| November 2005 · Vol. 17, No. 11 Surgical Techniques
Surgical management of vaginal vault prolapse
Choosing the right procedure is a judgment call, based on the patient’s age, desire for coitus, and overall health.
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Fast Track
Successful surgery supports the vault and corrects any enterocele, cystocele, or rectocele
Iliococcygeus fixation places less tension on the anterior vaginal wall
In the modified McCall procedure, sutures penetrate
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the posterior vaginal wall
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the cul-de-sac peritoneum
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remnants of the uterosacral-cardinal complex
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fascial tissue lateral and posterior to the upper vagina and rectum
Benefits of high uterosacral ligament suspension
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creates an anatomically correct midline vaginal axis
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preserves vaginal length
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less risk of nerve injury
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restores continuity of paracervical ring
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William
Irvin,
MDAssociate Professor, Division of Gynecologic Oncology, University of Virginia Health System,
Charlottesville, Va Kathie
Hullfish,
MDDirector, Division of Reconstructive, Pelvic Surgery and Urogynecology, University of Virginia Health System,
Charlottesville, Va
First, the good news: We have numerous techniques to choose from to repair prolapse of the vaginal vault, which affects as many as 50% of parous women.1 The bad news: Most of the data on these techniques are anecdotal or retrospective, not the result of randomized, controlled trials. Few investigators have compared the vaginal and abdominal approaches.
So how should we decide on a procedure? It is a judgment call, ultimately. After taking into account the patient’s age, functional status, comorbidities, desire for coitus, and surgical history, the surgeon must weigh the risks and benefits of the procedures that seem most appropriate. Part 1 of this 2-part article reviews what is known about the most widely used and newest vaginal techniques:
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