A new, simplified posterior culdoplasty and vaginal vault suspension during abdominal hysterectomy

Abstract

Objective: A new surgical technique of creating a prophylactic, reconstructive posterior culdoplasty and vaginal vault suspension during abdominal hysterectomy is described. The procedure restores the pelvic topography and gross and functional anatomy after removal of the uterus. A systematic order of the operation, its safety and effectiveness are presented and illustrated. Methods: This surgical technique has been studied for 10 years, from 1983 to 1993, in a group of 250 patients with ages ranging from 19 to 76 years, average age 43 years (Caucasian, n = 178; black, n = 61; and Asian, n = 11). The following new elements were introduced to achieve post-hysterectomy restoration of the posterior cul-de-sac and vaginal vault suspension: the deep layer of the uterosacral ligaments and pararectal-paravaginal fascia are incorporated for reconstructive posterior culdoplasty; the cardinal ligaments and the deep and superficial layers of the uterosacral ligaments are used for anatomical vaginal vault suspension from the latero-posterior aspect of the vaginal wall. Results: This study has documented a good outcome and effectiveness of the operation as well as good postsurgical patient satisfaction, with no symptomatology or signs of dysfunctional vagina, vaginal prolapse or enterocele formation. Conclusion: This new prophylactic procedure is effective, safe, simple to learn, easy to carry out, and adds very little on to the overall surgical time. Restoration of the pelvic topography, functional anatomy, prevention of dysfunctional vagina, vaginal prolapse and pelvic hernia (enterocele) formation can be achieved by following this technique. Post-hysterectomy dysfunctional vagina, vaginal prolapse and pelvic hernia formation are preventable occurrences when a surgical operation is appropriately selected and properly executed.