Posthysterectomy Prolapse Prevented With Culdoplasty


FORT LAUDERDALE, FLA. — Prevention is the best medicine when it comes to enterocele formation, so consider performing a McCall's culdoplasty in all patients undergoing vaginal hysterectomy, G. Willy Davila, M.D., advised.

“I almost always do McCall's culdoplasty when I do a vaginal hysterectomy, and so should you,” Dr. Davila said at a symposium on pelvic floor disorders, sponsored by the Cleveland Clinic Florida.

The procedure—which involves opening the vaginal cuff and suturing the full thickness of the vaginal mucosa, peritoneum, and uterosacral ligaments—results in elevation of the vaginal apex. It has been shown to help prevent posthysterectomy prolapse and recurrent prolapse, according to Dr. Davila, chair of the clinic's department of gynecology and head of the section of urogynecology and reconstructive pelvic surgery.

In patients with an existing enterocele, this culdoplasty technique can also be used for repair, although additional sutures may be needed. Permanent sutures are recommended.

If a discrete tear of the endopelvic fascia from the vaginal apex is noted in relationship to the enterocele, the fascia should also be reattached to the apex to correct the enterocele.

Cystoscopy should be performed to ensure that the ureters are not compromised. In addition, tagging the uterosacral ligaments so you know exactly where they are can help you to avoid ureteral injury in the vast majority of cases, he said.

Next Article: