Extraperitoneal high vaginal cuff suspension at the time of vaginal hysterectomy for advanced uterovaginal prolapse: Results of a modified McCall technique from a longitudinal clinical study
| Autor: | Lore Schierlitz, Peter L. Dwyer, Ariel Zilberlicht, Debjyoti Karmakar, Frida Carswell |
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| Rok vydání: | 2020 |
| Předmět: |
medicine.medical_specialty
030232 urology & nephrology Uterovaginal prolapse Pelvic Organ Prolapse Clinical study 03 medical and health sciences 0302 clinical medicine Gynecologic Surgical Procedures Uterine Prolapse medicine Hysterectomy Vaginal Humans Stage (cooking) 030219 obstetrics & reproductive medicine Ligaments business.industry Obstetrics and Gynecology Uterine prolapse Extraperitoneal approach General Medicine medicine.disease Vaginal cuff Surgery Treatment Outcome Hysterectomy vaginal Female Complication business |
| Zdroj: | The AustralianNew Zealand journal of obstetricsgynaecologyReferences. 61(2) |
| ISSN: | 1479-828X |
| Popis: | Background Women with high-grade uterovaginal prolapse have a greater risk of recurrent prolapse after pelvic organ prolapse surgery. Royal College of Obstetricians and Gynaecologists guidelines have recommended sacrospinous suspension (sacrospinous fixation) at the time of vaginal hysterectomy, whenever there is a marked uterovaginal prolapse. We have modified the McCall culdoplasty by placing sutures extraperitoneally, higher and more lateral into the uterosacral/cardinal ligaments to re-support the vaginal cuff at the time of a vaginal hysterectomy. Aims To evaluate the results of a modified technique of McCall high culdoplasty and native tissue repair at time of vaginal hysterectomy in women with advanced uterovaginal prolapse. Material and methods Longitudinal clinical follow-up conducted between 2000-2018, in a tertiary urogynaecology centre for patients presenting with stage 3-4 uterovaginal prolapse, who underwent vaginal hysterectomy and modified McCall vault suspension. Results There were 176 cases meeting the inclusion criteria. Mean follow-up was 19.35 months. There were 25 recurrences (14%) of ≥ stage 2 (76% not symptomatic). Twelve of these recurrences (48%) occurred in anterior compartment, six (25%) posterior, three (12%) combined anterior/posterior, two (8%) combined posterior/central and one case had recurrence in all compartments. Only six cases (3%) required another surgical procedure for symptomatic prolapse, all with an enterocele recurrence. Conclusions Our described modified McCall technique incorporates high extraperitoneal approach to apical resuspension along with closure of any existing large hiatal defects of the levator plate at the time of vaginal hysterectomy for advanced uterine prolapse has excellent outcomes and extremely low complication rates and avoids the need for sacrospinous fixation. |
| Databáze: | OpenAIRE |
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