Abstract
BackgroundStudies have shown that vaginal vault prolapse can affect up to 43% of women following hysterectomy for pelvic organ prolapse. Many techniques have been described to prevent and treat vaginal vault prolapse. The primary objective of our study was to compare McCall’s culdoplasty (when performed along side vaginal hysterectomy) with laparoscopic uterosacral plication (when performed along side total laparoscopic hysterectomy) for prevention of vaginal vault prolapse. Secondary outcomes included inpatient stay and perioperative complications.A retrospective comparison study comparing 73 patients who underwent ‘laparoscopic hysterectomy and uterosacral plication’ against 70 patients who underwent ‘vaginal hysterectomy and McCall culdoplasty’. All operations were carried out by two trained surgeons.ResultsThere was no significant difference between BMI or parity. There were statistically significantly more patients presenting with post hysterectomy vault prolapse (PHVP) in the group of patients who had undergone uterosacral plication (12 out of 73) compared with McCalls culdoplasty (0 out of 70) P = 0.000394. Inpatient stay in the uterosacral plication group was significantly shorter mean 1.8 compared to 3.6 for McCall group (P-Value is <0.00001). There was no significance in the perioperative complications between both groups (P = 0.41).ConclusionsMcCalls is a superior operation to prevent PHVP compared to uterosacral plication with no difference in terms of perioperative complications.
Highlights
All patients had presented with subjective symptoms of pelvic organ prolapse, and objectively, this was confirmed on objective Pelvic Organ Prolapse Quantification (POP-Q) examination
The technique used for vaginal hysterectomy and McCall culdoplasty is described by Raymond Lee of The Mayo Clinic [6]
The mean parity and Body mass index (BMI) in both groups were comparable with P values of 0.21 and 0.09 respectively. (P values were calculated using Student’s t test.) The mean parity in patients who underwent uterosacral plication was 3.1 compared with 3.0 in the McCall culdoplasty group
Summary
Studies have shown that vaginal vault prolapse can affect up to 43% of women following hysterectomy for pelvic organ prolapse. Many techniques have been described to prevent and treat vaginal vault prolapse. The primary objective of our study was to compare McCall’s culdoplasty (when performed along side vaginal hysterectomy) with laparoscopic uterosacral plication (when performed along side total laparoscopic hysterectomy) for prevention of vaginal vault prolapse. The risk of prolapse following hysterectomy is 5.5 times more common in women. Preventative techniques can be used at the time of a hysterectomy to prevent PHVP. McCall culdoplasty and sacrospinous fixation can be carried out at vaginal hysterectomy [2]. Suturing the cardinal and uterosacral ligaments to the vaginal cuff at the time of abdominal or laparoscopic hysterectomy is effective in preventing post-hysterectomy vaginal prolapse [3]. Methods of treatment offered depend on severity of prolapse and takes into consideration patient wishes and expectations
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