# Native tissue repair of the female pelvic floor: A four‐level surgical concept

## TL;DR

This paper presents a surgical concept for repairing the female pelvic floor by addressing multiple anatomical levels and structures.

## Contribution

The paper introduces a four-level surgical approach for pelvic floor repair, emphasizing comprehensive anatomical restoration.

## Key findings

- Complex pelvic floor repair should consider vaginal support across all three Delancey's levels.
- Repair should also include the external and internal anal sphincters for complete restoration.
- Illustrations were created to better understand multi-level pelvic floor defects.

## Abstract

This review describes our experience with native tissue repair of the visceral pelvic fascia, the perineum, and anal sphincters in women. We propose that complex repair of the pelvic floor should consider vaginal support in all three anatomical Delancey's levels, together with more caudal structures—the external and internal anal sphincters. Original illustrations were created to facilitate the understanding of the complex anatomy of common multi‐level defects. As the integrity of connective tissue adds to various aspects of the delicate function of the female pelvic floor, it is complete and as perfect as possible repair is a common goal of both gynecologists and colorectal specialists.

Practical illustrated surgical anatomy of female pelvic floor, from vaginal apex to anal verge.