Prolapso de la cúpula vaginal tratado mediante operación de Richter-Amreich asociada a colporrafia anterior

Abstract

Objective To study prospectively the succes rate of the sacrospinous vault suspension, using the vaginal approach associating an anterior colporrhaphy, in the cases of posthisterectomy vaginal vault prolapse. Material and methods Between January 1999-July 2005, 41 patients without urinary incontinence and vaginal vault prolapse were treated with the Richter-Amreich’s procedure associated with anterior colporrhaphy by the same surgeon. We have used the the Miya hook in all interventions and 2 sutures of Polyglactin 00. Every patient was 393 followed up a month after the operation and anually till now. We considered success as the lack of prolapse a month after the intervention, and relapse when another prolapse happened in a year or more after surgery. Patients were include in a database and Epi-info 3.3 TM was used to perform the statistical analysis. Results There were vaginal vault prolapse at 1- month follow-up in 4 of the 41 (success rate of 91.2%). Another 3 patients presented minor cystocele (grade 1), and one had a grade 2 cystocele without descent of vaginal apex (9.8%). There is no worsening of these cases till now in the annual follow-ups. The most common postoperatory complication was anemia, that was present in 13 patients (31,7%). The length of complete surgery was 102 ± 35 minutes. There is a clear correlation between operating time and surgeon experience. Conclusions This technique is an effective method, economic and safe to treat posthysterectomy prolapse of the apical vaginal compartment.