Abstract
Introduction and hypothesis
Women with high-grade uterovaginal prolapse have a higher incidence of levator injury, larger levator hiatal defects, and are at a greater risk of recurrent prolapse after pelvic organ prolapse (POP) surgery. RCOG guidelines have recommended prophylactic sacrospinous suspension at the time of vaginal hysterectomy, whenever there is a marked uterovaginal prolapse. The aim of the video is to describe our surgical approach at the time of surgery for advanced POP, and describe the technique for modified McCall high extraperitoneal vault suspension.
Methods
We have modified the McCall culdoplasty by extending the dissection of the middle portion of the uterosacral/cardinal ligaments so that the sutures can be placed higher and more laterally extraperitoneally to re-support the vaginal cuff at the time of a vaginal hysterectomy.
Results
The video highlights the surgical technique used for apical support at the time of surgery for advanced POP.
Conclusions
This video demonstrates our modified McCall technique for vault suspension at the time of vaginal surgery for advanced POP. This technique could be considered an alternative technique to other modes of apical support.
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References
Symmonds RE, Pratt JH. Vaginal prolapse following hysterectomy. Am J Obstet Gynecol. 1960;79:899–909.
Toozs-Hobson P, Boos K, Cardozo L. Management of vaginal vault prolapse. BJOG. 1998;105:13–7. https://doi.org/10.1111/j.1471-0528.1998.tb09343.x.
Barrington JW, Edwards G. Posthysterectomy vault prolapse. Int Urogynecol J Pelvic Floor Dysfunct. 2000;11:241–5. https://doi.org/10.1007/s001920070033.
Marchionni M, Bracco GL, Checcucci V, et al. True incidence of vaginal vault prolapse. Thirteen years of experience. J Reprod Med. 1999;44:679–84.
DeLancey JO. The anatomy of the pelvic floor. Curr Opin Obstet Gynecol. 1994;6:313–6.
Rahn DD, Stone RJ, Vu AK, et al. Abdominal hysterectomy with or without angle stitch: correlation with subsequent vaginal vault prolapse. Am J Obstet Gynecol. 2008;199:669.e1–4. https://doi.org/10.1016/j.ajog.2008.07.051.
Margulies RU, Rogers MAM, Morgan DM. Outcomes of transvaginal uterosacral ligament suspension: systematic review and metaanalysis. Am J Obstet Gynecol. 2010;202:124–34. https://doi.org/10.1016/j.ajog.2009.07.052.
Cruikshank SH, Cox DW. Sacrospinous ligament fixation at the time of transvaginal hysterectomy. Am J Obstet Gynecol. 1990;162:1611–5; discussion 1615. https://doi.org/10.1016/0002-9378(90)90927-Y.
Barber MD, Brubaker L, Burgio KL, et al. Comparison of 2 transvaginal surgical approaches and perioperative behavioral therapy for apical vaginal prolapse: the OPTIMAL randomized trial. JAMA. 2014;311:1023–34. https://doi.org/10.1001/jama.2014.1719.
De Boer TA, Milani AL, Kluivers KB, et al. The effectiveness of surgical correction of uterine prolapse: cervical amputation with uterosacral ligament plication (modified Manchester) versus vaginal hysterectomy with high uterosacral ligament plication. Int Urogynecol J Pelvic Floor Dysfunct. 2009;20:1313–9. https://doi.org/10.1007/s00192-009-0945-3.
Pal M, Bandyopadhyay S. Modified extraperitoneal uterosacral ligament suspension for prevention of vault prolapse after vaginal hysterectomy. Int Urogynecol J. 2019;30:633–7. https://doi.org/10.1007/s00192-018-3669-4.
Chene G, Tardieu A-S, Savary D, et al. Anatomical and functional results of McCall culdoplasty in the prevention of enteroceles and vaginal vault prolapse after vaginal hysterectomy. Int Urogynecol J Pelvic Floor Dysfunct. 2008;19:1007–11. https://doi.org/10.1007/s00192-007-0549-8.
Robinson D, Thiagamoorthy G, Cardozo L. Post-hysterectomy vaginal vault prolapse. Maturitas. 2018;107:39–43. https://doi.org/10.1016/j.maturitas.2017.07.011.
Lee RA. Vaginal hysterectomy with repair of enterocele, cystocele, and rectocele. Clin Obstet Gynecol. 1993;36:967–75. https://doi.org/10.1097/00003081-199312000-00021.
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Zilberlicht, A., Dwyer, P.L., Rajamaheswari, N. et al. Video of uterovaginal procidentia repair incorporating a high extraperitoneal uterosacral vault suspension. Int Urogynecol J 31, 2173–2175 (2020). https://doi.org/10.1007/s00192-020-04300-w
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DOI: https://doi.org/10.1007/s00192-020-04300-w