INTRODUCTION: This video describes the complex case of a 67-year-old patient presenting years after sacrospinous ligament fixation complicated by persistent sinus tract and gluteal abscesses refractory to multiple surgical interventions. Here, we demonstrate the final surgical approach that was able to locate the permanent suture that served as a continued nidus for infection and excision of her associated sinus tract and chronic abscesses. OBJECTIVE: The learning objectives for this video include: 1) discussing the importance of adequate history taking for complex surgical patients; 2) showcasing the utilization of 3D reconstructed MRI for surgical planning; 3) describing multidisciplinary teams' roles in managing this patient's surgical care. METHODS: This case was accomplished first through meticulous history-taking to understand the scope of this patient’s pathology and prior interventions. After that, leveraging 3D reconstructed images of her pelvic pathology using MRI data helped determine route of surgery and necessary consulting teams. While first approaching this case through the well-described retroperitoneal approach failed to locate the suture, we were able to pivot to a novel gluteal approach with our orthopedics colleagues by thorough planning and anatomic understanding. RESULTS: This video outlines a novel approach to operative management of sacrospinous ligament suspension complications refractory to commonly utilized interventions in a complex patient with a delayed surgical complication. It highlights the novel use of a 3D MRI reconstruction of her pelvis and a gluteal approach for the removal of sacrospinous ligament suture. CONCLUSIONS: Surgical preoperative planning incorporating different teams, perspectives, and imaging modalities optimized this case for success in the face of failure from traditional approaches.
Lafaire et al. (Fri,) studied this question.