Srpski arhiv za celokupno lekarstvo 2012 Volume 140, Issue 9-10, Pages: 666-672
https://doi.org/10.2298/SARH1210666A
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Posthysterectomy vault prolapse of vaginal walls: Choice of operating procedure
Argirović Rajka (Klinika za ginekologiju i akušerstvo, Klinički centar Srbije, Beograd + Medicinski fakultet, Beograd)
Post-hysterectomy vaginal vault prolapse is a common complication following
different types of hysterectomy with a negative impact on the woman’s quality
of life due to associated urinary, anorectal and sexual dysfunction. A clear
understanding of the supporting mechanisms for the uterus and vagina is
important in order to make the right choice of the corrective procedure and
also to minimize the risk of posthysterectomy occurrence of vault prolapse.
Preexisting pelvic floor defect prior to hysterectomy is the single most
important risk factor for vault prolapse. Various surgical techniques have
been advanced in hysterectomy to prevent vault prolapse. Vaginal vault repair
can be carried out abdominally or vaginally. Sacrospinous fixation and
abdominal sacrocolpopexy are the commonly performed procedures. The vaginal
approach for vault prolapse is superior to the abdominal approach in terms of
complication rates, blood loss, postoperative discomfort, length of hospital
stay and costeffectiveness. Moreover, it allows the simultaneous repair of
all coexistent pelvic floor defects, such as cystocele, enterocele and
rectocele. Abdominal sacrocolpopexy is associated with a lower rate of
recurrent vault prolapse and dyspareunia than the vaginal sacrospinous
colpopexy. Other less commonly performed procedures include uterosacral
ligament suspension and illeococcygeal fixation with a high risk of ureteric
injury. Surgical mesh of non-absorbent material is gaining in popularity and
preliminary data from vaginal mesh procedures is encouraging.
Keywords: posthysterectomy vaginal vault prolapse, sacrospinous fixation, sacrocolpopexy, mesh