the posterior part of the arcus tendineus of the levator ani. This third posterior part is like a curve concave anteriorly. This curve is thick and easy to recognize by the palpation. This third posterior curve is 1cm in front of the ischial spine and 2cm in front of the pudendal vessel which took place behind the ischial spine. The vessels of the obturator internus muscle originated from the internal iliac vessel and crossed laterally the median part of the arcus tendineus of the pelvic fascia., Conclusion: Sutures must be placed through the anterior and median part of the arcus tendineus fascia pelvis, in front of the posterior part of the arcus tendineus fascia pelvis to avoid any injury to the pudendal vessels.

Study Aim: The aim of this retrospective study was to demonstrate the feasibility of laparoscopic Jamain-Letessier procedure and to report its results., Patients and Methods: Between August 1993 and September 1997, 19 patients (mean age: 29.7 years, range: 20-39 years) with painful uterine retroversion were operated on according to a laparoscopic Jamain-Letessier procedure. A preoperative pessary test was performed in 15 patients. The procedure included suture of the uterosacral ligaments to the midline and resection of the pouch of Douglas, followed by peritoneal suture., Results: The pessary test was positive in 14 of the 15 patients. Mean operating time was 2 hours. There was no conversion to laparotomy. Postoperative urinary tract infection was observed in 3 cases. Mean postoperative hospital stay was 2.5 days. With a mean 3-year follow-up, 15 patients were completely pain-free and 2 patients were partially pain-free. The 14 patients with a positive pessary test obtained a good result., Conclusion: The pessary test is necessary for selection of patients. The Jalmain-Letessier procedure is easily performed laparoscopically and is associated with a low morbidity. With a mean 3-year follow-up, good results were obtained in 17 out of 19 patients (89%) and all patients with a positive pessary test obtained a good result.