title: Selecting suspension points and excising the vagina during Michigan four-wall sacrospinous suspension.
abstract: OBJECTIVE
  To describe the variations in the location of the vaginal apex and the length of vagina excised in women undergoing the Michigan four-wall sacrospinous suspension for posthysterectomy vaginal vault prolapse.
  
  
  METHODS
  A prospective observational study of 76 women who had the Michigan modification sacrospinous suspension performed between 1998 and 2001 for posthysterectomy vaginal vault prolapse was carried out. Demographics and preoperative, operative, and postoperative findings were noted, including the pelvic organ prolapse quantification score. The locations of the suspension points relative to the hysterectomy scar were recorded. The amount of vagina excised at surgery and the pre- and postoperative vaginal lengths are reported.
  
  
  RESULTS
  The mean length and standard deviation of vagina excised was 4.6 +/- 2.5 cm. The apex created at sacrospinous fixation was at the hysterectomy scar in only seven women (9%). It was most often situated behind the hysterectomy scar, in 58 cases (76%); it was situated in front of it in 11 (14%). In seven women no vagina was excised, and in the remaining 69 women a mean length of 5.1 +/- 2.2 cm was removed. The mean vaginal lengths were 9.7 +/- 1.7 cm preoperatively and 9.4 cm +/- 0.8 postoperatively, a 0.3-cm difference.
  
  
  CONCLUSIONS
  When one performs the Michigan modification sacrospinous suspension, the chosen suspension points are often not at the hysterectomy scar, and in women with large prolapses excess vagina frequently is excised without compromising postoperative vaginal length.
authors.affiliation: Department of Obstetrics and Gynecology, University of Michigan, Ann Arbor, Michigan, USA.
authors.forename: R
authors.initials: R
authors.lastname: Kearney
authors.forename: J O L
authors.initials: JO
authors.lastname: DeLancey
mesh_terms: D000368:Aged; D000704:Analysis of Variance; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D013509:Gynecologic Surgical Procedures / Q000379:methods*; D006801:Humans; D007045:Hysterectomy, Vaginal / Q000009:adverse effects* / Q000379:methods; D008875:Middle Aged; D017060:Patient Satisfaction; D011336:Probability; D011446:Prospective Studies; D019651:Plastic Surgery Procedures / Q000379:methods; D020127:Recovery of Function; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D016896:Treatment Outcome; D014596:Uterine Prolapse / Q000209:etiology / Q000601:surgery*; D014621:Vagina / Q000503:physiopathology / Q000601:surgery