Abdominal sacral colpoperineopexy: a new approach for correction of posterior compartment defects and perineal descent associated with vaginal vault prolapse.
OBJECTIVE
Our purpose was to assess a modification of abdominal sacral colpopexy in 19 patients.


METHODS
The rectovaginal space was dissected to the superior aspect of the posterior vaginal fascia still contiguous with the perineal body. Mersilene (Ethicon, Somerville, N.J.) mesh was sutured to this fascia and along the entire posterior vaginal wall. Patients with vault prolapse, perineal descent, and associated rectoceles or enteroceles are reported. Outcome measures included bowel symptoms and pelvic organ prolapse staging. Defecography was performed in three patients. Wilcoxon signed rank analysis was used for comparison of prolapse measures.


RESULTS
Mean follow-up was 11 weeks. Bowel symptoms improved in 8 of 11 women. No subjects had greater than stage II prolapse postoperatively and median improvement in stage was 3 (range 2 to 4). The mean decrease in the genital hiatus measurement was 3.13 +/- 1.25 (range 2 to 6) cm. Postoperative defecography documented correction of rectoceles and enteroceles and improvement in perineal descent with straining.


CONCLUSIONS
Abdominal sacral colpoperineopexy is effective surgery for vaginal vault prolapse associated with perineal descent and posterior vaginal defects.
Cundiff
G W
GW
Department of Obstetrics and Gynecology, Duke University Medical Center, Durham, North Carolina 27710, USA.
Harris
R L
RL
Coates
K
K
Low
V H
VH
Bump
R C
RC
Addison
W A
WA
D000328:Adult; D000368:Aged; D019841:Defecography; D005260:Female; D006547:Hernia / Q000000981:diagnostic imaging / Q000209:etiology; D059685:Herniorrhaphy; D006801:Humans; D008488:Medical Illustration; D008875:Middle Aged; D011184:Postoperative Period; D012002:Rectal Diseases / Q000000981:diagnostic imaging / Q000209:etiology / Q000601:surgery; D013536:Suture Techniques; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000150:complications / Q000601:surgery*; D014621:Vagina / Q000601:surgery*